Amino PCC AMSC 2018 by AMSA-Indonesia

AMINO AMSA-Indonesia Competition Archive for PCC Asian Medical Studentsâ&#x20AC;&#x2122; Conference 2018

All the works publicized here are the works of AMSA-Indonesiaâ&#x20AC;&#x2122;s member who participated in PCC Asian Medical Studentsâ&#x20AC;&#x2122; Conference 2018

CONTENT SCIENTIFIC POSTER VIDEOGRAPHY AND WHITE PAPER

SCIENTIFIC POSTER

CONT ROL L I NGI NF E CT I ONUS I NGPHY L L ANT HUSNI RURI ASANI MMUNOS T I MUL ANT Y OS I AY ONGGA R A , F E L I C I AHA NA NT O, HA NS E LB A NDA S O, R I C HA R DP HI L O

I NT RODUCT I ON

RESUL T

DI SCUSSI ON

I n f e c t i o nc o n t r o l i st h ewa yt op r e v e n t o r c u r e i n f e c t i o n P e o p l eg e t i n f e c t e dwh e nt h e i r i mmu n e s y s t e msa r ewe a k h u mo r a l

c e l l me d i a t e d

i mmu n es y s t e m i mmu n o a d j u v a n t e n h a n c e mmu n e mmu n o s u p p r e s o r i i mmu n o mo d u l a t o r s i i mmu n o s t i mu l a n t

P . n i r u r i c a nb ef o u n di nt r o p i c a l a n d s u b t r o p i c a l r e g i o ns u c ha si n d o n e s i a , c h i n a , a n d i n d i a . S t u d i e ss h o we dt h a t P . n i r u r i c a nc u r ei n f e c t i o u s d e s e a s es u c ha sh e p a t i t i sB , p u l mo n a r yT B , V a r i c e l l aZ o s t e r , a n dv a g i n a l c a n d i d i a s i s . A I MS : Wewa n t t op r o v et h a t P . n i r u r i c a nc o n t r o l t h e i n f e c t i o nb yi mp r o v i n gt h ei mmu n es y s t e m

S e c o n dF i g u r e . Us i n gA q u e o u se x t r a c t o f P h y l l a n t h u sn i r u r i a d d e dt o s p l e n o c y t ewi t hd i f f e r e n t c o n c e n t r a t i o n . T h e na n a l y s e dwi t hF A C Sa n a l y s i s t h ep r o l i f e r a t i o no f BC e l l ( Nwo r u , A k a h , Ok o y e , P r o s k c h , &E s i mo n e , 2 0 1 0 )

A d mi n i s t e r i n gP . n i r u r i c a nb et a k e ni n t o c o n s i d e r a t i o na sawa yi nma n a g i n gi n f e c t i o n c o n t r o l b ye l e v a t i n gt h ei mmu n es y s t e m

MET HODS

S y s t e ma t i cr e v i e w

P u b me d S c i e n c eDi r e c t L o c a l p u b l i s h e dj o u r n a l

CONCL USI ON

RE F E RE NC E S F o u r t hF i g u r es h o wsOr a l l y a d mi n i s t r a t e dP h y l l a n t u s n i r u r i e x t r a c t t os u b j e c t a n d c o u n t t h en u mb e r o f b l o o d c e l l u s i n gb l o o ds me a r ( A l d i , R a s y a d i , &Ha n d a y a n i , 2 0 1 4 )

J o s e , J . , S u d h a k a r a n , S . , M, S . K . , J a y a r a ma n , S . , &E , J . ( 2 0 1 4 ) . S t u d yo f I nv i t r oI mmu n o mo d u l a t o r yE f f e c t o f F l a v o n o i dI s o l a t e df r o mP h y l l a n t h u sn i r u r i o nHu ma nB l o o dL y mp h o c y t e sa n dE v a l u a t i o no f i t sA n t i o x i d a n t P o t e n t i a l . I n t e r n a t i o n a l J o u r n a l o f P h a r ma c o g n o s ya n dP h y t o c h e mi c a l R e s e a r c h, 2 8 4 2 8 9 . Nwo r u , C . S . , A k a h , P . , Ok o y e , F . , P r o k s c h , P . , &E s i mo n e , C . ( 2 0 1 0 ) . T h eE f f e c t so f P h y l l a n t h u sn i r u r i A q u e o u s E x t r a c t o nt h eA c t i v a t i o no f Mu r i n eL y mp h o c y t e sa n dB o n eMa r r o wDe r i v e dMa c r o p h a g e s . I mmu n o l o g i c a l I n v e s t i g a t i o n s , 2 3 5 2 6 7 . T j a n d r a wi n a t a , R . R . , S u n a n t o , L . , &No ﬁ a r n y , D . ( 2 0 1 7 ) . T h eu s eo f P h y l l a n t h u sn i r u r i L . a sa n i mmu n o mo d u l a t o r f o r t h et r e a t me n t o f i n f e c t i o u sd i s e a s e si nc l i n i c a l s e t t i n g s . A s i a nP a c i ﬁ cJ o u r n a l o f T r o p i c a l Di s e a s e , 1 3 2 1 4 0 . K u ma r , D . , A r y a , V . , K a u r , R . , B h a t , Z . , Gu p t a , V . , &K u ma r , V . ( 2 0 1 2 ) . Ar e v i e wo f i mmu n o mo d u l a t o r si nt h e I n d i a nt r a d i t i o n a l h e a l t hc a r es y s t e m. J o u r n a l o f Mi c r o b i o l o g y , I mmu n o l o g ya n dI n f e c t i o n , 1 6 5 1 8 4 . A l d i , Y . , R a s y a d i , Y . , &Ha n d a y a n i , D . ( 2 0 1 4 ) . I mmu n o mo d u l a t o r yA c t i v i t yo f Me n i r a nE x t r a c t s( P h y l l a n t h u sn i r u r i L i n n . ) t oB r o i l e r C h i c k e n s . J u r n a l S a i n sF a r ma s i &K l i n i s , 2 0 2 6 . , L . ( 2 0 1 6 ) . Hu ma nP h y s i o l o g yF r o mC e l l st oS y s t e ms . B o s t o n . S h e r wo o d

CONTROLLING INFECTION USING PHYLLANTUS NIRURI AS AN IMMUNOSTIMULANT Yosia Yonggara, Felicia Hananto, Hansel Bandaso, Richard Philo

Aim: Our aim is to propose a solution in managing infection control by presenting the fact that Phyllantus niruri is capable of enhancing immune system.

Background: Infection control is an act of preventing the dissemination of communicable diseases, either in a form of prevention or curation. We are in the urge of building our innate defense system in order to keep our bodies away from the communicable diseases. Our body have a specific system to against foreign invader such as viruses and bacteria and that system is our immune system (Sherwood, 2016). Immunomodulator functions as a compound that regulates our immune’s response in our body. There are 3 types of immunomodulator: immunoadjuvant, immunosuppressor, and immunostimulant. Immunostimulant is a compound that enhance the immune system. Not only is P. niruri spread in tropical and subtropical regions, including Indonesia, but also is a plant that can be utilized as an immunostimulant. In further studies, it is found that P. niruri can cure communicable diseases, such as Chronic Hepatitis B, Pulmonary TB, Varicella-Zoster, Vaginal candidiasis, and Tonsilopharyngitis.

Material and method: This review is conducted by searching in PubMed and Science Direct with systematic review method—comparing one literature to another—and with keywords (immunomodulatory), (immunostimulant), (Phyllantus niruri), and (proliferation of lymphocyte). In addition, this review is referenced from local journals in order to obtain an insight of whether local’s and overseas’ P. niruri provide the same result.

Results: •

Flavonoid from Phyllatus niruri significantly improves the proliferation of T and B cells.

•

Aqueous Extract of Phyllanthus niruri increases the proliferation activity of B and T cells. •

Phyllanthus niruri increases the amount of lymphocyte cells.

Discussion: The conducted searches for both national and international journals indicate that Phyllantus niruri can elevate immune system by inducing the T and B cells proliferation. Conclusion:

Phyllanthus niruri can be used to manage infection control by enhancing immune system.

Contact details Regional Chairperson: Elvira Lesmana rcindonesia@amsa-indonesia.org +6285811240637

Ma l a r i ai n t e r v e n t i o nwi t h g e o g r a p h i c a l i n f o r ma t i o ns y s t e ms Casey Christiany, Jessica Nathalia, Juliana Susantio, Magdalena

FACULTY OF MEDICINE CHRISTIAN KRIDA WACANA UNIVERSITY

Introduction Ma l a r i ai sa ne n d e mi cd i s e a s ei nI n d o n e s i awh i c hs p r e a d st h r o u g h o u tt h ec o u n t r y , wi t ht h emo s t 1 c o mmo nma l a r i a li n f e c t i o nf o u n df r o mt h ePl a s mo d i u mf a l c i p a r u m.An t i ma l a r i a lme d i c i n e sa n d t h eu s eo fi n s e c t i c i d e t r e a t e dn e t s( I TNs )a r ek e yi n t e r v e n t i o nt oc o n t r o lma l a r i a . I n t e r v e n t i o n c o v e r a g ev a r i e sa sc o n s e q u e n c eo fg e o g r a p h i c a la c c e s s a b i l i t yt or e mo t ev i l l a g e sa n dl i mi t a t i o n s 2 o ff i n a n c i a la n dh u ma nr e s o u r c e sf o rt h ei n t e r v e n t i o n .

Material & Method Ge o g r a p h i cI n f o r ma t i o nSy s t e ms( GI S)i n v o l v e s t h ema p p i n go fma l a r i ai n c i d e n c eo v e rs o me g e o g r a p h i ca r e a . Th ef o c u si so ne x a mi n i n gp a s t t r e n d sa swe l la st h ep r e s e n ts i t u a t i o na n dt y p i c a l l y d o e sn o ti n c l u d ea n ys t a t i s t i c a la n a l y s i swi t ht h e p o s s i b l ee x c e p t i o no fc o r r e l a t i n gma l a r i ai n c i d e n c e wi t hp o p u l a t i o ni no r d e rt oc a l c u l a t ep o p u l a t i o n sa t r i s k . Th eg o a lwi t ht h e s es t u d i e si st os e ei fa n y r e l a t i o n s h i p se x i s tb e t we e nma l a r i ai n c i d e n c ea n d ah o s to fo t h e rv a r i a b l e si n c l u d i n g :d e mo g r a p h i c s , g e o g r a p h i cl o c a t i o n , p o p u l a t i o n , a n dc l i ma t e 2 , 3 c h a n g e .

Results Asi n d i c a t e do nt h eGI Sma p s , v i l l a g e swi t h ma l a r i ac a s e s , l o we ri n t e r v e n t i o nc o v e r a g e , a n dl o we ra d h e r e n c ewe r ei d e n t i f i e d .

Discussion Theus eofGI Si sbe ne f i c i a lt ot a r ge tr e gi ons wi t hhi ghma l a r i ape va l e nc e ss ot ha ti nt e r ve nt i on bya nt i ma l a r i a lme di c i nea ndI TNsc a nbea ppl i e d. Wi t houtpr ope ri nve s t me ntf r omt hegove r nme nt e xpe ndi t ur ef orhuma nr e s our c e sa ndt e c hni c a l a s s i s t a nc e ,he a l t hc a r ewi l lbemor ei ne f f i c i e nt .

References

Conclusion Th eu s eo fGe o g r a p h i cI n f o r ma t i o n Sy s t e mi sb e n e f i c i a lf o rt h eg o v e r n me n t a n dHe a l t hDe p a r t me n ti nt a r g e t t i n gs p e c i f i e d a r e a sf o ri n t e r v e n t i o n .

1. Wor l dHe a l t hOr ga ni z a t i on( WHO) ,2016,Pr of i l eCount r i e sI ndone s i a . 2. Si pe ,N.G. ,&Da l e ,P.( 2003,Nove mbe r04) .Cha l l e nge si nus i ngge ogr a phi ci nf or ma t i ons ys t e ms( GI S)t ounde r s t a nda ndc ont r ol ma l a r i ai nI ndone s i a .Re t r i e ve dMa r c h31,2018,f r om ht t ps : / / ma l a r i a j our na l . bi ome dc e nt r a l . c om/ a r t i c l e s / 10. 1186/ 14752875236 3. Ma l a r i a .( 2017,De c e mbe r20) .Re t r i e ve dMa r c h31,2018,f r omht t ps : / / www. c dc . gov/ ma l a r i a / a bout / f a qs . ht ml

Novel Therapy for Dengue Fever using Tetravalent CYD-TDV Vaccine as an Effort to Combat All Four Serotypes of Dengue Virus : A Systematic Review of Randomized Controlled Trials in Children

*Juhan Khalila **Annisa Dewi Nugrahani

Aim To know the potential, efficacy, and safety of Tetravalent Dengue Vaccine (CYD-TDV) as a new prospective candidate in controlling all serotypes of dengue virus especially in children.

Background The reported cases of dengue as a vector-borne disease caused by four related serotypes of virus (DEN14) has increased since recent decades. Despite its concerning increase rate of incidence, there has not been specific treatment to treat dengue fever until recent years. There has been an increasing development in finding the vaccine for dengue but the result was not really satisfactory. Therefore, thereâ&#x20AC;&#x2122;s an urgency in finding a therapy that can offer protection for all four serotypes of the dengue virus for the therapy to be effective and efficient.

Material and Methods The systematic review was conducted in April 2018 by following standard guideline. The first step is framing questions for a review then identifying relevant work as a searching and selecting trials strategies (from 76 journals into 34 selected journals), followed by assessing the quality of full-text studies to be summarized. From here, we come across three different controlled trial journals suitable for this systematic review.

Results Efficacy estimates against serotype 1, 3, and 4 were in a range consistent with our assumed overall efficacy of 70%-80% in Asia and Latin America studies. Conversely, efficacy was not shown clearly against serotype 2. This vaccine also has a high efficacy against symptomatic dengue (60.8%), hospitalized dengue (80.3%), and severe dengue (95.5%) with no serious adverse event detected.

Conclusion CYD-TDV vaccine becomes a prospective candidate to control dengue infection in an effective way with its safety profile especially in children. However, further studies are needed to optimize this new vaccine so that it can be applied immediately to the patient, given the high urgency of this problem.

Ma l a r i ai n t e r v e n t i o nwi t h g e o g r a p h i c a l i n f o r ma t i o ns y s t e ms Casey Christiany, Jessica Nathalia, Juliana Susantio, Magdalena

References

Geographic Information Systems as Malaria Disease Intervention Casey Christiany, Jessica Nathalia, Juliana Susantio, Magdalena Aim Our aim is to determine the most effective method of intervention in the spread of malaria disease type Plasmodium falciparum in the endemic and distal region of Indonesia. Background Malaria is an endemic disease in Indonesia and is spread throughout the country, with the most common malarial infection found from the Plasmodium falciparum. Antimalarial medicines and the use of insecticide-treated nets (ITNs) are key intervention to control malaria.1 The intervention coverage varies as consequence of geographical accessability to remote villages and limitations of financial and human resources for the intervention. Knowledge and commitment of the people for malaria intervention is also a factor to the malaria health outcome.2 Material and Methods Geographic information system (GIS) involves the mapping of malaria incidence over some geographic area. The focus is on examining past trends as well as the present situation and typically does not include any statistical analysis with the possible exception of correlating malaria incidence with population in order to calculate populations at risk. The goal with these studies is to see if any relationships exist between malaria incidence and a host of other variables including: demographics, geographic location, population, and climate change.2,3 Results As indicated on the GIS maps, villages with malaria cases, lower intervention coverage, and lower adherence were identified. Conclusion The intervention for

malaria infection remains unevenly distributed within districts. Balancing the

intervention coverage in the distal villages and continued promotion of the proper use of ITNs are necessary for a further reduction of malaria cases in the province. The use of Geographic Information System is beneficial for the government and Health Departments target more specific areas in need of intervention.

References 1. World Health Organization (WHO), 2016, Profile Countries Indonesia. 2. Sipe, N. G., & Dale, P. (2003, November 04). Challenges in using geographic information systems (GIS) to understand and control malaria in Indonesia. Retrieved March 31, 2018, from https://malariajournal.biomedcentral.com/articles/10.1186/1475-2875-2-36 3. Malaria.

(2017, December

20).

https://www.cdc.gov/malaria/about/faqs.html Regional Chairperson Elvira Lesmana rcindonesia@amsainternational.org +6285811240637

Retrieved

March 31,

2018,

from

T HEPOT ENCYOFPOL YPHENOLFROM GERANI UM ( Pel ar goni um s i doi des )ROOTEXT RACTASAN ANT IHI V1DRUGI NPEDI AT RI CHI V Al e x a nde rFe r na ndo , Aul i aPa nduAj i , Ke v i nMa r c e l l oCha ndr a , St e f a niZa ne t aAg us I NTRODUCTI ON&BACKGROUND

RESULT&DI SCUSSI ON

HI Vbe c omeoneoft hemaj ort hr e ati nhe al t hs e c t orwor l dwi de Ac c or di ngt oWHO,t henumbe rofc as e sgl obal l yabout36. 7mi l l i on c as e s

I nI ndone s i a,t he r e ’ sabout7146c as e spe rye arwhe r epe opl el i vi ng wi t hHI V[2] ART ( Ant i r e t r ovi r alt he r apy)hasi mpr ove dt hequal i t yofl i f eof HI Vi nf e c t e dpat i e nt s ,butal s ohasapot e nt i alofl i f e t hr e at e ni ng andmor bi ds i dee f f e c t. I thasbe e nobs e r ve dt hatadve r s ee f f e c t ss uc hashe pat ot oxi c i t y , AZT i nduc e dane mi a,r as i e ds e r um amyl as e ,andNVPi nduc e dr as hdue [ 3] . t oART,t obequi t ehi ghi nHI Vi nf e c t e dpat i e nt Ther oote xt r ac tofGe r ani um pl ant( Pe l agor ni um s i doi de s )c ont ai n pol yphe nol i cc ompounds( f l avonoi dandl e uc oant hoc yani di n)t hat [ 4] . c anf unc t i onasant i vi r alwhi c har eus e f ulasant iHI Vi npat i e nt

Pe l agor ni um s i doi de sr oote xt r ac tc ani nhi bi tt hei nf e c t i onofHI Ve x vi voi nPe r i phe r albl oodmononuc l e arc e l l( PBMC)andal s oMonoc yt e de r i ve dmac r ophage s( MDM)wi t hEC50r e s pe c t i ve l yar e5. 70±2, 7 [ 4] . µg/ mland8. 27±2, 75µg/ ml

AI M

l ar goni um s i doi de sr oote xt r ac tc ani nhi bi tandpr ot e c tpat i e nt s -Pe f r om t hei nf e c t i onofHI V

METHODS

Pe l agor ni um s i doi de sr oote xt r ac tal s oac t i veagai ns ts omeHI Vc l i ni c al [ 4] l ow6µg/ ml . i s ol at e s ,yi e l di ngEC50be

Spi nni ngdi s cc onf oc alf l uor e s c e nc emi c r os c opys howst hatPSe xt r ac t c ompl e t e l ybl oc ke dc e l l ul arHI V1at t ac hme nt ,yi e l di ngl ow GFPs i gnal spe rc e l l . TheGFPs i gnal pe rc e l l f orPSe xt r ac ti sabout1. 1±0. 4s i mi l art o bac kgr oundc ont r ol( ne gat i vec ont r ol )whi c hi s0. 5±0. 7.Thi s c onc l udet hatPSr oote xt r ac tpr e ve nt sHI V1at t ac hme ntt ot ar ge tc e l l s , Thet abl ebe l ows howst hat whi c hi sanove lmodeofe nt r yi nhi bi t i on[4]. t het ar ge tofe nt r yi nhi bi t i oni st hee nve l ope dpr ot e i noft hevi r usand i nde pe nde ntt ot hec or e c e pt ort opi s m.

CONCLUSI ON

Re f er enc es

I nc onc l us i onPe l a r goni um s i doi de spl a nt sc ont a i nsr obus ta ndpot e nta nt i HI V1a c t i vi t y .PSe xt r a c tc ont a i nspol yphe nol i cc ompoundst ha tpr e ve nt HI V1pa r t i c l e sf r om a t t a c hi ngt ohos tc e l l s .I tdi s pl a ysanove lmode of a c t i ondi f f e r e ntf r om ot he rHI V1e nt r yi nhi bi t or s .Ove r a l l ,t he s emode ls how pr omi s i ngpot e nt i a lt ode ve l opane wc l a s sofa nt iHI V1dr ugt or e duc et he mor t a l i t yr a t eofpe di a t r i cHI Vwor l dwi de .

1. Wor l dHea l t hOr g a ni z a on( WHO) . , 2017, HI V/ AI DSS t a sc swor l dwi de. . 2. Di t j enPPda nPLKemenk esRI . , 2017, S t a skKa s usHI V/ AI DSdi I ndones i aDi l a pors / dS ept ember2017, J a k a r t a . 3. S a n ni Ol i v ei r aM, F r i edma nRK, Vel os oVG, CunhaCB, Pi l o oJ H, Ma r i nsL M, J oã oE C, T or r esT S , Gr i ns z t ej nB. I nc i denc eofa nr e t r ov i r a l a dv er s edr ugr ea consi npr eg na ntwomeni nt wor e f er r a l c ent er sf orHI Vpr e v en onofmot her t oc hi l dt r a ns mi s s i onc a r ea ndr es ea r c hi nRi odeJ a nei r o, Br a z i l . T heBr a z i l i a nJ our na l ofI nf ecousDi s ea s es . 2014Aug31; 18( 4) : 3728. 4. Hel f er , M. , Koppens t ei ner , H. , S c hnei der , M. , Rebens bur g , S . , F or c i s i , S . , Mül l er , C. , S c hmiKoppl i n, P . , S c hi ndl er , M. a ndBr a c k Wer ner , R. , 2014. T her oote x t r a c toft hemedi c i na l pl a ntPel a r g oni um s i doi desi sapot entHI V1a a c hmenti nhi bi t or . PL oSOne, 9( 1) , p. e87487.

THE POTENCY OF POLYPHENOL FROM GERANIUM (Pelargonium sidoides) ROOT EXTRACT AS AN ANTI HIV-1 DRUG IN PEDIATRIC HIV

Alexander Fernando1, Aulia Pandu Aji1, Kevin Marcello Chandra1, Stefani Zaneta Agus1

Abstract HIV infection is becoming a major threat in health sector. In 2016, there were 36.7 million people living with HIV worldwide. In Indonesia there are about 7,164 new cases of HIV annualy. Today, the treatment to HIV patients is done by giving synthetic drugs (antiretroviral). The use of these drugs is usually combined with two or more types of drugs to be more effective in inhibiting viral replication. However, these drugs cause more harmful side effects for people with HIV / AIDS. The root extract from the medicinal plant Pelargonium sidoides (PS) is licensed in Germany as the herbal medicine with numerous clinical trials supporting its safety in humans. PS contains polyphenolic compounds that are able to inhibit the development and replication of HIV-1. It can inhibit the infection of HIV ex vivo in Peripheral blood mononuclear cell (PBMC), Monocyte-derived macrophages (MDM), and also clinically isolated HIV specimens. PS extract act as an antiviral by preventing HIV-1 particles from attaching to host cells. The target of entry inhibition is the enveloped protein of the virus. This mechansim is independent to the co-receptor tropism. It displays a novel mode-of-action different from other HIV-1 entry inhibitors. In conclusion, PS root extract shows promising potential to develop a new class of antiviral drug to reduce the mortality rate of HIV worldwide.

Keywords: HIV, polyphenol, Pelargonium sidoides root extract

Evaluation Of P75NTR and Krox-20 as biomarkers In the Early Detection of Disability In Leprosy : A Systematical Review 1

Andra Danika , Adolf Gideon2, Hanna Melisa3, Putu Ijiya Danta Awantara4

Aim : To find alternative biomarkers for early detection of leprosy which will help reducing the mortality and morbidity of leprosy. Background :Leprosy is caused by Mycobacterium leprae which infection will cause nerve damage that often leads to permanent loss of cutaneous sensitivity and limb deformities. Early diagnosis of nerve damage is so important to prevent any further damage, with good biomarkers, the early diagnosis is possible. P75NTR and Krox-20 have been found to be useful in early detection of specific kind of leprosy. Material and Method : The research design that is used is systematical review using relevant scientific journals. The study focused on evaluating P75NTR and Krox-20 as biomarker in the early detection of disability in leprosy. Results : The result shows that significant difference of Krox-20 expression between patients multibacillary (MB) leprosy with degree of disability 0 and 1. Finding show a significant decline in Krox20 expression in degree of disability 1 compared to degree of disability 0 . There is linear line between P75 and MH type leads to the upper right. The correlation test results between P75 with MH type above shows the correlation coefficient value of 0.377 with p = 0.031. This proves the linearity of P75 with MH type and means that PB patients tend to have higher levels of P75 than MB patient. Similar results were observed in PGP 9.5 expression (borderline: p<0.001 and lepromatous: p<0.05) and NF-L (lepromatous: p<0.05), suggesting advanced Remak bundles degeneration in multibacillary leprosy. There are also association between Schwann cells and axons in Remak bundles. Remak bundles was achieved by p75NTR, and axonal markers NF-L and PGP 9.5 immunostaining. Conclusion : Krox-20 expressed and among the Schwann cells, as well as P75NTR reduction, are two indicators that can detect disability in leprosy.

Keywords: Leprosy, Biomarkers, P75NTR, Krox-20 Author: 1 Andra Danika andradanika64@gmail.com +6281331729308

Adolf Gideon

adolfgideon@yahoo.com +6287852812474

Hanna Melisa

hnnamelisa@gmail.com + 6282230567789

Putu Ijiya Danta

Awantara ijiyadanta19@gmail.com +6281232270119

Regional Chairperson AMSA-Indonesia Elvira Lesmana rcindonesia@amsainternational.org +6285811240637

Potency of Quercetin from Garlic Cloves (Allium sativum) Aqueous Extract as HemePolymerization Inhibitor for Multidrug-resistant Plasmodium falciparum Dennis Ievan Hakim1, Putu Ayu Tania K. P.1, Alexander Fernando1, Maulida Mardhatillah1 Aim: Garlic (Allium sativum L.) was investigated to identify antimalarial compounds that has antiplasmodial activity, specially in aqueous extract as heme polymerization inhibitor Background: Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. In 2016, there were an estimated 3 cases of malaria every minute and 10% of every case happened in Indonesia. Plasmodium falciparum known as the highest cases contributor by donating 63% of total cases. Infection of Plasmodium falciparum has some severe symptoms and it is going to be hard to be treated because the parasites are generating resistance to the most effective medication, artemisinin (ACT). Material and Methods: Hemin chloride, Crude and solvent fraction of aqueous garlic extract were tested in heme polymerization assay and antimalarial assay to identify active factor. Result : Investigation of geometric mean inhibitory concentration for flavonoid analogues against fresh isolated Plasmodium falciparum shown that quercetin has 50% inhibitory (IC50) concentration 14.7±12.62 μM. Solvent fraction of aqueous and crude garlic extract were tested in heme polymerization assay and antimalarial assay to identify active factor. Mass spectroscopy analysis of the high activity of fraction indicates quercetin as a promising hit with and acceptable limit of error by inhibiting heme polymerization and parasite growth. The aqueous fraction of garlic extract has a high level of heme polymerization inhibition activity measured by 0.18 ±0.017 μg/ml. Because aqueous garlic extract contain quercetin, it has potential to inhibit heme polymerization with high antimalarial activity by chelating free available hemin for polymerization. Conclusion : Aqueous garlic extract has potency to be heme polymerization inhibitor with high antiplasmodial activity. Quercetin is the main active constitution responsible for the activity of inhibiting heme polymerization by chelating free available hemin for polymerization.

THE ALTERNATIVE ANTIBIOTIC THERAPY FOR HEALTHCARE-ASSOCIATED INFECTION OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS BY USING BANYAN HANGING ROOTS (FICUS BENJAMINA): IN SILICO AND IN VITRO STUDIES Donni Santoso1, Putu Sri Maharani Utami2, Desak Gede Yuliana Eka Pratiwi3, Putu Ijiya Danta Awatara4 Aim: To determine the antimicrobial effects of Banyan Hanging Root Extract (Ficus benjamina) as an alternative treatment for Healthcare-associated infection of MRSA in vitro and in silico. Background: Health care-associated infection is an infection occurring in a patient during the process in healthcare facility. Based on WHO, the prevalence of HAIs varies between 5.7% and 19.1% in lowand middle-income countries. Infection of MRSA are a major cause of illness and death. In fact, progress in infection control is threatened by the rapid development and spread of antibiotic drug resistance. Tannin has a major biologically active component to inhibit nucleic acid synthesis and destruct bacterial cell walls. Tannin has an important role in controlling MRSA growth. Material and Method: The research design was using a pure experimental research with post-test only control group design. The study focused on the state of MRSA bacteria with the treatment of ethanol extract of the banyan hanging root in vitro by the well diffusion method. In silico research was needed by using data that exist in online database. Results & Discussion: The result from the analysis of in vitro shows the effectiveness of banyan hanging roots extract in increasing diameter on inhibitory zone of MRSA growth followed by the increasing concentration of the extract. Administration of banyan hanging roots extract against MRSA showed that the inhibition zone at the lowest concentration 5% is 6.74 mm and the highest concentration 100% is 19.40 mm. The result from the analysis of in silico shows tannin strongly binds to LasR in their amino acid active site. The binding affinity among tannin and LasR amino acid is -7.8 kcal / mol -3.7 kcal/mol as the highest score. Conclusion: Banyan hanging roots extract (Ficus benjamina) can be an alternative antibiotic therapy for Healthcare Associated Infections of MRSA. Keywords: Health care-associated infection, Methicillin-Resistant Staphyloccus aureus, Antibiotic, Flavonoid, Tanin, Ficus benjamina, In silico, In vitro

Authors:

Donni Santoso

+6281946359004 donni.san97@gmail.com 2

Putu Sri Maharani Utami

+6282144003396 dindamaharani369@gmail.com 3

Desak Gede Yuliana Eka

Pratiwi +6282145907203 yulianapratiwidesak@gmail.com 4

Putu Ijiya Danta Awatara

+6281232270119 ijiyadanta19@gmail.com

Regional Chairperson: Elvira Lesmana +6285811240637 rcindonesia@amsa-internasional.org

Decreasing The Outspread of HIV by Performing Post-Donation and Behavioral Strategies System: A Systematical Review Haﬁdh Fahreza Rusti, Putu Ijiya Danta Awatara, Dyane Puspa Pertiwi, Andi Rahmania Aisha

INTRODUCTION

RESULT & DISCUSSION

Ÿ The Human Immunodeﬁciency Virus (HIV) infects cells of

the immune system, destroying or impairing their function (WHO, nd). In Indonesia, there have been 48.000 HIV infections and 38.000 AIDS- Related deaths in 2016 ( UNAIDS, 2016 ). Indonesian goverment effort to prevent the spreads of HIV is enforced through Permenkes No. 21 2013 about countermeasure of HIV and AIDS but it still lacks in many ways and has not produced optimal results as the key to fight agains HIV is to stop the outspread of it. Early detection performed by Blood Donor Center in Indonesia has an aim of only screening whether or not it is safe to be accepted by the blood’s recipient and not to diagnose. HIV testing uses a strategy called unlinked anonymous where the blood bags are permanently stripped of personal identifiers and occurs without informed consent (NCBI,2012). As the result are not informed to the donors leading to them still not knowing about their HIV status, thus spreading the HIV infection to many others. Whereas if the system is enforced, it can potentially reduce the outspread of HIV by early diagnosis and treatment which results from donor notification. Aim: Therefore, this paper proposes a post-donation notification system that includes post-donation notification, counseling and treatment referral.

Ÿ Ÿ

Table 1. Assesment included journal using Critical Appraisal studies

: High : Low : Unclear

Table 2. Extracted data of included studies No 1

MATERIAL AND METHODS Ÿ Search Method: search of the literature in Pubmed

Central, Science Direct and Proquest of materials published prior to 2018. Ÿ Study Selection & Data Extraction: Critical Appraisal on decreasing outspread of HIV using post-donation donor notiﬁcation. All articles are written in English. Screening was conducted by two independent reviewers and a third reviewer was consulted to resolve discordance.

INCLUDED

ELIGIBILITY

SCREENING

IDENTIFICATION

Science Direct (n: 862)

\ (n: 542)

Proquest (n: 833)

Total records (n: 2237)

Records screened by title (n: 30)

excluded full-text non availability ( n=2 )

F i r s t A u t h oTr i t l e P a r t ic ip a n t s D e s c r i p t io n o f i n t e r v e n t i o n O u t c o m ei n o tfe r v e n t io n G r o C uo p n c lu s io n K u m a r i, R e a c t iv e D o n o r T o t a l ly , 1 1 6 r e a c t iv e d o n•oNr so t i f ic a t io o fn t h e i r r e a c t i v e t e s t r e s u l t s a O nd n l y 3354. % ( 4 1 ) o f d o n o r s M a i n t e n a nocf ep r i v a c y 2017 N o t i f i c a t io n a n d w e r e i n f o r mt eeld e p h o n ic a lly ca , l l e d f oor ucn s e l i n g a bdoeut te c t i o n o f a n r e s p o n d e d t o n o t i f i c a t i o n .d T uh r ien g d o n o r snci n r ege, C o u n s e l i n g : R e v e oa u l sto f w h ic h 1 0 6 w e r e a b n o r m a l t e s t r e s u l t w it h aedpvoi cr e t ttoo trh e r e s p o n s e f rvooml u n t a r y d o n o rps r e d o n a t io n e d u c a t io C o n c e a le d R i s k c o n t a c t e d a n d 1 0 c o u ld n bo l ot obde b a n k f o r-tfo-f a caec e c o u n s e l i n g a n d r e p weaasct o s m p a tr iv e l y l e s s a s a n d c o u n s e lin g a n d F a cto rs c o n t a c t e d ( m os w b i il tec h e d s a m p l i n g a s w e l l a s f o r r e f e r r a l t o t h e r ecso pm e cpt a i vree d t o r tehpel a c e m e n t p o s t n o t i f i c a t io n o f f , n o t r e s p o n d i n g , o r nd o et p a r t m e n t o f t h e h o s p it a l f o r f u r t h e r d o n o r s ( 3 4 . 6 % v s . 4 1 . 7 % ) .c ou n s e l i n g o f r e a c t iv e a v a ila b le ) . m a n a g e m eTh n te. n o t i f i c a t i o n s o v e r t e l e p h oAnre o u n d 2 2 (% 5 3) .o 7 f c o u n s e l eddo n o r s arreec o m m e n d e w e r e p r o v i d e d t w i c e ( s e c o n d c ai nl li m a fu t emr ar e ma c t iv e d o nr o e rv se a le d h i s t o r y g a p o f 1 w e e k ) a n d b y l e t t e r o n c e t o t h oosfe hw i g-r hho i s kb e h a o v ir / f a c t o r s c o u ld n o t b e c o n t a c t e d o n p h o n e t h r ic e w . h i c h w e r e dnio s ct lo s e d d u r i n g • c o n f id e n t ia lit y w a s m a in t a in e d b y in f o d rm on i nogr trh ee g i s t r a t io n a n d d o n o r a b o u t d e t e c t i o n o f a n a b n o r m a l tsecsrte reensiu n lgt . w i t h a d v ic e t o r e p o r t t o t h e b l o o d b a n k . R e a c t iv e d o n o r s r e tpi n og r t o b lo o d b a n k w e r e c o u n s e le d fa c e -t o-f a c e w h i l e p r i v a c y w a s m a i n t a i n e d , f r e s h s a m p le s w e r e t a k e n fo r r e p e a t t e s t in g a s w e ll a s t h e y w e r e r e f e r r e d t o t h e r e s p e c t iv e d e p a r t m e n t K o tw a l B l o o d d o n o r n o t iD f i u r i n g t h e s t u d y p e r io d ,•aI n c a s e o f a r e a c t iv e d o n o r f o r a n y m a rTkhe er , Tt-r T he Ie a c t iv e d o n o r s ( 4 6 4Do ) n o r n o t i f i c a t io n a n d e t .a l, 2 0 1 5 c a t io n a n d a n n u adlo n a t i o n o f 1 5 , 3 2 2 b l o o d b a n k c o u n s e l o r i n f o r m s t h e d o n o w r eeirt e h co en r t a c t e2d2: 9 ( 4 9 . 4 % ) p o s-d t o n a t io n c o u n s e li c o u n s e l i n g : O u r u n i t s , b oftrho m v o l u n t a r y at n e lde p h o n i c a l ly o r b y p o s t a b o u t d e t e c t iotne loe fp a h no n i c a l ly a n d t h e a r e a n e s s e n t i a lc ta sopf e e x p e r i e n c e f r o m r e p l a c e m e n t d own eorres a b n o r m a l t e s t r e s u l t w it h a n a d v i c e t o r e r epm o rat i n t oi n tgh 2 e 3 5 ( 5 0 . 6 % ) n o tt h e b l o o d b a n k t h a t e a t e r t ia r y c a r e s u b j e c t e d t o r tohuet i n e T T I b l o o d b ka n fo r o n -t e o-o n e c o u n s e l i n g a n d r e pceoant t a c t e d o n p h o n e w e r e p r o v i s io n o f i n f o r m a t i h o s p i t a l i n I n d i a s c r e e n i n g b y b o t h E L I S A saanm d p l i n g a s w e l l a s f o r r e f e r r a l t o t h e r eisnpf e oc rm t i veed b y p o s t . O f t h e 2o2n9 s e r o lo g i c a l N A T m e th o i nd s th e d e p a r t m e n t o f t h e h o s p it a l f o r f u r t h e r c o n t a c t e d d o n o r s , t h e r e s sptoa n tu se s , a s s e s s t h e im p D e p a r t m e n t o f T r a n s f u s io m na n a g e m e n t . r a t e w a s 9 8 . 2 % a s o n ly 2 2 o 5f t e s t r e s u lt s o n t h e M e d i c i na et a t e r t i a r y c a r e • A s a p r o t o c o l , t h r e e p h o n e c a l l s a n d t wdoo n l eot rt se rrse p o r t e d ( 2 2 1 o n tdhoen o r a n d f i n a l ly r e f e h o s p i t a l ni n o r t h I n d i a o v e r aar e s e n t b y p o s t t o i n f o r m t h e d o n o r a b foi rustt ,a tnhyr e e o n s e c o n d a n d f o n r e m e d ic a l c a r e . p e r io d o f 1 y e a r . a b n o r m a l r ebs e u fl to r e t h e i r -c no om n p l i a n c e i s o n t h e t h i radl l )c f o r o n e t o o n e t e r m e d a s -r no e snp o n d e r . c o n f i d e n t i a l i t y i s c o u n s e l i n g . T h e r e m a i n i n g f o u r m a i n t a i n e d b y j u s t i n f o r m in g t h e d o n o r naobn -r oe u st p o n d e r s w- e o rnee H I V d e t e c t io n o f a n a b n o r m a l t e s t r e s u l t w i tahn adnt h ad r ev ei c H e B s A g r eT ah c tei v e . t o r e p o r t t o t h e b lo o d b a n k . r e m a in in g 2 3 5 ( 5 0 .6 % ) r e a c t iv e C h o u d h u r yN o t i f i c a t io n o f P a r t i c i p a n t s c o m p r i s e d aC o l l e ct th ed a t au s i n g a s t r u c t u r esdt io qu ne n a ir e 1 . O n ly h a lf (5 3 p e r c e n Nto) t i f i c a t io n o f p o s i t i v a n d T e t a li, t r a n s f u s io n g r o u p o f v o l u n t a r y b l o o dc o m p r i s i n g 1 0 q u e s t io n s . A p a r t f r o m d e m o g r aopf ht ihce d o n o r s w e r e r e s u l t s s h o u l d b e m a d 2008 t r a n s m it t e d d o n o r s a t t h e W o r l d B lo o i ndf o r m a t i o n ( a g e a n d s e x ) , t w o q u e s t io n s w e r a e wo anr e t h a t bt h l oeo d m a n d a to ry , b u t c a re in f e c t io n D o n o r s ’ D a y m e e t i n g i n Jbul o l yo d d o n a -t t io h en n u m b e r o f t i m e s t h e b a n k is s u p p o s e d t o s h o u ld b e t a k e n t o m 2 0 0 6 in p a r t i c i p a n t d o n a t e d b l o o d in t h e l a s t o n e y e a ri n , faonrdm t h e m i f t h e y gt e n s te r a l , T r iv a n d r u m , K e r a la . n u m b e r o f t im e s h e / s h e f i l le d t h e d o n o r f o r m p. o s i t i vfe o r T T I. w it h o u t r e f e r r in g t o a A n o t h e r qs tui e o n w a s a b o u t e a c h d o n o r ’s 2 . A lm o s t h a lf t h e d o n s opr s e c if ic d is e a s e . T T I r e a w a r e n e s s a b o u t h i s / h e r d o n a t e d b lo o d b e i n gt h o u g h t t h a t t h e y d isdh o u l d b e t e s t e d f o r T T I , t h e n u m b e r o f t im e s t h e d o n o rnw o ta sh a vbelo o -b d o rn e p r e s e n t e d a n d e x p la in c o n t a c t e d i n t h e l a s t o n e y ebalo r o bd y b t haen k , in f e c t io n s o n l y i n pae r s o-tno-p e r s o n a n d w h e t h e r d o n o r s s o u g h t t h e ir t e s t r e p o r t s . in t e r v ie w . T h e r e m a i n i n g q u e s t rio e nosnwwe h e rt hd o n o r s w a n t t o ibnef o r m e d a b o u t t h e i r uTsT, Iasnt d at w h e n a n d h o w t h e y l iw ke ou to ldb e c o n t a c t e d

Records after duplicates removed (n: 28)

· Feasibility of post-donation notiﬁcation service Donor Notiﬁcation system is a highly applicable system. Some developed countries such as US, Australia, UK, and even developing countries like South Africa, Gambia, Ghana, and Egypt have applied the system without noticeable problems (The Australian Red Cross Blood, n.d).

Records screened by abstract excluded due (n: 17)

to duplication ( n=2 ) Full text articles assessed for eligibility (n: 15)

excluded n=12

Studies included (n: 3) Figure 1. Study Selection Flow Diagram

Refrences: 1. Choudhury, L. P., & Tetali, S. (2008). Notification of transfusion transmitted infection. Indian J Med Ethics, 5(2), 58-60. 2. Kotwal, U., Doda, V., Arora, S., & Bhardwaj, S. (2015). Blood donor notification and counseling: Our experience from a tertiary care hospital in India. Asian journal of transfusion science, 9(1), 18. 3. Australian Red Blood Cross. (n.d).Blood Testing and Safety. Retrieved from http://www.donateblood.com.au/eligibility/blood-testing-and-safety 4. Attia, S., Egger, M., Müller, M., Zwahlen, M., & Low, N. (2009). Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis. Aids, 23(11), 1397-1404. 5. Kumari, S. (2017). Reactive donor notification and counseling: Reveals concealed risk factors. Indian Journal of Social Psychiatry, 33(1), 38. 6. Infodatin Kemenkes, R. I. (2015). Pusat Data dan Informasi Kementrian Kesehatan Republik Indonesia. 7. World Health Organization. (n.d). HIV/AIDS. Retrieved from http://www.who.int/topics/hiv_aids/en/ 8. Delage, G., Myhal, G., Grégoire, Y., & Simmons-Coley, G. M. (2014). Donors' psychological reactions to deferral following false-positive screening test results. Vox sanguinis, 107(2), 132-139.

*If there is no respond in a given period of time, second method of notiﬁcation will be applied

Figure 1. Percentage of TTI infection in blood bag Figure 2. Number of blood bag production in in Indonesia from 2005-2014 Indonesia from 2005-2015

· Benefit of post-donation service system The existence of notification system will benefit not only the HIV infected person but also the blood donor center and the blood recipient. For HIV infected person, a clear benefit will be gained through early treatment which is the end results of the post-donation service system.

Donor notification can decrease outspread of HIV through increasing the number of HIV-positive person who are aware of their status and decreasing who are unaware. Dr Valerie Delpech, head of Public Health England (PHE)'s national HIV surveillance state that knowing one's HIV status is the key to both effective treatment, and to preventing onward transmission (Public Health England, 2014). With 3,054,747 production of blood bags each year, this means the application of the post-donation service can detect more than 7,900 HIV positive person each year and can give consultation that can prevent the outspread of HIV to thousands of people (infodatin PMI,2015). With a positive trend of blood donor, from less than 1.5 million in 2005 into more than 3 million in 2014, and the promotion of blood donating that is more intense to a lot of schools, office, music concert and other events, blood donation service can reach more people from different background and can indirectly optimize the effort of reducing the outspread of HIV (infodatin PMI,2015).

CONCLUSION This system si able to decrease HIV by notifying HIV positive blood donors to increase their awareness and counseling through behavioral strategies approach, to sustain safer sexual behavior and so avoid further transmission.

Decreasing The Outspread of HIV by Performing Post- Donation and Behavioral Strategies System : A Systematical Review 1

Hafid Fahreza Rusti, 2Putu Ijiya Danta Awatara, 3Dyane Puspa Pertiwi, 4Andi Rahmania Aisha

Aim : this paper proposes a system to optimize the function of blood donors in an effort to suppress the outspread of HIV. Background : The Human Immunodeficiency Virus (HIV) is a retrovirus that infects cells of the immune system. HIV has caused many problems in a lot of countries around the world, including in Indonesia. One of the ways to stop the outspread of HIV is to perform an early detection in individuals post donating their blood through Blood Donation Center. Material and Methods : The method used in this paper is systematic review and the materials are relevant scientific journals. Results : The system includes post blood-donor notification, counseling and treatment referral. After blood screen test is done to a blood donor, they will be sent a notification letter to their house if the results are positive. The notification letter provides a sufficient confidentiality as it requests the donor for a personal appointment to attend the Blood Donation Center. If the donor does not call in two weeks, a second similar letter is sent followed by a phone call. If the phone call is not answered, clinicians with HIV counseling background from Community Health Care Center will be sent to the donorâ&#x20AC;&#x2122;s house. Patient is then recommended to hospital for further consultation. This system emphasizes the importance of meeting the patients and letting them know about the positive HIV results face to face rather than telling the results straightforward in the notification letter. The existence of post-donor notification system will benefit the HIV positive donor, the blood recipient and also the Blood Donation Center. Conclusion : This approach will be able to decrease the outspread of HIV by notifying HIV positive blood donors to increase their awareness of self-status so that further transmission can be avoided.

Keyword: HIV, Blood Donor, Post-Donor Notification

Author:

Hafidh Fahreza Rusti

+6281330608127 Hafidhrusti@gmail.com 2

Putu Ijiya Danta Awatara +6281232270119 ijiyadanta19@gmail.com

Dyane Puspa Pertiwi

+6281235813154 dyanepp@gmail.com 4

Andi Rahmania Aisha

+6281231661231 rahmania.aishaa@gmail.com Regional Chairperson AMSA-Indonesia : Elvira Lesmana rcindonesia@amsa-international.org +6285811240637

Epidemiological Study of ACT (Artemisinin-based Combined Therapy) Resistance in Plasmodium falciparum (jangan lupa di italic) due to Mutatation of the K-13 Propeller Gene in Southeast Asia 1 Nicholas Kevin P. , Nathanael Ibot D.1 , Bernadus Bernardino B.1 , Yohana Hartya D.F.1 Introduction : Artemisinin Combined Therapy (ACT) is known as the first-line therapy for malaria. It has been applicated in Indonesia since 2004 and has been applicated worldwidely in over 80 countries. (Depkes RI, 2008; WHO, 2016). Problems arise when there were some cases reported about ACT resistance against Plasmodium due to mutation of K13-Propeller gene. (MĂŠnard et al., 2016) .The mechanism of this resistance has not been defined. In this study, we would like to analyze the prevalence of ACT resistance cases in Southeast Asia regarding to K13propeller gene. Objective : To present the spread of Artemisinin-based Combination Therapy in Plasmodium falciparum due to mutation of K13-Propeller gene in Southeast Asia Method : The method used is to analyze the data regarding the resistance of Plasmodium falciparum against ACT through this epidemiological study. From this study, it is hoped that this study could show the spread of the resistance so that the resistance could be overcome in the future. Result : Plasmodium falciparum resistance against ACT has spread to 5 countries in Southeast Asia. The aforementioned countries are Cambodia, Laos, Myanmar, Thailand, and Vietnam. The case with most number of mutation of K13-Propeller gene was reported in Cambodia. In Indonesia and Philippines, no data regarding mutation of K13-Propeller gene has been observed. The rise and decline of the amount of cases per year could still not be observed due to the lack of data collection, especially the difference of the amount of sample taken each year. Conclusion : Plasmodium falciparum resistance against ACT as the first line medication option for malaria has spread through several countries in Southeast Asia. Therefore, data sampling should be conducted in a greater scale. Regarding to the resistance of ACT, a new guideline to treat malaria is needed.

The Correlation between Multiple Drug Resistant Tuberculosis (MDR-TB) and Patient Compliance to Tuberculosis Medication in Indonesia Novelina Gracea1, Silvia Husodo2, Ivanna Yuhan3, Emi Lia Halim4

Tuberculosis is one of the world's most important infectious diseases caused by the intracellular pathogen Mycobacterium tuberculosis (MTb). This disease remains a major public health issue worldwide cause of death in humans from a single infectious agent. Mycobacterium tuberculosis transmitted by droplets nuclei. Indonesia become the 2nd (360,565 cases) in the world. The problem becomes aggrevated due to the emergence of Multiple Drugs Resistant Tuberculosis (MDR-TB) especially rifampicin and isoniazid. Indonesia is ranked 8th in the world, it is estimated there are 6,800 MDR-TB cases annually. Factors leading to development of drug resistance need to be understood to develop appropriate control strategies, such as obedience about TB medication. This study aim to find out the correlation of drug obedience compliance with MDR-TB in Indonesia. The search method that is used is systematical review from Science Direct and Google Scholar journals also Inclusion and Exclusion Criteria to identify the correlation between TB medication obedience rate and MDR TB in Indonesia. The combinations of term used for the journals included “TB medication obedience rate”, “MDR TB”, and “Indonesia”. Limits were applied in this reviews only journals that published in the last 5 years (2013-2018). Journals outside of the five years range were excluded to avoid subjectivity and bias. Based on the search results from several journals obtained, stated that the rate of medication obedience in Indonesia highly varies, this is done with cross sectional method and the result showed in Padang 21,7%, Pekanbaru 34,4%, Riau 48,6%, Lampung 24,7%, Jakarta 40,8%, Cirebon 23,8%, Semarang 36,7%, North Borneo 61%, Jember 67%, and Manado 19,3. Based on data from WHO, MDR-TB cases in Indonesia are always increase anually, obedience of medication has been contribute for that. Therefore arise awareness to obedience would be a simple, cost-effective, and impactful method to reduce this development resistant.

Revolutionary Therapy of Toxoplasmosis using Allicin by Inhibiting Tubulin β-chain in Toxoplasma gondii : A Systematical Review & Insilico Studies AMSA CHAPTER INDONESIA SHANTIDEWI, IRENE YASMINA VILADO, GEDE KRISNA ADITYA, PUTU IJIYA DANTA AWATARA FACULTY OF MEDICINE BRAWIJAYA UNIVERSITY

Introduction

Results and Discussion

• Toxoplasma gondii is a member of the phylum Apicomplexa that cause serious disease in humans and animals. The parasites can be transmitted from the mother to the fetus, resulting in congenital toxoplasmosis which can cause severe and disabling disease in the developing fetus (Hunter and Sibley, 2012). • Toxoplasmosis has a world-wide epidemiology and is believed to infect 25–30% of the world’s population (Furtado et.al, 2011). In Indonesia, the prevalence is being reported to be 53% from 17735 women as the sample, and 46% of the sample is at the childbearing age (Flegr et.al, 2014). • Therapy of the disease often consists of pyrimethamine in combination with a sulfonamide. Adverse side effects and resistance of pyrimethamine combinations highlight the need for alternative therapeutic options (Andrews, Fisher, and Skinner-Adams, 2014). • Allicin is an organ sulphate compound that is produced from Allium sativum L. The injuries activate allinase (or alliin-lyase), a pyridoxal 5-phosphate containing enzyme, which metabolises alliin into allicin (Marchese et.al, 2016) o

H2C

S+

o OH

H2C

S+ S

NH 2

Alliin

Allicin

• Studies have investigated possible interaction of allicin with alpha–beta tubulin since allicin has been reported to inhibit microtubule polymerization, it is a potential inhibitor of the mitosis of the parasite’s cells (Chhabria et.al, 2015). Aim To show the effect of allicin as potential antitoxoplasma by in vitro and in silico

Insilico Results : Pharmacodynamic

Figure 1. Pharmacodynamics Results : [Molecular view of protein active site (A) , allicin and Tubulin β-chain binding (B and C), Bonding Affinity (D)]

Pharmacodynamics Results : - Bonding Affinity -3.7 kcal/mol - Allicin inhibit/block tubulin β-chain protein of Toxoplasma gondii - Allicin could give a significant effect to tubulin β-chain protein and prevent the formation of microtubule thread spindle and inhibit the cell proliferation in Toxoplasma gondii. - The Molecular View of Allicin and tubulin β-chain Bond showed that Allicin can bind to the Amino Acid sequence in bacteria cell Alanin 206 Insilico Results: Pharmacokinetic

Materials and Methods Search Method: Search of the literature in NCBI, Science Direct, and Proquest of material published prior to March 10, 2018. Inclusion: Journal ranged from 2008 until 2018, studies about congenital toxoplasmosis. Exclusion: Journal before 2008, studies about other parasite infection. Keywords: Allicin, Toxoplasma gondii, congenital toxoplasmosis, antiparasite, antiprotozoa Pharmacodinamic

Figure 2. Pharmacologic Effect Prediction

Pharmacokinetic Results : - Allicin has an antiprotozoal, Apoptosis agonist and Lipid metabolism regulator which based on Pharmacologic Effect Prediction - The logP value of this compound is 1.870 so allicin has high reactivity, prominent antioxidant activity and high membrane permeability, allowing it to rapidly penetrate different cell compartments - Allicin is trapped by reactions with proteins and fatty acids in the plasma membrane before it can be absorbed. -Allicin acts as an oxidant in the bloodstream, binding to red blood cells and oxidizing them. When ingested it binds to lumen, and does not pass through the membrane of the digestive tract to enter the blood.

Pharmacokinetic NCBI n=39

Science Direct n=1242

Proquest n=874

the histology as evidenced by the tubular degeneration, tubular congestion, tubular dilatation, necrosis and glomerular injuries, H&E and Masson's trichrome, X640.

Total records n=2505 Record screened by title n=67 Record after duplications removed n=42 Record screened by abstract n=19 Full text article asssessed for eligibity n=10 Studies included n=2

Figure 3. Toxoplasmosis markedly disrupted

Excluded due to duplication (n= 25)

Excluded full-text nonavailability (n= 9) Excluded (n=8)

Figure 4. Healing of nephropathological injuries was determined in toxoplasmosis group that receive garlic juice, Masson's trichrome, X640.

The study conducted by Ghadaradgi (2012), showed T.gondii have significantly effect on protein losing and cause to hypoproteinemia, increased creatinin and decreasing albumin in serum. These findings revealed fresh garlic juice has strong antioxidant potential and decreasing cell injury, such as apoptosis in tubules and nephrons and doing antiprotozoal role with decreasing cell injury in nephrons, so it is suggested that eating of garlic is useful in infected patients.

Conclusion

Allicin has an antiprotozoal effect and effective as an alternative treatment for Toxoplasmosis caused by Toxoplasma gondii in in vitro and in silico studies

References 1. Andrews, K. T., Fisher, G., & Skinner-Adams, T. S. (2014). Drug repurposing and human parasitic protozoan diseases. International Journal for Parasitology: Drugs and Drug Resistance, 4(2), 95-111 2. Chhabria, S. V., Akbarsha, M. A., Li, A. P., Kharkar, P. S., & Desai, K. B. (2015). In situ allicin generation using targeted alliinase delivery for inhibition of MIA PaCa-2 cells via epigenetic changes, oxidative stress and cyclin-dependent kinase inhibitor (CDKI) expression. Apoptosis, 20(10), 1388-1409 3. Flegr, J., Prandota, J., Sovičková, M., & Israili, Z. H. (2014). Toxoplasmosis–a global threat. Correlation of latent toxoplasmosis with specific disease burden in a set of 88 countries. PloS one, 9(3), e90203 4. Furtado, J. M., Smith, J. R., Belfort Jr, R., Gattey, D., & Winthrop, K. L. (2011). Toxoplasmosis: a global threat. Journal of global infectious diseases, 3(3), 281 5. Hunter, C. A., & Sibley, L. D. (2012). Modulation of innate immunity by Toxoplasma gondii virulence effectors. Nature Reviews Microbiology, 10(11), 766

UTI ALTERNATIVE THERAPY USING TANNIN IN FICUS BENJAMINA BY INHIBITING LASR PROTEIN OF ESCHERICIA COLI : IN VITRO & IN SLICO STUDIES Putu Ijiya Danta1, Beatrice Patricia2, Lois Theodora3, Azzura Jasmine4

Aim : To determine the antimicrobial effect of Ficus benjamina as an alternative treatment for urinary tract infection (UTI) caused by Eschericia coli bacteria in in vitro and in slico studies. Background : UTI is an infection when bacteria get into the urinary tract and multiply. UTI is considered to be one of the most common bacterial infection. Escherecia coli has been proved as the pathogenic bacteria causing UTI that contributes 90% of all UTI cases. UTI treatment has been shown to have a resistance in many antibiotics. Ficus benjamina contains tannin substance and it has the effect of an antimicrobial agent by inhibitting the activity of LasR protein and reduce the virulence factor of Eschericia coli. Material and Method : The research design that is used is experimental research with post-test only control group design. The study focused on the state of Eschericia coli bacteria with the treatment of ethanol extract of the Ficus benjamina by in vitro. In silico research was needed by using data that exist in online database such as Microsoft Windows 10 with Google Chrome browser verse 53.0.2785.116 m, Pyrx 8.0, Pymol, Vega ZZ, and Discovery Studio. Results : In silico result shows that tannin could give a significant effect to Membrane Intregity Agonist and Sugar Phosphatase Inhibitor which is tannin could penetrate to membrane cell. Tannin is soluble in fat and slightly soluble in water. Lethal dose value showed a moderate reliability when administrated through intraperitoneal, oral, subcutaneous route and borderline reliability through intraveous route. In vitro studies shows increasing of inhibitory zone for Eschericia coli was followed by increasing concentration of Ficus Benjamina. Conclusion : Ficus benjamina has an antimicrobial effect and effective as an alternative treatment for urinary tract infection (UTI) caused by Eschericia coli bacteria in in vitro and in slico studies.

Keywords: Eschericia coli, Urinary tract infection , Antibiotic, Tanin, Ficus benjamina, In vitro, In silico Author: 1

Putu Ijiya Danta Awatara

+6281232270119 ijiyadanta19@gmail.com

Beatrice Patricia Sindhu +6281234514352

beatricesindhu@gmail.com 3

Lois Theodora +6281938383332 lois_th@yahoo.com

Azzura Jasmine

+6282392069848 azzura.simanullang@gmail.com

Regional Chairperson AMSA-Indonesia Elvira Lesmana rcindonesia@amsainternational.org +6285811240637

Introduction

Results and Discussion

H2C

S+

o OH

H2C

S+ S

NH 2

Alliin

Allicin

Insilico Results : Pharmacodynamic

Figure 1. Pharmacodynamics Results : [Molecular view of protein active site (A) , allicin and Tubulin β-chain binding (B and C), Bonding Affinity (D)]

Figure 2. Pharmacologic Effect Prediction

Pharmacokinetic NCBI n=39

Science Direct n=1242

Proquest n=874

the histology as evidenced by the tubular degeneration, tubular congestion, tubular dilatation, necrosis and glomerular injuries, H&E and Masson's trichrome, X640.

Total records n=2505 Record screened by title n=67 Record after duplications removed n=42 Record screened by abstract n=19 Full text article asssessed for eligibity n=10 Studies included n=2

Figure 3. Toxoplasmosis markedly disrupted

Excluded due to duplication (n= 25)

Excluded full-text nonavailability (n= 9) Excluded (n=8)

Figure 4. Healing of nephropathological injuries was determined in toxoplasmosis group that receive garlic juice, Masson's trichrome, X640.

Conclusion

Allicin has an antiprotozoal effect and effective as an alternative treatment for Toxoplasmosis caused by Toxoplasma gondii in in vitro and in silico studies

Revolutionary Therapy of Toxoplasmosis using Allicin by Inhibiting Tubulin β-chain in Toxoplasma gondii : A Systematical Review & In silico Studies 1

Shantidewi , Irene Yasmina Vilado2, Gede Krisna Aditya Pranata3, Putu Ijiya Danta Awatara4

Aim : To show the effect of Allicin as potential antitoxoplasma Background: Toxoplasma gondii is a member of the phylum Apicomplexa that cause serious disease in humans and animals. Toxoplasmosis has a world-wide epidemiology and is believed to infect 25–30% of the world’s population. Adverse side effects and resistance of pyrimethamine combinations highlight the need for alternative therapeutic options. Studies have investigated possible interaction of allicin is a potential inhibitor of the mitosis of the parasite’s cells. Material and Method : The research design that is used is systematical review using relevant scientific journals. The study focused on evaluating Allicin as inhibitor of the mitosis of the Toxplasma gondii’s cells. In silico research was needed by using data that exist in online database such as literature in NCBI, Science Direct, and Proquest of material published prior to March 10, 2018. Results : Pharmacodynamics results show that Allicin give a significant effect to tubulin β-chain protein and prevent the formation of microtubule thread spindle and inhibit the cell proliferation in Toxoplasma gondii. Pharmacokinetic results show that Allicin has an antiprotozoal , Apoptosis agonist and Lipid metabolism regulator. The logP value of this compound is 1.870 so allicin has high reactivity, prominent antioxidant activity and high membrane permeability, allowing it to rapidly penetrate different cell compartments. The study showed Toxoplasma gondii have significantly effect on protein losing and cause to hypoproteinemia, increased creatinin and decreasing albumin in serum. Allicin has strong antioxidant potential and decreasing cell injury, such as apoptosis in tubules and nephrons and doing antiprotozoal role with decreasing cell injury in nephrons. Conclusion : Allicin has an antiprotozoal effect and effective as an alternative treatment for Toxoplasmosis caused by Toxoplasma gondii in in vitro and in slico studies.

Keywords: Toxoplasmosis, Toxoplasma gondii, Allicin, Allium sativum

Author:

Shantidewi

+6282144149257 Shantidewi46@gmail.com 2

Irene Yasmina Vilado

+6282140284702 irene.vilado@gmail.com 3

Gede Krisna Aditya Pranata

+6281330541643 krisnapranata25@gmail.com 4

Putu Ijiya Danta Awatara

+6281232270119 ijiyadanta19@gmail.com

Regional Chairperson AMSA-Indonesia Elvira Lesmana rcindonesia@amsa-international.org +6285811240637

ALLICIN FROM GARLIC EXTRACT (ALLIUM SATIVUM) COMBINED WITH SILVER NANOPARTICLE AS ANTIMICROBIAL AGENT IN TREATMENT OF MRSA (METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS) SKIN INFECTION THROUGH THE INIBITION OF PBP-2A (PENICILLIN-BINDING PROTEIN 2A) ON MRSA CELL WALL Theodore Isaac M., Aulia Fahira, Reselina Utami, Gusti Rajendra Yoga P. Faculty

Aim : To know the potential of Allicin-based silver nanoparticles as an alternative therapeutic agent for MRSA skin infections. Background : Methicillin-resistant Staphylococcus aureus (MRSA) is a bacteria which is resistant to many antibiotics and cause highly contagious infections. Penicillin Binding Protein 2a (PBP2a) is a major factor of resistance in MRSA. Garlic extract contains Allicin which potentially inhibit the growth of MRSA. Silver nanoparticle is a new technology that have an antimicrobial effect because they can enter the cell and damage MRSAâ&#x20AC;&#x2122;s intracellular structures. Material and methods : The author uses two methods, namely literature review and in silico. In silico method uses PBP-2a sequences obtained from uniProt and pubchem databases. Active site and chemical bond are seen using pymol and discovery studio. The literature review study used three major search engines, NCBI, Sciencedirect, and Pro Quest. The search limit is a study published in 5 years (2013 2018) and literature in English. Results : In silico results showed that Allicin was able to inhibit PBP-2a of MRSA cell and strongly bind to the active site of the resistant PBP2a protein, serine 49, by an hydrogen bonding with a bond strength of -3.9 kcal/mol as the highest and -3.5 kcal/mol as the lowest value. In vitro results indicate that Allicin has a strong potential for inhibiting the growth of MRSA bacteria with an effective inhibitory zone, and In vivo results showed that Allicin combined with silver nanoparticles can significantly decrease the number of MRSA colonies in treated mice. Allicin has a high bioavailability and lipophilic properties, so its effective for topical administration as antimicrobial agent against MRSA. Conclusion : Allicin-based silver nanoparticles can be an alternative therapeutic agent for MRSA skin infections that has been resistant. Keywords : Allicin, Silver Nanoparticle, Methicillin-Resistant Staphylococcus aureus, PBP-2a.

Abstract Background In Southeast Asia, MRSA is the major resistant gram-positive pathogen. Carriers may acquire MRSA from the community and hospitals. MRSA is commonly transmitted by nosocomial infections, through contamination of medical worker's hands and contact surfaces in the hospitals. Objectives To reduce prevalence of MRSA transmission from health care provider to patients through infection control. Methods The journal used were from Google Scholar, Research Gate, Science Direct, and Oxford Academics. The combination of keyword that we used are “Hand hygiene and Staphylococcus aureus” (Methicilline-resistant Staphylococcus aureus), “Staphylococcus aureus between medical staff” and “Tingginya prevalensi MRSA”, “prevalence of MRSA in Indonesia” The journal were published from 2009-2017. We did some selection that compatible with our scientific poster and we chose five journals. Results A study at New South Wales Hospital shows that after infection control intervention, 16% reduction in new MRSA infections identified from ICU non-sterile sites and 25% reduction in MRSA infections from non-ICU sterile sites. Another study at Australian hospital shows that ICU sterile sites and nonICU sterile sites MRSA interventions remained stable over the same period after infection control program. In Thailand hospital, facilities with ≥75% compliance with the prevention bundle for MRSA experienced on average a 17.4% reduction in MRSA rates. Involvement in a collaborative to reduce HAI was also associated with a reduction in MRSA rates (18.9%). Conclusion MRSA is a serious infectious disease that is commonly transmitted through nosocomical infection. MRSA is hard to be cured. From the journals that we have reviewed there is significant reduction in MRSA rates after infection control. Proper infection control like hand hygiene, isolation of MRSA patients, education to patients and health care provider, decontamination of patient’s room, and decolonization of MRSA for patients and medical staff carrier MRSA can reduce the infection significantly.

INFECTION RISK SCAN (IRIS) IN IMPROVING INFECTION CONTROL Anthony Yusuf, Jessica Anastasia, Maria Claudia, Steven Nanda

Aims To review the effectiveness of Infection Risk Scan (IRIS) in improving infection control in healthcare institutions and provide a simple but effective solution for healthcare institutions in Indonesia.

Background Infections acquired from healthcare procedures done in hospitals are called hospital acquired infection (HAI). HAI has been a threat to patients’ safety. To reduce the risk of HAI, several measures can be done, such as doing infection control assessments and surveillances in hospitals. However, this measure had not been properly conducted in Indonesia. In fact, hand-hygiene compliance in Indonesia was poor and was more likely to be undertaken after patient contact (34% after-patient contact vs 5% beforepatient contact). Lack of HAI and infection control reporting proves that Indonesia’s awareness regarding this issue is low. In fact, published surveillance data on HAIs in Indonesian hospitals is rare despite multiple studies showing that the prevalence of HAIs in Indonesia is high, including SSI, phlebitis, UTI, and septicemia. Therefore, we need an effort to increase infection control to reduce HAI. Infection Risk Scan (IRIS) can be one way for healthcare institutions in Indonesia, to improve infection control thus decreasing the rate of HAI. This program measures a number of objectifiable variables in the field of infection prevention. The scan converts the measurements into a risk profile and an improvement chart, a graphic presentation that is easy to understand for care professionals, managers and patients. By applying IRIS, we hope that infection control in Indonesia will improve and can be well-distributed throughout the country due to its simplicity and cost-effectiveness.

Materials and Methods We conducted a systematic review from online journals in PubMed and online thesis with inclusion and exclusion criteria. Keywords: Infection control; Infection prevention; Surveillance

Results The IRIS has been successfully applied in 5 hospital departments, a rehabilitation clinic and 19 nursing homes in Netherlands. IRIS has been proven to significantly increase hand hygiene compliance (43% to 66%, p<0.001), and ATP levels were significantly reduced (p < 0.000), showing reduced environmental contamination.

Conclusion IRIS has shown to be effective in increasing hand hygiene compliance and reducing environmental contamination, thus improving infection control. IRIS is applicable in healthcare institutions in Indonesia because it is effective and can be easily understood by both medical professionals and nonmedical individuals, such as the society.

Regional Chairperson: Elvira Lesmana rcindonesia@amsainternational.org +6285811240637

Infection Risk Scan (IRIS) in IMPROVING INFECTION CONTROL Anthony Yusuf, Jessica Anastasia, Maria Claudia, Steven Nanda Faculty of Medicine Pelita Harapan University Introduction

Results

Infections acquired from healthcare procedures done in hospitals are called hospital acquired infection (HAI). HAI has been a threat to patients’ safety. To reduce the risk of HAI, several measures can be done, such as doing infection control assessments and surveillances in hospitals. However, this measure had not been properly conducted in Indonesia. In fact, hand-hygiene compliance in Indonesia was poor (Marjadi, 2010) and was more likely to be undertaken after patient contact (34% after-patient contact vs 5% before-patient contact). Lack of HAI and infection control reporting proves that Indonesia’s awareness regarding this issue is low. In fact, published surveillance data on HAIs in Indonesian hospitals is rare despite multiple studies showing that the prevalence of HAIs in Indonesia is high, including SSI, phlebitis, UTI, septicemia (Duerink, 2009). Therefore, we need an eﬀort to increase infection control to reduce HAI. Infection Risk Scan (IRIS) can be one way for healthcare institutions in Indonesia, to improve infection control thus decreasing the rate of HAI. This program measures a number of objectifiable variables in the field of infection prevention, including the dissemination of highly-resistant microorganisms, the use of antibiotics and indwelling medical devices, environmental contamination using ATP measurements, and hand hygiene compliance of healthcare workers. The scan converts the measurements into a risk profile and an improvement chart, a graphic presentation that is easy to understand for care professionals, managers and patients. By applying IRIS, we hope that infection control in Indonesia will improve and can be welldistributed throughout the country due to its simplicity and cost-eﬀectiveness.

Aims

• •

To review the eﬀectiveness of Infection Risk Scan (IRIS) in improving infection control in healthcare institutions. Provide a simple but eﬀective solution for healthcare institutions in Indonesia.

Methods Keywords

Articles

Inclusion and exclusion criteria

Remaining articles

Keywords: Infection control; Surveillance; Infection prevention Inclusion: Observational study, Systematic review, English language Exclusion: Publication >10 years, non-English language

Independent review by each member

Figure 1: Example of an empty IRIS improvement plot

Figure 2: Example of an IRIS plot from a hospital

IRIS Cycle

Environmental Contamination

70%

53%

35%

18%

23 1st

2nd

3rd

Hand-hygiene compliance increases from 44% to 66% (p<0.001) after three cycles of IRIS

Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5 Comparison graph of environmental contamination score from 1st IRIS cycle (yellow) with 3rd IRIS cycle (orange); a significant decrease is observed.

Discussions Results of IRIS were categorized as low-, intermediate- and high risk, presented in an easy-to-read graphic risk spider-plot. This plot was given as feedback to management and healthcare workers. The IRIS has been successfully applied in 5 hospital departments, a rehabilitation clinic and 19 nursing homes in Netherlands. After 3 cycles, IRIS has been proven to significantly increase hand hygiene compliance (43% to 66%, p<0.001), and ATP levels were significantly reduced (p < 0.000), showing reduced environmental contamination in five diﬀerent hospitals in the Netherlands.

Conclusions IRIS has shown to be effective in increasing hand hygiene compliance and reducing environmental contamination, thus improving infection control. IRIS is applicable in healthcare institutions in Indonesia because of its effectivity and it can be easily understood by both medical professionals and non-medical individuals. IRIS is also cost-effective, meaning hospitals in rural areas can apply it as well. Nevertheless, the number of studies published regarding IRIS is still limited. We suggest that further experimental and observational study should be made to confirm our result.

References: 1. Willemsen I, Nelson-Melching J, Hendriks Y, Mulders A, Verhoeﬀ S, Kluytmans-Vandenbergh M, Kluytmans J. (2014). Measuring the quality of infection control in Dutch nursing homes using a standardized method; the Infection prevention RIsk Scan (IRIS). PubMed. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/ 25243067

2. Willemsen I, Kluytmans JA. (2016). [The Infection RIsk Scan in clinical practice: improving infection prevention and antibiotic use through transparency]. PubMed. Retrieved from https://www.ncbi.nlm.nih.gov/ pubmed/27900923

3. Willemsen I, Kluytmans J. (2018). The infection risk scan (IRIS): standardization and transparency in infection control and antimicrobial use. PubMed. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/ 29541449

5. Marjadi B, McLaws ML. (2010). Rural Indonesian health care workers' constructs of infection prevention and control knowledge. PubMed. Retrieved from https:// www.ncbi.nlm.nih.gov/pubmed/20227793

4. Santosaningsih D, Erikawati D, Santoso S, Noorhamdani N, Ratridewi I, Candradikusuma D, Chozin IN, Huwae TECJ, van der Donk G, van Boven E, Voor In 't Holt AF, Verbrugh HA, Severin JA. (2017). Intervening with healthcare workers' hand hygiene compliance, knowledge, and perception in a limited-resource hospital in Indonesia: a randomized controlled trial study. PubMed. Retrieved from https://www.ncbi.nlm.nih.gov/ pubmed/28239452

6. Duerink DO, Roeshadi D, Wahjono H, Lestari ES, Hadi U, Wille JC, De Jong RM, Nagelkerke NJ, Van den Broek PJ; Study Group 'antimicrobial Resistance In Indonesia Prevalence And Prevention' Amrin. (2009). Surveillance of healthcare-associated infections in Indonesian hospitals. PubMed. Retrieved from https:// www.ncbi.nlm.nih.gov/pubmed/16307823

Analysis of Immunoboosting Effect Curcumin and Garlic for Better Prevention Againts Diphtheria Infection ABSTRACT Diphtheria is still an infectious disease with a considerable incidence rate in some countries. In December 2017 diphtheria cases in Indonesia increased to 591 cases spread over 20 provinces that led to declaration of extraordinary incident of diphteria. This disease can actually be prevented easily through vaccination. Combined use of vaccine and immunomodulators can increase the effect of vaccine. This review analyze the potency of curcumin obtained from turmeric (Curcuma longa) and garlic (Allium sativum) as safe and effective adjuvant to be used as immunopotentiator in vaccine. Based on the studies, curcumin can enhance antibody response; modulate activation of T cells, B cells, macrophages, neutrophils, natural killer (NK) cells, and dendritic cells; and downregulate various proinflammatory cytokine and chemokine. Previous studies shows that garlic can increase response of delayed-type hypersensitivity, natural killer (NK)-cell activity, cytotoxicity of macrophages, and stimulates differentiation of plasma cells. The present findings indicate that S1PC promotes the intestinal IgA production in mice by inducing Xbp1 mRNA expression. Therefore, combining vaccine with curcumin and garlic as immunopotentiators hopefully can be used to increase the effectivity of vaccination and decrease the side effects of vaccine all at once.

INTRODUCTION AND BACKGROUND Diphtheria is an infectious disease caused by exotoxin produced by Corynebacterium diphtheriae. Toxigenic strain that produce toxin as the result of lysogenic bacteriophage infection carrying gene for toxin production is the only strain that can cause severe disease. This disease is classified as an extraordinary incident and may lead to death.2 The number of diphtheria incidences based on WHO data in 2016 was 7097 cases and mostly concentrated in Asia, including India (3380 cases), Indonesia (342 cases), Nepal (140 cases) and Myanmar (136 cases). In December 2017 diphtheria cases in Indonesia increased to 591 cases spread over 20 provinces that led to declaration of extraordinary incident of diphteria.Travellers to areas with endemic diphtheria (e.g., the Indian sub-continent, Africa, South East Asia) who are not vaccinated or inadequately vaccinated are at higher risk of acquiring disease. Pre-school and school age children are most often affected by respiratory diphtheria. Nowadays prevention of diphtheria is done using DPT or DaPT vaccination for children and Td vaccination for booster in adults. To increase the effect of vaccine, combined use of vaccine and immunomodulators is now considered as one of innovative approaches in vaccine design and development. Hence, there are needs for safe and effective adjuvants to be used as immunopotentiators in vaccines. Plant-based immunomodulators are being considered as one option.

Figure 1. Augmentation of NK cells cytotoxicity by curcumin (0.01 μg/ml) alone or in combination with IFN-γ. *p<0.01; data were analyzed by one-way ANOVA.

Figure 2. Eﬀect of curcumin on IL-2 production in human PBMCs culture. Human PMBMCs (0.5 x 106 cells/ml) were cultured in RPMI-1640 in the presence or absence of 0.01 μg/ml or 0.05 μg/ml curcumin. PHA was used as positive control to stimulate IL-2. *p<0.01

POTENCY AND MECHANISM OF GARLIC AS IMMUNOPOTENTIATORS Garlic (Allium sativum L., Amaryllidaceae) likely originated in Central Asia. Eugenol, active chemical compound from garlic, exhibits many pharmacological properties. An immunomodulatory glycoprotein of ~14 kD purified from raw garlic was found to augment a delayed-type hypersensitivity response and NK-cell activity in BALB/c mice when administered intraperitoneally ; further, the protein fraction was found to augment parasite engulfment and destruction of intracellular parasites by macrophages in vivo. In another study, a 10–14 kD protein fraction was identified as responsible for induction of nitric oxide production, thus promoting the activation of reduced macrophage activity.22 It has been recognized as an important mechanism of the innate and adaptive immune responses to pathogens. The results showed that 40 μg/mL of FGPS and 0.4 μg/mL of LPS displayed higher FITC-fluorescent intensity (greater phagocytic activity) than the control group. FGPS displayed a concentration-dependent increase of dextran uptake. Furthermore, it is reported in previous study that fructan displays immunomodulatory activity on macrophage via toll-like receptor 4 signaling. The previous studies suggest that sulfur-containing amino acids in AGE such as S-allylcysteine (SAC) and Sallylmercaptocysteine (SAMC), have immunomodulatory effects S-1-Propenylcysteine (S1PC) is one of sulfurcontaining amino acids in AGE5. S1PC is structual isomer of SAC and is produced from γ-L-glutamyl-S-(trans-1propenyl)-L-cysteine (GSPC), the precursor of isoalliin, during the aging process of AGE. GSPC can be converted to isoalliin but not to S1PC in raw garlic. Thus, the aging process is essential for the production of S1PC and the content of S1PC is increased during aging process of AGE to the level similar to that of SAC. IgA level in the intestinal lavage fluid of mice treated with S1PC was higherthan that of control mice.

MATERIALS AND METHOD Literature used by authors is journals and books concerning in diphtheria, diphtheria vaccination, and potency of curcumin and garlic as immune booster. Author uses Google Scholar, PubMed and Science Direct as search engine. The key words are "diphtheria", "immune booster", "vaccine DPT", " Curcuma longa ", and "Allium sativum”. Searches are limited to English-language and Indonesian-language journal published between 20002017. Research will be excluded if the title and abstract are not relevant to the purpose of research. Total number of journals used were 25 journals. The author then analyzes the various journals that have been discovered and make conclusions at the end of the literature.

RESULTS AND DISCUSSION DIPHTHERIA The world prevalence studies in 2011-2016 showed that Indonesia has 3203 cases of diphtheria. Although C. diphtheriae is part of the normal flora of human mucosa, toxigenic strains that cause severe infection can arise as the result of bacteriophage infection. Lysogenic infection of this specific virus carrying genetic information for toxin production can transform bacteria to toxin-producing strains. Systemic manifestations of diphtheria occur following absorption and dissemination of the diphtheria toxin through the blood stream to other organs, most importantly the heart, nervous system and kidneys. The risk of developing cardiac and/or neurological toxicity is proportional to the severity of local infection; in one large outbreak, 30% of patients hospitalised with severe forms of respiratory diphtheria developed systemic manifestations, with cardiac complications being the most common. The major virulence of C.diphtheriae results from the action of potent exotoxin, which inhibits protein synthesis in mammalian cells but not in bacteria.The toxin effects all cells in the body. Diphtheria toxin is extremely potent: a single molecule can stop protein synthesis in a cell within hours, and 0.1μg/kg will kill susceptible animals. Within the first few days of respiratory tract infection, toxin, elaborated locally induces a dense necrotic coagulum composed of fibrin, leukocytes, erythrocytes, dead respiratory epithelial cells, and organisms. Removal of this adherent gray-brown ”pseudomembrane” reveals a bleeding edematous submucosa. The membrane can be local (tonsillar, pharyngeal, nasal) or extend widely, forming a cast of the pharynx and tracheobronchial tree. The underlying soft tissue edema and cervical adenitis can be intense, and particulaappearance. Individulas (especially children) who are not vaccinated or are partially vaccinated are at higher risk of getting diphtheria infection. Adults are also at risk as immunity due to vaccination wanes over time .rly in the proportionally smaller airways of children can cause respiratory distress and a bull-neck

POTENCY AND MECHANISM OF CURCUMIN AS IMMUNOPOTENTIATORS Curcumin (diferuloylmethane), a polyphenolic phytochemical compound naturally obtained from spice plant, turmeric (Curcuma longa), is well-known for its antiinflammatory activity and immunomodulatory effect on immune system. Curcumin downregulated Th2 response through decreased recruitment of eosinophils, reduced IgE antibody and cytokine production, and lesser inflammatory responses. The effects of curcumin on mitogen (phytohemagglutinin, PHA) stimulated T-cell proliferation, NK cell cytotoxicity, production of cytokines by human peripheral blood mononuclear cells (PBMCs), and NO production in mouse macrophage cells, RAW-264.7 have been investigated. The results indicate that curcumin inhibits PHA-induced T-cell proliferation, IL-2 production, NO generation, and LPS-induced NF- κB but augments NK cell cytotoxicity (Figure 1, Figure 2 ). These results suggest that curcumin most likely inhibits cell proliferation and cytokine production by inhibiting NF-κB target genes involved in the induction of these immune parameters. Recently it has been shown that curcumin inhibited IL12 production in macrophages in a dose-dependent manner, leading to the inhibition of Th1 cytokine profile in CD4+ T cells, suggesting that a variety of known biological effects of curcumin also include anti-inflammatory activity.

Figure 3. Eﬀect of S1PC on IgA production in mouse small intestine in vivo. (A) IgA level in the intestinal lavage ﬂuid of mice treated with S1PC. (B) Population of IgA-producing cells in the PPs lymphocytes.

Figure 4. Eﬀect of S1PC on the expression of transcription factors associated with plasma cell diﬀerentiation.

GARLIC AND CURCUMIN EXTRACT PRODUCTION METHOD Fructan and euglenol extracted from Allium cepa L. using methanol and curcumin extracted from Curcuma longa.24 Methanol can inhibit the negative eﬀects of polyphenol oxidase produced Allium cepa L. and Curcuma longa. The processes of extraction are as follows. Allium cepa L and Curcuma longa are each dried (0.02-0.05 g), extracted with 1-2 ml of solution (water: methanol = 6: 4), and then heated for 30 minutes. After that the extract is dried in a desiccator under vacuum and puriﬁcation of the extract is done by crystallization. Extract served per oral because of high bioavailability and to facilitate patient in taking it.

RESULTS CONCLUSIONS AND DISCUSSION Curcumin effects that are discussed in the journal consist of 4 aspects of its effect on anti-allergy, increasing antibody response, blocking the occurrence of edema and decreased body temperature. Garlic effects discussed in terms is improving antibody response in the form of increased work of delayed-type hypersensitivity and the work of Natural killer cell by a protein contained in the garlic is evidenced by intraperitoneal injection in murine model. In garlic, there is a polysaccharide called fructan which can increase the work of macrophages. The S1PC could increase IgA-producing B cells in intestine and therefore may enhance the intestinal immune system. The effects produced by both plants (Allium sativum and Curcuma longa) are expected to synergize in the fight and shorten the side effects of diphtheria vaccine.

REFERENCES 1. Murakami H, Phuong NM, Thang H V., Chau N V., Giao PN, Tho ND. Endemic diphtheria in Ho Chi Minh City; Viet Nam: A matched case-control study to identify risk factors of incidence. 2010;28(51):8141–6. Available from: 2. Artikel I. FAKTOR RISIKO KEJADIAN DIFTERI DI KABUPATEN BLITAR TAHUN 2015 RISK FACTOR OF DIPHTHERIA INCIDENCE IN BLITAR. 2016;61–6. 3. Kememterian Kesehatan Republik Indonesia. 2017. UPDATE ON DIPHTHERIA IN INDONESIA DECEMBER 2017. 4. WHO. 2017. Diphtheria Case Report 2000-2016. 5. Yusof IM, Illzam EM, Husain SS, Sharifa AM. Diphtheria : Clinical Manifestations , Diagnosis , and Role of ImmunizationIn Prevention. 2016;15(8):71–6. 6. Centers for Disease Control and Prevention. Corynebacterium diphtheriae. Epidemiol Prev Vaccine Prev Dis 13th Ed 2015;107–18. 7. Vitek CR and Wharton M. Diphtheria toxoid. In: Plotkin SA, Orenstein WA, Offit PA, eds. Vaccines Sixth Edition. China: Elsevier Saunders Inc. 2013: 139-152. 8. Jawetz, melnick and adelbberg by Geo F. Brooks, et.al . 2010. Microbiology 25th edition. The McGraw-Hill Education. 9. Response U, Of I. Diphtheria : NICD recommendations for diagnosis , management. 2016;1–19. 10. Dominicus Husada, MD1; Dwiyanti Puspitasari, MD1; Leny Kartina, MD1; Parwati Setiono, Prof. MD1; Ismoedijanto Moedjito, and Bambang Kartika. 2017. Six-Year Surveillance of Diphtheria Outbreak in Indonesia. 11. Response U, Of I. Diphtheria : NICD recommendations for diagnosis , management. 2016;1–19. 12.MacgregorRR.Corynebacteiumdiphtheria.In.Mandell,Douglas and Benntte’sPrinciples of InfectiousDiseases,7thed.MandelGL,BennetteJE,Dolin R(editors), ,Churchill Livingstone Elsevier,2010.p.2687-2693. 13.Response U, Of I. Diphtheria : NICD recommendations for diagnosis , management. 2016;1–19. 14. WHO. Diphtheria vaccine. Weekly Epidemiological Record. 2006;81(3):24-32. 15. Viswanath P. Kurup1 and Christy S. Barrios2. Immunomodulatory effects of curcumin in allergy. Mol. Nutr. Food Res. 2008, 52, 1031 – 1039 16. Kurup, V. P., Barrios, C. S., Raju, R., Johnson, B. D., et al., Immune response modulation by curcumin in a latex allergy model. Clin. Mol. Allergy 2007, 5, 1. 17. Gao, X., Kuo, J., Jiang, H., Deeb, D., et al., Immunomodulatory activity of curcumin: suppression of lymphocyte proliferation, development of cell-mediated cytotoxicity, and cytokine production in vitro. Biochem. Pharmacol. 2004, 68, 51– 61. 18. Yadav, V. S., Mishra, K. P., Singh, D. P., Mehrotra, S., Singh,V. K., Immunomodulatory effects of curcumin. Immunopharmacol. Immunotoxicol. 2005, 27, 485–497. 19. Block, E. Garlic and Other Alliums: The Lore and the Science; Royal Society of Chemistry: Cambridge, UK, 2010. 20. National Center for Complementary and Integrative Health. Garlic. Available online: https://nccih.nih. gov/health/garlic/ataglance.htm (accessed on 5 June 2017). 21. Dima Mnayer 1,2, Anne-Sylvie Fabiano-Tixier 1, Emmanuel Petitcolas 1, Tayssir Hamieh 2,3, Nancy Nehme 2, Christine Ferrant 4, Xavier Fernandez 5 and Farid Chemat 1,*2014. Chemical Composition, Antibacterial and Antioxidant Activities of Six Essentials Oils from the Alliaceae Family. 22. Prabodh Satyal, Jonathan D. Craft, Noura S. Dosoky and William N. Setzer. 2017. The Chemical Compositions of the Volatile Oils of Garlic (Allium sativum) and Wild Garlic (Allium vineale). MDPI. 23. Min Li, Yi-Xi Yan, Qing-Tao Yu, Yong Deng, Ding-Tao Wu, Ying Wang, Ya-Zhong Ge, Shao-Ping Li, and Jing Zhao. 2017. Comparison of Immunomodulatory Effects of Fresh Garlic and Black Garlic Polysaccharides on RAW 264.7 Macrophages. Vol. 00, Nr. 0, 2017 _ Journal of Food Science 24. Lin L-Z, Harnly JM. A Screening Method for the Identification of Glycosylated Flavonoids and Other Phenolic Compounds Using a Standard Analytical Approach for All Plant Materials. J Agric Food 25. Jun-ichiro Suzuki, Takako Yamaguchi, Toshiaki Matsutomo, Hirotaka Amano, Naoaki, Morihara and Yukihiro Kodera. 2016. S-1-Propenylcysteine promotes the differentiation of B cells into IgA-producing cells by the induction of Erk1/2-dependent Xbp1 expression in Peyer’s patches. Drug Discovery Laboratory, Wakunaga Pharmaceutical Co. Ltd., Hiroshima, Japan.

Abstract Diphtheria is still an infectious disease with a considerable incidence rate in some countries. In December 2017 diphtheria cases in Indonesia increased to 591 cases spread over 20 provinces that led to declaration of extraordinary incident of diphteria. This disease can actually be prevented easily through vaccination. Combined use of vaccine and immunomodulators can increase the effect of vaccine. This review analyze the potency of curcumin obtained from turmeric (Curcuma longa) and garlic (Allium sativum) as safe and effective adjuvant to be used as immunopotentiator in vaccine. Based on the studies, curcumin can enhance antibody response; modulate activation of T cells, B cells, macrophages, neutrophils, natural killer (NK) cells, and dendritic cells; and downregulate various proinflammatory cytokine and chemokine. Previous studies shows that garlic can increase response of delayed-type hypersensitivity, natural killer (NK)-cell activity, cytotoxicity of macrophages, and stimulates differentiation of plasma cells. The present findings indicate that S1PC promotes the intestinal IgA production in mice by inducing Xbp1 mRNA expression. Therefore, combining vaccine with curcumin and garlic as immunopotentiators hopefully can be used to increase the effectivity of vaccination and decrease the side effects of vaccine all at once.

Keywords: diphtheria, vaccine, immunopotentiator, curcumin, garlic

Authors

1. Muhammad Iqbal Fauzi 2. Vianney Natasaputra 3. Fatin Camilla 4. Bernadetha AMSA-Universitas Diponegoro Regional Chairperson

Elvira Lesmana rcindonesia@amsa-international.org +6285811240637

Effectiveness of Mantoux Tuberculin Test as an Early Nosocomial Tuberculosis Screening: A Systematic Review of Large Cohort and Cross-Sectional Studies Gracia Natalia Theresia,1 Muhammad Rian Fathurrahman, Yolanda Dwitania, Jeremy Rafael Tandaju 1

(+62) 81282353813, stugrcmathers@yahoo.com

Background: Nosocomial infection is the fifth biggest killer worldwide, yet neglected in some countries. It occurs in 2,000,000 people and kills 90,000 yearly in the USA â&#x20AC;&#x201C; causing US$ 28,000,000,000-45,000,0000,000 loss. Among all odds, tuberculosis is one most-common etiology which kills 35,967 and cause US$ 9,966 loss yearly in the USA. Although infection-control actions have been taken, the number is still increasing 1% yearly including in Indonesia. Aim: Evaluate Mantoux tuberculin test as early-screening method to enlighten health-care workers (HCW) and managers on reducing nosocomial tuberculosis incidence and causalities. Material and Methods: We conducted systematic review from large cohort and cross-sectional studies. Among 3,142 studies, 8 studies passed inclusion-exclusion criteria were assessed using STROBE statement based on PRISMA statement. Results: Average tuberculin skin test conversion rate is 10.25%: 1/10 HCW get nosocomial tuberculosis detected using this method in 24-month period. This result is affected by various factor. BCG vaccination could cause false-positive (OR= 9.70), therefore should noted in testâ&#x20AC;&#x2122;s protocol. Highrisk area such as living in South-East Asia, encounter with TB-patient (OR= 3.50), and HCW (OR= 12.60) also contributive. In addition, previous history of TB (OR= 4.10) or nosocomial infection (OR= 3.25) increase the risk, thus more frequent checking on HCW in high-risk area or having those histories are recommended. Other factors such as lack of education, prolonged work-duration, electricity is slightly linked. Conclusion: Mantoux tuberculin test still the most affordable and efficient modalities to diagnose nosocomial tuberculosis for early-treatment to prevent more causalities. It should be held at least once in 6 month, more frequent in higher-risk areas and people with risk factors above, and considering BCG as false positive agent. Those founding are expected to enlighten HCW and managers to reduce its prevalence and causalities, moving closer to SDG 3 by reduction of infectious diseases by 2030.

Risk Factors of Acquiring HIV/AIDS among Southeast Asian Population: A Systematic Review Christine Lieana, Ko Abel Ardana Kusuma, Nathasha B Selene, Adrianus J Sugiharta Background: Human Immunodeficiency Virus (HIV) is a virus that attacks CD4 T cells, which depress the immune system and manifest into acquired immunodeficiency syndrome (AIDS). There were 3.5 million HIV-positive people in Southeast Asia in 2015. Adults aged 25-49 years are the most affected group of people compared to the others. Early sexual debut, use of injection drugs, unprotected sex, and men who have sex with men act as established risk factors of HIV infection that contribute to its high prevalence. Objective: This scientific poster is aimed to assess the risk factors contributing to HIV infection among Southeast Asian population, which in turn, can provide useful recommendation for the effective prevention. Material and method: 826 studies were searched through Pubmed database searching. Then, we eliminated publications that did not meet our inclusion criteria (n = 782). There were 44 full-text articles retrieved and assessed for eligibility: 20 of which were included in the study after assessments using exclusion criteria. Results: 99,777 participants from 20 studies were included. In order to improve the reporting quality, STROBE Statement was used to assess the included studies for systematic review. Chimm S, et al. 2017 becomes the best study, scoring 20.4 out of 22. Drug use and sexual behaviors are the most discussed and problematic risk factors in Southeast Asia. Among drug use, the most significant risk factor is illicit drug use (OR: 87.3), while that in sexual behavior is direct sex (OR: 15.1). Risk factors with the highest odd ratio are illicit drug use (OR: 87.3), currently injected recreational drugs (OR: 63.58) with heroin as the highest recreational drug used (OR: 48.16). Conclusion: This systematic review shows that drug use and sexual behavior are the most significant risk factors of HIV infection in Southeast Asia. The information provided in this review is expected to be used as a consideration by the government and health departments in making interventions to prevent further HIV incidence.

RISK FACTORS OF ACQUIRING HIV/AIDS AMONG SOUTHEAST ASIAN POPULATION: A SYSTEMATIC REVIEW Christine Lieana*, Ko Abel Ardana, Nathasha Brigitta, Adrianus Jonathan christinelieana@gmail.com

METHODS

INTRODUCTION Human Immunodeficiency Virus (HIV) is a virus that white blood cells specifically CD4 T Cells causing deficiency in the immune system and produce a range of clinical manifestations known as acquired immunodeficiency syndrome (AIDS). According to UNAIDS , there are 36.7 million people living with HIV in 2016 around the world, 1 million people infected died from AIDS related illnesses, and 1.8 million people are newly infected in 2016. In Southeast Asia itself, there are 3.5 million individuals in total living with HIV, 180.000 new infections, and 130.000 deaths in 2015. Although there is declining 10% in new infection and 23.5% in mortality between 2010 and 2015, there is still a high prevalent of individual living with HIV across Asia Pacific. From all age groups, adults aged 25–49 years is known to be most affected. Several known risk factors of HIV infection that contribute to its high prevalent are early sexual debut, the use of injection drugs, unprotected sex, and men who have sex with men. In response to HIV AIDS epidemic, several measures have been made. Various global declarations and commitments with its specific objectives have been made and set by world governments since 2000. For example, The United Nations General Assembly Special Session on HIV and AIDS (UNGASS) in 2001 include a target to decrease the prevalence of HIV in adolescents aged 15–24 years globally by 25% in the end of 2010 as well as increasing young people’s access to HIV prevention information, skills, and services to 95% of those in need. By 2015, United Nation aim to combat HIV/AIDS as mentioned in their Millennium Developmental Goals. According to UNAIDS, Treatment coverage for individuals living with HIV is 47% in Asia Pacific. This shows that the prevention and management for HIV infections can and should be improved. This review aim to assess the risk factors contributing to HIV infection which in turn can be used to give recommendation for the effective prevention especially to the most affected group.

Record identified through Pubmed database searching (n = 826)

Systematic Review

Publications did not meet inclusion criteria (n = 782)

20 Observational studies among South-east Asia

Full text articles retrieved and assessed for eligibility (n = 44)

STROBE Statement

Total Samples from Studies: 99,777 samples

Publications met exclusion criteria (n = 24)

Qualitative Analysis

Total articles used (n=20), assessed with STROBE statement

OBJECTIVES This scientific poster is aimed to assess the risk factors contributing to HIV infection among South-east Asian population, which in turn, can be used to give recommendation for the effective prevention especially to the most vulnerable group

Figure 1. Conceptual Framework

Figure 2. Selection and Analysis Method

RESULTS Table 1. Characteristics of Studies and STROBE’s Scoring AUTHOR AND YEAR OF PUBLICATION

STUDY DESIGN

STUDY LOCATION

SAMPLE SIZE

AGE

OUTCOME

METHOD OF ANALYSIS

STROBE SCORE (MAX: 22)

Le TMD, et al. 2016

Cross-sectional

Ho Chi Minh City, Vietanam

397 Men who have sex with men (MSM)

26.8 years

Age over 25 (OR:7.82); low educational level below grade 5 (OR: 2.74); Having anal sex with male partners in past month (OR: 2.7); Have sexual partners who injected drugs in past 12 months (OR: 2.24); Feel risk of HIV infection (OR: 2.42)

Multivariate analysis

13.7

25.2 years

Living in southeastern province (OR: 2.28); occupation as small bussiness/vendor (OR: 2.70), occupation as singer/barber shopper (OR: 2.48); have a religion (OR:3.56); Engaged in sex with a foreigner in past 12 months (OR: 9.24); Previously but no longer use recreational drug (OR: 7.37), currently inhaling/swallowing recreational drug (OR: 19.29), currently injecting recreational drug (OR: 63.58); recreational drug use is Amphetamine-type stimulants (OR: 28.87); recreational drug use is heroine (OR: 48.16); HIV self assessment likely to be infected (OR: 2.48); HIV self assessment very likely to be infected (OR: 3.76); syphilis positive (OR: 8.12)

Univariate analysis

15.4

Univariate and multivariate risk factors analysis

Nguyen TV, et al. 2016

Nadol P, et al. 2015

Le LVN, et al. 2015

Griensven FV, et al. 2013

Cross-sectional

Souther Vietnam

2768 MSM

Cross-sectional

Ho Chi Minh City, Vietnam

445 female sexual partners of male injection drug users (MWID)

30.2 years

History of injection drug use (OR 6.42); currently using opioid drugs (OR 2.03); sexual activity and behavior with the MWID within 30 days (OR: 1.32); HIV-positive status for the MWID partner (OR: 3.98); > 1 year duration of injection drug use (OR: 5.04); ≤ 1 year duration of injection drug use (OR: 2.94)

Cross-sectional

Vietnam: Hanoi, Haiphong, Quangninh, Yenbai, Danang, NghenAngiang

5298 female sex workers

30.3 years

Age 25 - 29 in high HIV prevalence province (OR: 2.75) while in low prevalence province (OR: 1.60); marital status widowed in high HIV prevalence (OR: 1.75) while in low prevalent (OR: 8.94); injection drug use in high HIV prevalence (OR: 3.44) while in low prevalent province (OR: 22.05)

Multivariate logistic regression

18.9

Bangkok

1744 homosexually active men

26 years

Receptive only or both (OR: 1.75); group sex (OR: 1.56); prior HIV testing (OR: 1.52); HSV-1 antibody(OR: 1.48); HSV-2 antibody (OR: 1.52); Treponema pallidum positivity (OR: 1.82); unemployed (OR: 1.96); nitrite inhalation (OR: 1.58), drug use for sexual pleasure (OR: 1.53), sexual coercion (OR:1.56)

Multivariate anlysis

16.5

Cohort

Quan VM, et al. 2009

Case control

Bac Ninh, Vietnam

128 MWID

27 years

Sharing drug solution through frontloading (OR: 2.75)

Multivariable logistic regression

16.8

Sheridan S, et al. 2007

Cross-sectional

Vientiane, Laos

540 men

≥ 15 years

Contemplated suicide (OR: 2.91)

Multivariate analysis

14.8

Nguyen TA, et al. 2007

Cross-sectional

Ho Chi Minh, Vietnam

600 MSM

27 years

Age 19 - 41 (OR: 4.72), education level < 6 years (OR: 2.98), only selling sex (OR: 6.12), ever injected drugs in the last 12 months (OR: 33.52), had more than five male partners for anal sex in the past month (OR: 2.55)

Logistic regression

13.5

Bivariate analysis, simple logistic, multiple logistic regression

16.9

Bivariate analysis, multivariable logistic regression

16.1

Multivariable logistic regression

20.4

Multivariate analysis

15.2

Bivariate & multivariate regression

Multivariable logistic regression

16.6

Perngmark P, et al. 2002

Cross-sectional

Southern Thailand

302 Injected drug users (IDU)

30 years

MAJORTIY ETHNIC THAI: Needle sharing (lifetime) (OR: 6.95), injecting immediately at drug onset (OR: 2.53), age 1st injected (OR: 2.61) MINORITY ETHNIC MALAY: Injecting immediately at drug onset (OR: 4.32), not carrying new needles (OR: 4.47)

Kim AA, et al. 2005

Cross-sectional

Battambang, Cambodia

92 women

24 years

lifetime sexual numbers > 11 partners (OR: 15), genital rash (OR: 3.5) Urban community type (OR: 2.7), formal education attained only primary (0-6 years) (OR: 1.7), age 2534 (OR: 2.1), age >35 (OR: 2.6), frequency of express and/or dressing as a woman: all the time (OR: 2.1), ever self-injected hormone (OR: 4.4), ulcerations or sores in the genital area in the past 12 months (OR: 3), didn't use online services developed for men who have sex with men/transgender in the past 6 months (OR: 1.9) age ≥ 25 (OR:1.68), ever married (OR:1.34), street-based sex worker (OR:1.34), no condom use during last sex (OR:1.45), price per sex <150000 VND(OR:1.64), >3years of sex work (OR:2.02), ever detained from rehabilitation (OR:3.25), inconsistent condom use during last month(OR:1.30), drug-injecting sex partner (OR:1.45), ever used drugs (OR:6.00), ever inject drugs (OR:4.92), perceived positive HIV infection (OR:2.65) more than 16 clients during last month(OR:2.65), drug injector(OR:6.47), have drug-injecting partner(OR:6.32) Live in province Bali (OR: 2.27), type of sex worker direct (OR: 2.54), duration of selling sex > 24 months (OR: 1.51), have siphilis (OR: 1.61)

Chimm S, et al. 2017

Cross-sectional

Phnom Penh and 12 other provinces in Cambodia

1375 sexually active transgender women

25.9 years

Le T, et al. 2015

Cross-sectional

Vietnam

5298 female sex workers

28.8 years

Tran B, et al. 2014

Cross-sectional

Mekokng Delta, Vietnam

1999 female sex workers

26.5 years

Magnani R, et al. 2010

Cross-sectional

Jakarta, Indonesia

5947 female sex workers

27 years

Morineau G, et al. 2009

Cross-sectional

Jakarta, Indonesia

1450 MSM

27 years

Use methamphetamine in last 3 months (OR: 2.69), currently infected with rectal CT or NG (OR: 2.04)

Simple & multivariate logistic regression

29 years

Risk factors for consistent condom with regular partners during the last 12 months: males (OR: 1.5), educational attaintment: secondary school (OR: 1.5); high school and higher (OR: 2.3), married (OR: 1.4), time since HIV status known: 2-4 years (OR: 1.4); > 5 yrs (OR: 2.4), HIV testing was voluntary (OR: 1.5), ever injected drugs (OR: 1.3), number of sex partners during last 12 months not > 2 (OR: 1.6), received condom during last 6 months (OR: 2.3)

Univariate & multivariate logistic regression

Multivariate analysis with logistic regression

11.6

Thanh DC, et al. 2009

Cross-sectional

Hanoi, Vietnam

4266 men and women

Khongphatthanayothin, et al. 2006

Cross-sectional

Thailand

65807 men and women

30.5-32.4 years

Age 35-39 (OR: 1.43); 30-34 (OR: 1.75); 25-29 (OR: 1.53); female (OR: 1.41), married (OR: 1.25), widowed (OR: 1.86), current residence elsewhere from Bangkok ( OR: 1.71), education: none (OR: 7.26); elementary (OR: 5); high school (OR: 3.99); college (OR: 2.43), monthly income: < 5000 Bath (OR: 1.33, profession: farmer (OR: 3.32); monk (OR: 1.4); private employee (OR: 1.29); bussines owner (OR: 1.19

Samnang P, et al. 2004

Cross-sectional

Phnom Penh, Cambodia

446 men

26 years

Port time > 1 day (OR: 3.1)

Multiple logistic regression

Nguyen TV, et al. 2008

Cross-sectional

Mekong Delta Province, Vietnam

406 female sex workers

26.2 years

Direct sex work (OR: 15.1); Early sexual debut ≤ 15 years old (OR: 6.8); Used illicit drugs (OR: 87.3); Trichomoniasis (OR: 11.7); Candidiasis (OR: 15.4)

Multivariate regression

16.6

Logistic regression

14.1

Khumasen N, et al. 2017

Cross-sectional

Thailand

469 MSM

19.7 years

never HIV test (OR: 1.137); partner status unknown (OR: 1.129); Age 18 never HIV tested (OR:3.163); Age 21 never HIV tested (OR: 3.160); Current regular male partner having drunk sex (OR: 2.435); never HIV tested (OR: 1.137); partner status unknown (OR: 1.129); drunk sex (OR: 1.170); cues to action in never HIV tested (OR: 1.195); partner status unknown (OR: 1.078)

VARIABLE DISTRIBUTION OF OBSERVATIONAL STUDIES • Syphilis/treponema pallidum positive • Sores in genital area in the past 12 months • Currently infected with rectal CT/NG • Trichomoniasis • Candidiasis

STD 7 studies

Drug use 12 studies

Education 5 studies Sexual factors 11 studies

• Not having any education • Education level < 6 years • Educational attaintment: • Only primary • Secondary • High school/higher

• Recreational drug use (amphetamine, heroine, opioids) • Use of injection drug (age 1st injected and duration) • Nitrite inhalation • Needle sharing • Using illicit drugs • Early sexual debut ≤ 15 years old • Sexual partners: • Who injected drugs • With HIV positive status • Male with male partner (MSM) • Number of sexual partner • Inconsistent condom use • Not using online services • Sex works • Duration of sex selling • Price per sex works

• The total of participants included were 99,777 from 20 observational studies • STROBE Statement, stands for Strengthening the Reporting of Observational Studies in Epidemiology, was used to assess the included observational studies for systematic review to improve the quality of reporting. The best study regarding to STROBE Statement is Chimm S, et al. 2017 with score 20.4 out of 22. • Risk factors of HIV-infection which are most discussed in studies and problematic in South-east Asia is drug use and sexual factor • Highest Odd Ratio from included studies are illicit drug use (OR: 87.3); currently injected recreational drug (OR: 63.58); (OR: 1.52).

CONCLUSION

DISCUSSION EDUCATION Studies have confirmed that level of education is associated with risk of HIV infected. According to Chimm S, participants who only took primary eduation were 1.7 times more likely to be infected compared with those with high school education. Nguyen TA also showed that participants with education level < 6 years were 2.6 times with greater risk to be infected with HIV. This has important implications for HIV programmes to ensure that poorly educated people have to be reached with education, information, communication and skills related to HIV prevention and other health-related services. On the other hand, according to Thanh DC, high education attainment was found to be significantly associated with consistent condom use with regular partners OR = 1.5 for secondary school and OR = 2.3 for high school and higher). Consistent condom use has lower risk for HIV infected.

SEXUAL TRANSMITTED DISEASE Sexual transmitted disease (STD) and sexual transmitted infection (STI) have great contribution in increasing risk of HIV infected. According to Nguyen TV, syphilis-seropositive was 8.12 times more likely to be infected by HIV. He also found that trichomoniasis and candidiasis was 11.7 and 15.4 respectively greater risk for HIV infected. Magnani R also showed that syphilis positive was 1.61 times with greater risk for HIV infected. Both of these vaginal infections increased the risk of HIV infection since they can cause vaginal inflammation , which disrupts the vaginal mucosa and increase vulnerability to HIV. These outcome was also supported by studies that conducted by Chimm S and Kim AA. According to Chimm S, history of genital sores over the previos 12 months wad 3 times more vulnerable to be infected by HIV while Kim AA found that genital rash was 3.5 more likely to be infected by HIV.

The studies show that risk factors of HIV which most discussed and problematic in South-east Asia are drug use and sexual behavior. Risk factors with highest odd ratio are illicit drug use (OR: 87.3), currently injected recreational drugs (OR: 63.58), and recreational drug use is heroin (OR: 48.16). From this systematic review, we hope that these significant risk factors of HIV infection can be used as a consideration by the government and health departments in making interventions to prevent further HIV incidence.

SEXUAL FACTORS/BEHAVIORS Several studies confirmed that there was association between sexual factors/behaviors among HIV infected. According to Le TMD, male who have anal sex with male partners in past month have 2.7 higher risk on infected by HIV. Khumasen S also showed that current regular male partner having drunk sex was 2.435 times more likely to be infected by HIV. Beside having male sex partners, number of sex partners also contribute as HIV-infected risk factors. According to Nguyan TA, had more than 5 male partners for anal sex in the past month 2.55 higher risk on infected by HIV. Tran B also found that had > 16 clients during last month increases the risk by 2.65. On the other study conducted by Chimm S, didn’t use online service provided for MSM/transgender women increases the risk by 1.9. Online service tend to provide HIV information, education and communication. According to Nguyen TV, direct sex work contributed as the most significant risk factors which increases the risk by 15.1

DRUG USE Numerous studies has been conducted regarding the interaction between drug use and HIV-infection. According to Nguyen TV, et al., currently injecting recreational drug people are 63.58 times likely to get HIV infection and heroin injection increases the risk of being HIV-infected by 48.16 times. This is because injection is one of the main method of HIV transmission. In addition, people with more than one year duration of injecting drug use are 5.04 times more vulnerable according to Nadol P, et al. A study by Tran B, et al. also observed that being a drug injector increases the risk of HIV-infection by 6.47 times. Based on a study conducted by Le LVN, et al., injection drug use made one 3.44 times and 22.05 times more prone consecutively in high HIV prevalence province and in low prevalent province. It was caused by the lesser risk of getting HIV in the low prevalence province so people tend to underestimate the probability of getting infected. Sharing drugs through frontloading has been reported to increase the risk of getting HIV by 2.75 times in a study by Quan VM, et al. Additionally, sharing drug via needle sharing increases the risk by 6.95 times in a study by Perngmark P, et al. A similar study by Thanh DC, et al. stated that the risk of being HIV-infected increased by 1.3 times in people who ever used drugs. According to Morineau G, et al., people who uses methamphetamine in last 3 months have 2.69 higher risk because it is associated with inconsistent condom use. The usage of illicit drugs increased the probability of being HIV-infected significantly by 87.3 times according to a study by Nguyen TV, et al.

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malaria infection remains unevenly distributed within districts. Balancing the

(2017, December

20).

https://www.cdc.gov/malaria/about/faqs.html Regional Chairperson Elvira Lesmana rcindonesia@amsainternational.org +6285811240637

Retrieved

March 31,

2018,

from

Ma l a r i ai n t e r v e n t i o nwi t h g e o g r a p h i c a l i n f o r ma t i o ns y s t e ms Casey Christiany, Jessica Nathalia, Juliana Susantio, Magdalena

References

Strategy in Enhancing Drug Compliance through Factor Identification Associated with Tuberculosis Treatment Default Among South-East Asian: A Systematic Review of Cohort Studies Kristian Kurniawan*, Fabiola Cathleen, Marco Raditya, Johan Cahyadirga Kristian.k9027@gmail.com

Background: Tuberculosis has become the world’s leading cause of death done by a single infectious agent, Mycobacterium tuberculosis. Indonesia holds the second highest TB infection, with 391 per 100,000 population per year. This is due to treatment failure caused by low patients’ compliance, which is associated with usage of 5-regiments TB drugs (R/H/Z/E/(S)) and long-term treatment duration, resulting in the emergence of drug-resistant TB, making it a continuous world health crisis. In addition, a population-specific systematic review of factors associated with TB patient compliance among South-East Asian has never been done before.

Aim: To identify risk factors of TB treatment failure amongst South-East Asian in order to reduce its incidence and prevent its resistancy through creating a strategy to increase patients’ compliance as an infection control

Materials and Method: Systematic review was conducted on cohort studies. 1,423 studies identified from Pubmed database were screened and assessed, resulting in 11 included studies, then data extracted and evaluated according to STROBE’s Statement of Cohort Studies by 4 reviewers.

Results: Among 11 studies with total of 7,112 participants, the most discussed factor associated with TB treatment default is knowledge and perception of TB, followed by age, and primary healthcare and facilities. Factor with the highest OR is fear of losing jobs or death (OR:12.713), while treatment decentralization (OR:0.3); middle-to-high socioeconomic status (OR:0.3); paid diagnostic (OR:0.14) are protective factors. According to STROBE Statement, the best study is study conducted by Putera I in 2015 (Score:19.6/22).

Conclusion: Top 3 most common cause of treatment failure due to non-compliance are old age, poor knowledge regarding TB and inadequate facility. This indicates how the real problem in current TB infection control is the society’s false stigma on TB. Thus, we suggest that health advocation and peer groups should be made to increase knowledge and provide support for TB patients.

Strategy in Enhancing Drug Compliance through Factor Identification Associated with Tu b e r c u l o s i s Tr e a t m e n t D e f a u l t A m o n g S o u t h - E a s t A s i a n : A Systematic Review of Cohort Studies Kristian Kurniawan*, Fabiola Cathleen, Marco Raditya, Johan Cahyadirga *kristian.k9027@gmail.com

RESULTS

BACKGROUND E S T I M AT E D T B I N C I D E N C E R AT E , 2 0 1 6

D I S T R I B U T I O N O F C AT E G O R I Z E D VA R I A B L E S

Incidence per 100 000 p o p u l ati o n p e r ye a r :

Table 1. Characteristi cs of Studies and STROBE’s Scoring

C at ego r i ze d Va r i abl e s

0-24 25-99 100-199

200-299 > 300

N o d ata N o t a p p l i ca b l e

Figure 1. World’s Estimated TB Incidence Rate in 2016 1

Tub e rc ulosi s ( T B ) i s a n a i r bor ne disease caused by My cobacterium tu b er cul osi s. I t i s the wor l d’s l e a di ng cause of deat h done by a single infe ctio us a ge nt , resul ting i n 10.4 m illion people to be infected and 1.7 mil l i o n to di e i n 2016. M ore tha n 9 5% of t hose cases occurred in lowa nd mi ddl e - i ncom e countri e s, wi th India as t he leading count , followed by In do ne si a and 5 other countr i es respo nsible for 64% of them. Indones ia i s stil l i n t he top-20 l i st of hi gh T B burden count ries in t he world, w it h t he e stim ate d tota l T B i nc i denc e rate of 391 per 100,000 population per ye a r. 1 I n 2 0 1 6 -2035 pe r i od, the United Nations’ S ustainable Developme nt G o a l s a nd WH O ’s ‘E nd T B Strategy ’, bot h aim to end t he TB epidemi c. S p e c i fi c ta rgets i nc l ude a 90% reduction of TB deat hs and 80% of TB i nci de nc e co m pa red wi th 2015. H owever, high level of t reat ment failure towa rds t he regul a r tuberc ul osi s, resulting from low patient s’ complia nce , l e a ds to the em erge nc e of more drug-resistant TB, mak ing it a worl d h e a l t h c ri si s a nd a continui ng t hreat . 1 A n e stim ate d 53 m i l l i on l i ve s t hat had been saved over t he past 16 ye a rs due to proper di a gnosi s a nd t reatment , it indicates t hat TB is a cura bl e di se a s e a nd shoul d be cont rollable. 2 On t he ot her hand, low com p l i a n c e i s one of the m a j or rea s on in TB t reat ment failure, associat e d w i th the usa ge of 5- regi m ents of TB drugs (R/H/Z/E/(S )) and long t re at me nt duration. An i nte r rupte d medication of TB result s to t he requi re me nt o f sta rting ove r a nd i nc re ased risk of developing multidrug res ista n c e T B . T hi s resul ts i n the di ffi c ult y in eradicating and cont rolling TB i nfe c tio n. M o reover, the ex i sting worldw ide program to increase drug com p l i a n c e , na m e d D OTs, onl y affe c t s t he ex ternal factors of compliance t he refo re do e s not a l ways prom ote adherence according to report by WH O. 3 T he refo re , we woul d l i ke to i dentif y ot her factors associated w it h dr ug co m p l i a nc e to m i ni m i ze tre atment failure in order to reduce incide nc e o f T B a nd to prevent i ts re si stancy, by mak ing a population-specifi c syste m atic revi ew of fa c tors a sso ciated w it h TB patient compliance a mo ng So u th- Ea st Asi a n that ha s no t been done before. . 2

OBJECTIVES

To ide ntif y t he ri sk fa c tors a ssoc i ated w it h t reat ment failure in t uberculos i s am o ng st So uth-Ea st Asi a n, i n order to create an eﬀective and eﬃcient st rate g y a s a n i nfec tion control i n achiev ing UN’s S ustainable Developm e nt G o a l s a nd WHO ’s “ E nd T B Strategy ”.

MATERIALS & METHOD SYST E M AT I C R E V I E W Based on PRISM A Statement

1 1 CO H O RT ST UD I ES A M O NG S O UTH-EA ST A S I A N From Pu b M ed Datab ase

ST RO BE ’ S STAT E M E N T Q u ality assessment of Coh ort S tu d y

Q UA L I TAT I V E A N A LYS IS

TOTA L SA M P L ES F RO M ST UD IES 7,112 samp les

Figure 2. Selection and Analysis Method Reco rds ide ntiﬁ e d t h ro ug h data ba se s e a rc h in g ( n= 1 4 2 3 )

Re co rds Sc re e n e d ( n= 1 0 5 )

F ul l tex t st udie s a sse sse d fo r e lig ib ilit y ( n= 1 3 )

To ta l inc lude d stu die s a sse sse d wit h ST RO B E ’s state m e nt ( n= 1 1 )

Records excl uded ( n= 1318) No speci ﬁc reference on Tubercul osi s on resea rch a rea Records excl uded ( n= 92) • S t u d i e s w i t h i n c o m p a ti b l e d e s i g n ( n = 2 6 ) •No assessment of TB outcome (n=20) • S t u d i e s e xc l u s i v e l y d i s c u s s i n g T B c o m p l i c a ti o n (n=18) • S t u d i e s a b o u t p r e v e n ti v e fa c t o rs o f T B ( n = 8 ) •Studies assessing treatment and diagnosis of TB (n=20)

Records excl uded ( n= 2) Insuﬃ ci ent i nform ation of T B outcom e a nd com pl i a nce

Figure 3. Conceptual Framework

REFERENCES 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11 . 12. 13. 14. 15. 16. 17. 18.

Wo r ld H eal t h O r gani z at i on. G l obal t u b e r cu l o si s r e p o r t 2 0 1 7 . Ge n e va : Wo r l d H e a l th Or g a n i za ti o n ; 2017 Wo r ld H eal t h O r gani z at i on. Tuber c u l o si s fa ct sh e e t [In te r n e t]. 2 0 1 8 Ja n [ci te d 2 0 1 8 M a r 2 9 ]. Ava i lable from: http://www.who.int/mediacentre/factsheets/fs104/en/ Wo r ld H eal t h O r gani z at i on. A dher en ce to l o n g - te r m th e r a p i e s: e vi d e n ce fo r a cti o n . Ge n e va : Wo r l d Health O rganization; 2003 A n u nnat s i r i S , C het c hot i s ak d P, Wan ke C . Fa cto r s a sso ci a te d w i th tr e a tm e n t o u tco m e s i n p u l m o n ary tuberculosis in northeastern Thailand. Southeast Asian J Trop Med Public Health. 2005 Mar;36(2):324-30. Ch e e C B , Wang Y T, Tel em an M D , B ou d vi l l e IC , C h e w SK. Tr e a tm e n t o u tco m e o f Si n g a p o r e r e si d e nts with pulmonary tuberculosis in the first year after introduction of a computerised treatment surveillance mo d ul e. S i ngapor e M ed J . 2006 J un;4 7 ( 6 ) :5 2 9 - 3 3 . Da s M , et al . S el f - A dm i ni s t er ed Tube r cu l o si s Tr e a tm e n t Ou tco m e s i n a Tr i b a l Po p u l a ti o n o n th e Indo-Myanmar Border, Nagaland, India. PLoS O ne. 2014; 9(9):e108186. Gle r M T, P odew i l s LJ , M unez N , G al i p o t M , Qu e l a p i o M ID , Tu p a si TE. Im p a ct o f p a ti e n t a n d p r o g r am factors on default during treatment of multidrug-resistant tuberculosis. NT J TUBERC LUNG DIS. 2 0 1 2 ; 16( 7) : 955–60 K a p el l a B K , et al . D i r ec t l y obs er v ed tr e a tm e n t i s a sso ci a te d w i th r e d u ce d d e fa u l t a m o n g fo r e i g n tuberculosis patients in Thailand. NT J TUBERC LUNG DIS. 2009 Feb;13(2):232-37 K ip p A M , P ungr as s am i P, S t ew ar t P W, C h o n g su vi va tw o n g V, Str a u ss R P, R i e AV. Stu d y o f tu b e r cu losis and AIDS stigma as barriers to tuberculosis treatment adherence using validated stigma scales. NT J T UB E R C LU N G D I S . 2011; 5( 11) : 154 0 – 4 5 K ittik r ai s ak W, et al . F ac t or s as s oc i ate d w i th tu b e r cu l o si s tr e a tm e n t d e fa u l t a m o n g H IV- i n fe cte d tuberculosis patients in Thailand. Trans R Soc Trop Med Hyg. 2009 Jan;103(1):59-66 L ia m C K , Li m K H , Wong C M M , Tang BG. Atti tu d e s a n d kn o w l e d g e o f n e w l y d i a g n o se d tu b e r cu l o si s patients regarding the disease, and factors affecting treatment compliance. Int J Tuberc Lun Dis. 1 9 9 9 ; 3( 4) : 300- 9 P u te r a I , P ak as i TA , K ar y adi E . K no w l e d g e a n d p e r ce p ti o n o f tu b e r cu l o si s a n d th e r i sk to b e co m e treatment default among newly diagnosed pulmonary tuberculosis patients treated in primary health care, E a s t N us aTenggar a: a r et r os pec t i v e stu d y. BM C R e s N o te s. 2 0 1 5 ;8 :2 3 8 Ru th e r f or d M E , H i l l P C , M ahar ani W, Sa m p u r n o H , R u sl a m i R . R i sk fa cto r s fo r tr e a tm e n t d e fa u l t among adult tuberculosis patients in Indonesia. Int J Tuberc Lung Dis. 2013;17(10):1304-9 T h u M K , et al . H i gh t r eat m ent s uc c ess r a te a m o n g m u l ti d r u g - r e si sta n t tu b e r cu l o si s p a ti e n ts i n M yanmar, 2012–2014: a retrospective cohort study. Trans R Soc Trop Med Hyg. 2017 Sep 1;111(9):410-17. B e r r y D . H eal t h c om m uni c at i on: t heor y a n d p r a cti ce . L o n d o n : Op e n U n i ve r si ty Pr e ss; 2 0 0 7 P e r o n E P, G r ay S L, H anl on J T. M edi ca ti o n U se a n d Fu n cti o n a l Sta tu s D e cl i n e i n Ol d e r Ad u l ts: A Narrative Review. Am J G eriatr Pharmacother. 2011 Dec;9(6):378–91. S h r u t hi R , J y ot hi R , P undar i k ak s ha H P, N a g e sh GN , Tu sh a r TJ. A Stu d y o f M e d i ca ti o n C o m p l i a n ce in G eriatric Patients with Chronic Illnesses at a Tertiary Care Hospital. J Clin Diagn Res. 2016 De c ;10( 12) : F C 40–3. Ha n coc k T. T he m andal a of heal t h: a h u m a n m o d e l e co syste m . Fa m C o m m u n i ty H e a l th . 1 9 8 5 ;8 ( 3 ) :1-10.

Age

Facility

D OT s

Knowledge & Pe rc e p t i o n

Comorbidity

Smoking

Social

Race/Others/ Gender

Figure 4. Distributi on of Categorized Variables

•

The to tal s am ple s in t his rev iew we re 7 ,1 1 2 par ticipant s f ro m 1 1 inclu de d st udie s .

•

Re garding to “St re ngt he nin g t he Re po r ti ng o f O bs e r vatio nal St udie s in Epide m io lo gy ( STRO B E) State m e nt ” as s e s s m e nt , t h e b e st st u dy is co nd ucte d by P u te ra I , et al. 2 0 1 5 ( 1 9 .6 /2 2 )

•

Ris k facto r var iab le o f TB t re at m e nt d efault which are m o st d is cus s e d in m any st u die s is knowle dge and pe rce ptio n o f TB .

•

H ighe st O dd Ratio f ro m includ e d st udie s is fe ar o f lo s ing t he ir j o bs o r fe ar o f dyin g f ro m t he d is e as e ( O R: 1 2 .7 1 3 ) .

•

Pro te ctive facto rs o f tre at m e nt default include d st udy are t re at m e nt de ce nt ralizatio n ( O R: 0 .3 ) , m idd le -h igh s o cio e co n o m ic indicate d by hav ing ref r ige rato r o r TV at h o m e ( O R: 0 .3 ) , paid diagn o stic ( O R: 0 .1 4 ; 0 .2 4 ) . I n additio n, facto r as s o ciate d wit h s ucce s sf ul TB t re at m e nt is D OTs t re at m e nt ( O R: 3 .1 ) .

DISCUSSION There are several factors of low patients’ compliance and TB treatment failure, nevertheless we will discuss the top-3 factors. Kn owl e d ge a n d p e rc e pti on of TB St u die s h ave e m ph as ize d th e m aj o r im po r tan ce o f patie nt s ’ knowle dge and pe rce ptio n towards high e r r is k o f TB t re at m e nt d efault . P ute ra I state d t hat low knowle dge o f TB car r ie d a 2 .4 9 fo ld o f in cre as e d r is k and low pe rce ptio n incre as e s t h e r is k by 5 .4 tim e s . This re latio n s hip is s up po r te d by t he fact t hat low knowle dge and pe rce ptio n o fte n le ads to co m m o n m is co n ce ptio n t hat pe rce ive d TB as in curable dis e as e , cau s e d by s in o r cu rs e , and as ham e d what o t he r m ight s ay, t he refo re re s ulting in re luctance o r re j e ctio n in fo llowing m e dical care . 1 2 A cco rdin gly, Liam C K s howe d an 1 2 .7 3 in cre as e d r is k o f t re at m e nt default re s ultin g f ro m fe ar o f lo s ing t he ir j o bs o r fe ar o f d ying. This facto r indicate s p o o r p atie nt s ’ ins ight du e to s o ciet y ’s stigm a, le ading to te nde ncy o f de nying t he d iagno s is . 1 1 The u nde r lying re as o ns m ay be f ur t h e r o r igin ate d f ro m cu lt ural be liefs , no h is to r y o f TB in fam ily, an d failure in do cto r-patie nt co m m u nicatio n . 3 , 1 2 , 1 5 This m ay be re s po ns ible fo r t h e re s ult s o f s eve r al st udie s th at state d t he ineffi cacy o f D OTS, s in ce it is o nly wo r king ex te r nally as a m e re re m ind e r. 3 A new app ro ach t hat affe ct s inte r nally, paralle l to t he he alt h co m po ne nts o f bo dy, s pir it , and m in d in as s ur ing a bette r patie nt s ’ aware ne s s and co m pliance , is ne e de d . St ud ie s s howe d t h at an im prove d do cto r-patie nt inte r pe rs o nal re latio ns h ip have a s ignifi cant infl ue n ce o n patie nts ’ bette r un de rstand ing o f t he dis e as e , cle are r e m o tio n al state an d v iew towards t he effe ct o f t he dis e as e , and high e r dr ug adh e re nce . 1 5 Pati e nt ’s Age St u die s have prove n t hat dr ug co m pliance is affe cte d by age , in which o lde r age wo uld re duce dr u g co m plian ce t hus re s ultin g in t re at m e nt failure . A cco rd ing to Thu M K , patie nt s wit h age above 5 5 has 3 .2 tim e s highe r ch an ce o f t re at m e nt failure . 1 4 M o re ove r, bas e d o n A nu nnats ir i S, patie nt s wit h age above 6 0 has 3 .1 tim e s highe r r is k. 4 I t is als o state d by C h e e C B t h at patie nt s wit h age < 6 5 ye ars o ld h as 1 .9 tim e s high e r chance fo r t re atm e nt s ucce s s . 5 A s age p ro gre s s e s , t he f unctio n al stat us als o d e cline s , in wh ich it h as be e n prove n t hat lowe re d f unctio nal stat us wo uld caus e lowe re d dr ug adh e re n ce . 1 6 A st udy by Sh r ut hi R has s hown t hat t h e num b e r o n e re as o n fo r lowe re d dr ug adhe re nce in e ld e r ly is due to fo rgetf ulne s s to take t h e m e dicatio n due to po o r re call. A no t he r is h ow s o m e e lde rs are no t cap able to take m u lti ple m e dicatio n do ne in co m plex re gim e s by t he m s e lve s . 1 7 A st udy by Pe ro n EP has s h own t h at a de cre as e d phys ical f un ctio n in g s co r m ake s it harde r fo r t h e e ld e r ly to o btain m e dicatio ns f ro m he alt hcare ce nte rs . Lack o f pro pe r aware ne s s , fam ily and s o cial s u ppo r t has als o be e n o t he r ge n e ral re as o ns fo un d. 1 6 , 1 7

Pr i m a r y H e a l t h C a re an d Faci li ti e s Patie nt ’s co m pliance i nvo l ves bo th i nterna l a nd ex ternal facto rs . A n im po rta nt ex terna l ri s k fa c to r fo r T B t re at m e nt default i s d ru g p res c ri pti o n. Patients w h o we re pre s cr ibe d m o re th a n 5 d rug s h a d a hi g her ri s k o f t re at m e nt default 7 . 2 tim es . 7 However, there i s a l s o co nd itio n whe re giv i n g fi xed do s e co m bi natio n drug s ho u ld be re co ns idered i f the patient hav i ng pa i n w hi l e swallowing , t h us it co ul d i n c rea s e 3 . 0 fo l d ri s k o f defau lt . 1 0 A no t he r ex tern a l ri s k fa c to r i s p o o r c l i n i c a c c es s ibilit y, which incre a s es th e ri s k by 1 . 7 1 ti m es . Peo p l e who h as to walk to t he c l i n i c a l s o ha s a n i nc rea s ed ri s k o f t re at m e nt d efault 4 . 5 tim es . T hi s i s s up po rted by the fact t hat walkin g is s een a s l es s des i ra bl e fo r peo pl e who are ill. M o re over, we a l s o fo und a study s how i ng t hat de ce nt ralizatio n o f ca re fo r p atients have decre as e d th e r is k s i g ni fi ca ntl y ( O R : 0 . 3 ) , beca us e i t allows patie nt s to ac c es s treatm ent ea s i er by reduc i ng t rans p o r tatio n tim e a nd co st. 13 It i s c l ea rl y s een that T B t re at m e nt co m plianc e co ul d b e i nc rea s ed by prov i di ng patie nt s wit h b ette r a c c es s to hea l thca re a nd a fi xed do s e co m binatio n drug i n pri m a r y hea l th ca re. T hes e facto rs are als o pre s ent a s a p a rt the m a nd a l a o f hea l th and co uld b e o n e o f the pi l l a rs to esta b l i s h s usta i n a bl e he alt h syste m . Th e m a nda l a o f hea l th s h ows that to affe ct an indiv idual’s hea l th, i t i s i m p o rta nt to n o t o nl y do it phar m aco lo gica l l y but a l s o by p rov i d i ng b etter phys ical e nv iro n m e nt. 18

Figure 4. Mandala of Health 1 8

The lim itatio n s o f o ur rev i ew a re th e s m a l l n um ber o f st ud ie s and t h e ina bi l i ty to state the l evel o f co m pl i ance quantitati ve ly f ro m tho s e stu di es . T herefo re we reﬂ e ct t he facto rs a s s o c i ated w i th treatm ent fa i l ure to ind icate low co m p lia nc e.

CONCLUSION B as e d o n t h e syste m atic rev iew, it can be s e e n t h at 3 m o st co m m o n caus e o f t re at m ent fa i l ure due to no n- co m pl i a nc e are o ld age , po o r knowle dge re garding TB and inade q uate facilit y. A s o f now, TB is o ne o f the m o st m ed i ca l l y fa c i l i tate d infe ctio n , yet TB still pe rs ist s . B as e d o n t he rev iew, it has be e n ide ntiﬁ e d t hat fa i l ure i n T B i nfec tio n co ntro l i s a l s o due to low t re at m e nt co m pliance as s o ciate d wit h lack o f aware ne s s and m e ntal s upp o rt rega rdi n g T B i n th e s o c i ety. The re are a lo t o f fals e stigm as re gardin g TB an d it s m e d icatio n , which co uld le ad to treatm ent fa i l u re a nd at tim es dis cr im in atio n. Pe o ple have yet to b e co ns cio us o n t he im po r tance o f f ulﬁ lling t he w ho l e treatm ent reg i m e a nd th e co ns e que nce s o f failin g to do s o . Thus , we s ug ge st t h at a he alt h pro m o tio n pro gra m to el uc i date k n ow l edge a nd to re ctif y t he stigm a re garding TB in s o ciet y s ho uld b e do ne in o rd e r to incre as e peo p l e’s awa ren es s ; T B peer g ro ups s ho u ld als o be fo r m e d to incre as e m o ral s u ppo r t fo r TB p atie nt s and to ex pand bo th thei r i ns i g ht a nd co m pl i a nc e i n o rd e r to re du ce TB m o r talit y an d co nt ro l it s infe ctio n.

HIGH NURSE WORKLOAD AND ITS RELATION WITH NOSOCOMIAL INFECTION INCIDENCE IN INTENSIVE CARE UNIT Kevin Luke – Andro Pramana Witarto – Della Anastasia Candra AIM: Explain high nurse workload and its relation with NI incidence in ICU settings.

BACKGROUND: Nosocomial infection (NI) occurs 5-10 times more frequent in Intensive Care Unit (ICU) compared with general wards and might cause up to 60% mortality in ICU. NI is known to increase length of ICU stays and morbidity. Moreover, arising antimicrobial resistance in healthcare settings worsen this condition. High nurse workload in ICU is associated with worsen patient outcome.

MATERIAL AND METHODS: Records were searched by computerized database PubMed, ScienceDirect, Cochrane Library, using keywords: nurse workload, nurse staffing, burnout ICU, nosocomial infection, healthcare associated infection, and reviewed based on PRISMA Protocol. Included records’ eligibility criteria are: (1) Observational or experimental study; (2) ICU settings; (3) Define nurse workload measurements; (4) Conducted <10 years. The outcome expectation of the records were relation analysis between nurse workload and NI incidence in ICU settings.

RESULT AND DISCUSSION: Five studies were reviewed. Three out of five studies conclude high nurse workload is related with NI incidence, contrast with study by Bogaert, et al. (2014) and Tawfik, et al. (2016). In Bogaert, et al. (2014) study, workload is related with patient/family verbal abuse (p<0.001; OR 1.79 [1.29-3.49]) and emotional exhaustion is more likely to cause NI incidence than workload (p<0.001; OR 1.33 [1.15-1.53]). In Tawfik, et al. (2016) study, although overall burnout measurement show no relation with NI incidence, perceptions of working too hard and feeling fatigue are related with NI incidence in item-level analysis. (p=0.002 OR 1.22 [1.07-1.38] ; p=0.008 OR 1.27 [1.06-1.52]).

CONCLUSIONS: Even though the final results is still debatable, we can conclude that high nurse workload is related with NI incidence in ICU settings by considering bias factors and sub-group/item analysis that is likely to lead into workload/burnout and NI incidence.

Elvira Lesmana rcindonesia@amsa-international.org +6285811240637

High Nurse Workload and Its Relation with Nosocomial Infection Incidence in Intensive Care Unit Kevin Luke | Andro Pramana Witarto | Della Anastasia Candra

INTRODUCTION Nosocomial infection (NI) occurs 5-10 times more frequent in Intensive Care Unit (ICU) compared with general wards and might cause up to 60% mortality in ICU (Oliveira et al., 2010). NI is known to increase length of ICU stays and morbidity (Dasgupta et al., 2015). Moreover, arising antimicrobial resistance in healthcare settings worsen this condition (Kritsotakis et al., 2017). High nurse workload in ICU is associated with worsen patient outcome (West et al., 2014 & Lee et al., 2017). This systematic review aims to explain high nurse workload and its relation with NI incidence in ICU settings.

MATERIAL AND METHODS This systematic review was conducted by computerized database searching in PubMed, ScienceDirect, and Cochrane Library. We used several keywords such as nurse workload, nurse staffing, burnout ICU, nosocomial infection, Healthcare Associated Infection. Records were reviewed by two reviewers based on PRISMA Protocol. Included records must fulfill eligibility criteria, which are: 1. Observational or experimental study 2. ICU settings 3. Define nurse workload measurements 4. Conducted <10 years The outcome expectation of the records were relation analysis between nurse workload and NI incidence in ICU settings

RESULTS AND DISCUSSIONS

Five studies were reviewed. Total sample size are 10.872 nurses; 23.752 patients; and 209 hospital/ICUs. All studies have different method to measure nurse workload. Only Ferrer, et al. (2014) and Rogowski, et al. (2013) specify NI type. Three out of five studies conclude high nurse workload is related with NI incidence, contrast with study by Bogaert, et al. (2014) and Tawfik, et al. (2016). In Bogaert, et al. (2014) study, workload is related with patient/family verbal abuse (p<0.001; OR 1.79 [1.29-2.49]) and emotional exhaustion is more likely to cause NI incidence than workload (p<0.001; OR 1.33 [1.15-1.53]). However, the authors stated that bias likely to happen due to ICU selection (based on response rate); cross-sectional design; and also nurse-reported data. In Tawfik, et al. (2016) study, even though overall burnout measurement show no relation with NI incidence, perceptions of working too hard and feeling fatigue are related with NI incidence in item-level analysis. (p=0.002 OR 1.22 [1.07–1.38] ; p=0.008 OR 1.27 [1.06–1.52]). This can be explained due to personal characteristics, job-related factors, or both. Moreover, bias can occurred at the ICU and individual levels, as unmotivated ICUs and burned out individuals may not have tendency to participate.

CONCLUSION Even though the final results is still debatable, we can conclude that high nurse workload is related with NI incidence in ICU settings by considering bias factors and sub-group/item analysis that is likely to lead into workload/burnout and NI incidence. Based on this result, we suggest better nurse management in hospital especially in ICU settings. Moreover, better and bigger studies are needed to justify this result. References: 1. Aycan, I., Celen, M., Yilmaz, A., Almaz, M., Dal, T., Celik, Y., & Bolat, E. (2015). Bacterial colonization due to increased nurse workload in an intensive care unit. Brazilian Journal Of Anesthesiology (English Edition), 65(3), 180-185. http://dx.doi.org/10.1016/j.bjane.2014.05.005 2. Dasgupta, S., Das, S., Hazra, A., & Chawan, N. (2015). Nosocomial infections in the intensive care unit: Incidence, risk factors, outcome and associated pathogens in a public tertiary teaching hospital of Eastern India. Indian Journal Of Critical Care Medicine, 19(1), 14. http://dx.doi.org/10.4103/0972-5229.148633 3. Ferrer, J., Boelle, P., Salomon, J., Miliani, K., L’Hériteau, F., Astagneau, P., & Temime, L. (2014). Management of nurse shortage and its impact on pathogen dissemination in the intensive care unit. Epidemics, 9, 62-69. http://dx.doi.org/10.1016/j.epidem.2014.07.002 4. Kritsotakis, E., Kontopidou, F., Astrinaki, E., Roumbelaki, M., Ioannidou, E., & Gikas, A. (2017). Prevalence, incidence burden, and clinical impact of healthcare-associated infections and antimicrobial resistance: a national prevalent cohort study in acute care hospitals in Greece. Infection And Drug Resistance, Volume 10, 317-328. http://dx.doi.org/10.2147/idr.s147459 5. Lee, A., Cheung, Y., Joynt, G., Leung, C., Wong, W., & Gomersall, C. (2017). Are high nurse workload/staffing ratios associated with decreased survival in critically ill patients? A cohort study. Annals Of Intensive Care, 7(1). http://dx.doi.org/10.1186/s13613-017-0269-2

6. Oliveira, A., Kovner, C., & Silva, R. (2010). Nosocomial Infection in an Intensive Care Unit in a Brazilian University Hospital. Revista Latino-Americana De Enfermagem, 18(2), 233239. http://dx.doi.org/10.1590/s0104-11692010000200014 7. Rogowski, J., Staiger, D., Patrick, T., Horbar, J., Kenny, M., & Lake, E. (2013). Nurse Staffing and NICU Infection Rates. JAMA Pediatrics, 167(5), 444. http://dx.doi.org/10.1001/jamapediatrics.2013.18 8. Tawfik, D., Sexton, J., Kan, P., Sharek, P., Nisbet, C., & Rigdon, J. et al. (2016). Burnout in the neonatal intensive care unit and its relation to healthcare-associated infections. Journal Of Perinatology, 37(3), 315-320. http://dx.doi.org/10.1038/jp.2016.211 9. Van Bogaert, P., Timmermans, O., Weeks, S., van Heusden, D., Wouters, K., & Franck, E. (2014). Nursing unit teams matter: Impact of unit-level nurse practice environment, nurse work characteristics, and burnout on nurse reported job outcomes, and quality of care, and patient adverse events—A cross-sectional survey. International Journal Of Nursing Studies, 51(8), 1123-1134. http://dx.doi.org/10.1016/j.ijnurstu.2013.12.009 10. West, E., Barron, D., Harrison, D., Rafferty, A., Rowan, K., & Sanderson, C. (2014). Nurse staffing, medical staffing and mortality in Intensive Care: An observational study. International Journal Of Nursing Studies, 51(5), 781-794. http://dx.doi.org/10.1016/j.ijnurstu.2014.02.007

ABSTRACT

Title: Application of Momordica charantia Extract Based on PLE as Herbal Alternative of Type 2 non-Insulin Resistance Diabetic Drug and Bacterial Infection Prevention Name of University and Author(s):, Ivan Angelo Albright Aim: to prove that M. charantia extract based on PLE has promising future as Herbal Alternative of Type 2 non-Insulin Resistance Diabetic Drug and Bacterial Infection Prevention Background: Diabetes is a well-known disease which affect around 422 million people in the world. It caused 1.6 million death every year. Antidiabetic drugs such as Metformin and Gibenclamide are contraindicated for renal impairment. Momordica charantia, a tropical fruit, only used as cooking material even though it contains a high level of antidiabetic compounds which has been proved (on mice, 4g/day) to not affect renal function. It can be used as alternative way to treat type 2 diabetes, but, its bitter taste made people reluctant to eat it. Application of Pressurized Liquid Extraction (PLE) is expected to be an effective way to obtain the extract of Momordica charantia. Material and Method: This scientific poster is based on systematic review and further analysis by 1 reviewer. 7 journals between 2007-2018 have been selected from digital databases such as PubMed and World Health Organization. Results: -

Momordica charantia can be used to treat type 2 diabetes by inhibit adipose differentiation, boost HMP pathway, and increase skeletal muscle glucose intake

Momordica charantia can also be used as a broad-spectrum antibacterial agent to fight off infections caused by Escherichia coli, Salmonella, Staphylococcus aureus, Staphylococcus, and Pseudomonas

Conclusion: M. charantia extract based on PLE has promising future as Herbal Alternative of Type 2 non-Insulin Resistance Diabetic Drug and Bacterial Infection Prevention

Contact details of Regional Chairperson (name, email, phone number)

Association between Endemicity Level and Compliance to Mass Drug Administration for Filariasis: A Cross-sectional Study in West Papua 2015 Assyifa Gita Firdaus AMSA-INDONESIA Aim To identify association between Endemicity Level and Compliance to Mass Drug Administration for Filariasis Background Filariasis is a neglected tropical disease that becomes the main cause of disability in the world. Asia is the continent where most filariasis cases are found. By 2015, there were 13,032 filariasis cases in Indonesia, West Papua which has 1,244 cases is the third highest province with filariasis in Indonesia. To eliminate filariasis, World Health Organization develops a global program namely Mass Drug Administration (MDA) by using Diethylcarbamazine (DEC) and Albendazole, single-dose, onceyearly, to be used in all endemic areas with goal of reaching 65% total population coverage for 4â&#x20AC;&#x201C;6 years. In West Papua, the rate of filariasis endemicity varies from low to high. It was found that in low filariasis endemicity areas, the coverage of MDA was also low. Hence, it is necessary to further investigate whether there is a significant association between filariasis endemicity levels and MDA compliance. Method Cross-sectional study design using secondary data from West Papua Health Department. Statistical analysis was done using chi-square test with Yatesâ&#x20AC;&#x2122; correction (SPSS 22.0). Result There is significant association between filariasis endemicity level and MDA compliance (P = 0.000). The prevalence ratio of 2.245 (95%CI: 2.216-2.273) indicates that a personâ&#x20AC;&#x2122;s risk to not comply MDA is 2.245-fold greater if he lives in area with low filariasis endemicity. Conclusion This study concludes that low level of filariasis endemicity is a risk for low compliance of taking MDA to the population. It is still important for low filariasis endemicty areas to comply MDA so that they do not end up as high filariasis endemicity area, a vicious cycle which can disrupt global filariasis

elimination program. Thererefore, there is urgent need to improve MDA awareness by healthcare workers and community, especially in low filariasis endemicity areas.

Regional Chairperson AMSA-INDONESIA Elvira Lesmana rcindonesia@amsa-international.org +6285811240637

Variable Filariasis Endemicity

Variable Groping

MDA Compliance

Low

Not comply 41,696

Comply 7,352

High

16,299

26,737

P Prevalence Value Ratio 0.000

2.245

NOVEL MATERNAL SCREENING IMPORTANCE TOWARDS RISK FACTORS ASSOCIATED WITH NEONATAL HEPATITIS B IMMUNOPROPHYLAXIS FAILURE THROUGH VERTICAL TRANSMISSION: A SYSTEMATIC REVIEW ABSTRACT Ariel Valentino, Muhamad Faza Soelaeman, Adriana Viola M, Aji Wahyu W Aim The objective of this study is to figure out the most contributing risk factors towards Hepatitis B immunoprophylaxis failure among neonates infected by vertical transmission. Background Hepatitis B infections are mainly through mother-to-child (vertical) transmissions and have a high risk to become chronic in later ages. Organizations, such as WHO, have taken measures to eradicate this disease by obligation of vaccines in many countries. However, these efforts are delayed by immunoprophylaxis failure caused by associable risk factors. Therefore, this systematic review is conducted to elucidate all prevalent risk factors of hepatitis B immunoprophylaxis failure among infected neonates through vertical transmission. Material and Methods A systematic literature search was conducted in PubMed and Scopus database to identify cohort studies about risk factors contributing to immunoprophylaxis failure for HBV in mother-to-child transmissions. There were 64 studies identified (55 in PubMed database, 9 in Scopus database) and 16 studies which met the criteria were selected. Studies other than cohort studies and lack extractable data were excluded, resulting in 9 final selected studies. Results From 9 cohort studies, there are 21.983 participants. The common risk factors contributing to Hepatitis B immunoprophylaxis failure found in the studies were seropositivity of HBeAg (OR=1,84 and RR=31,740) and Hepatitis B virus DNA load log IU/mL (OR=2,42-7,98 and RR=22,583). More uncommon risk factors include young maternal age (RR=6,8), vaginal delivery (OR=6,52), and neonatal immunization with vaccine only (RR=0,427). Protective factors against immunoprophylaxis failure found in the studies include increase in maternal age (OR=0,84), increase in gestational age (OR=0,69), and increase in birth weight (OR=0,031-0,443).

Conclusion Immunoprophylaxis failure of vertically transmitted hepatitis B are caused by a number of risk factors, mainly HBV DNA load and HBeAg, which are found in the maternal serum. Therefore, screenings to these factors are essential to prevent further cases of HBV infections Contact Details of Regional Chairperson Elvira Lesmana rcindonesia@amsa-international.org +6285811240637

BACKGROUND

MATERIALS & METHODS

According to the World Health Organization (WHO) in 2017, 257 million people worldwide are chronically infected with Hepatitis B Virus (HBV), causing more than 887,000 deaths in 2015. HBV infection during the first year of infant's life has up to 90% probability to develop into chronic infection. Many local governments and non-governmental organizations such as WHO has taken serious measures to eradicate this disease as it has become one of the main target of SDG and vaccines are obligated in many countries, including Indonesia, deploying a horde of efforts and costs. However, there are still lack of knowledge regarding the causes of immunoprophylaxis failure thus endangering those measures. Therefore, this systematic review is conducted in order to elucidate the most prevalent risk factors of immunoprophylaxis failure among HBV-infected neonates from mother-to-child transmission

Figure 2. Conceptual framework

Figure 1.Selection and analytical method

Identification of studies through PubMed Database searching (n=9) Total

Systematic Review

Records do not meet criteria (n=48)

9 Observational Cohort Studies

Records screened for eligibility (n=16)

From PubMed and Scopus Database

OBJECTIVES

Identification of studies through Scopus Database searching (n=55)

STROBE Statement

Records excluded (n=2)

Quality assessment of the studies

Objectives of this systematic review are:

Full text studies assessed for eligibility (n=14)

Qualitative Analysis

To figure out the most contributing risk factors towards hepatitis B immunoprophylaxis failure among neonates infected by mother-to-child transmission. Therefore, further actions could be conducted, such as:

Total Samples :21.983

Encouraging local governments dan non-governmental organizations towards creating an applicable screenings for infected pregnant women to prevent hepatitis B immunoprophylaxis failure

The remaining full text studies included and assessed with STROBE Statement (n=9)

Full text studies excluded, due to: 1. Study design incompatible (n=2) 2. Data not extractable (n=5)

Educating people, especially mothers, regarding immunoprophylaxis failure in Hepatitis B infection

RESULTS Distribution of factors category

Table 1. Studies characteristics with Strobe scoring AUTHOR AND YEAR OF PUBLICATION

STUDY DESIGN

STUDY LOCATION

Zou H, et al. 2012

Retrospective cohort

Beijing, China

NUMBER OF PARTICIPANTS Mothers

Infants

864

869

Wang C, et al. 2016

Prospective cohort

Jilin, China

890

871

Yin Y, et al. 2012

Prospective cohort

Taipei, Taiwan

1355

Wen W-H, et al. 2013

Prospective cohort

Guangzhou, China

Zhang L, et al. 2014

Prospective cohort

Wuhan, China

METHOD OF ANALYSIS

415 case, 735 control

1150

Chengdu, China

Ding Y, et al. 2013

Prospective cohort

Shengyang, China

Lee LY, et al. 2015

Prospective cohort

Singapore, Singapore

161

Lu Y, et al. 2017

Prospective cohort

Jiangsu and Henan Province, China

1448

172 cases, 84 control

4536

STROBE Score (Max: 22)

Maternal HBeAg + (OR = 1,84), detectable maternal HBV DNA (OR = 1,57), maternal HBV DNA level <1 million (OR = 1) 1-9,99 million ( OR = 5,63) 10-99,9 million (OR = 2,62) >= 100 million (OR = 7,98),detectable HBV DNA in cord blood (OR = 74,43)

T-test (continuous variable), chi square (univariate analysis of odds ratio), Fisher (proportion)

Maternal HBV DNA levels (OR = 4,53)

Chi square or Fisher (categorical variable)

18.6

Maternal HBV DNA >=10^-7 (RR = 22,583), maternal HBeAg positive (RR = 31,740)

Student t-test (quantitative data), Chi-Square data, Fisher exact test (qualitative data)

17.2

Wilcoxon rank-sum test (continuous variable); chi-square test, Fisher's exact test (categorical variable), univariate and multivariate logistic regression

Positively associated = Maternal viral load (per log10-copy/ml 81 cases, 97 cases, increase) (OR Univariat = 2.54, OR Multivariat = 3.49). Negative262 controls 222 controls ly associated = increasing gestational age (OR univariat = 0.69), birth weight (per 1-kg increase) (OR univariat = 0.031)

Prospective cohort

Liu C-P, et al. 2014

OUTCOME

14.8

16.3 7

Chi-square test (categorical variables), t-test, logistic regression analysis

15.7

High maternal HBV DNA Level (per log 10 IU/mL increase) (OR univariat= 2.42, multivariat = 2.44), vaginal delivery (OR univariat = 6.52, multivariat = 6.96)

Univariate and multivariate logistic regression

17.6

Older than 20 years HBsAg positive (OR = 4,54), older than 20 years anti-HBc positive (OR = 5,69), older than 20 years anti-HBs positive (OR = 0,61)

Fisherʼs exact test

15.5

Young maternal age (RR = 6,8), HBV DNA load log IU/mL (RR = 3,8)

Fisherʼs exact test

19.8

Increasing maternal age (OR = 0,84), maternal HBV DNA load log IU/mL (OR = 3,68), maternal HBeAg (OR = 2,90)

Chi square or Fisher (categorical variable)

18.4

Mother's age <28 years (RR = 0,164), birth weight <2,500 or >=4,000 g (RR 0,443) , neonate without given HBIg (RR = 0,427)

62.5% Risk Factors

37.5% Protective Factors

20% Others

40% Agent-related Factors

6 5 4 3

40% Host-related Factors

2 1 HBV DNA HBeAg Count

Distribution according to epidemiological triangle

Young Vaginal Neonates Maternal Delivery without Age given HBIg

Numbers of journals assessing the risk factors

Figure 3. Pie charts and bar diagram of factors assessed in the study

DISCUSSIONS Limitation

From this study, we found the top 2 risk factors in term of prevalence, which are:

1. Limited study scope Coincidentally, this review only consist of observational studies, conducted in Asia. Even though Asia has the largest population infected by Hepatitis B, other region such as Africa also has a significant prevalence for the disease. 2. Insufficient sample size The limited study scope leads to lack of sample population identified in the databases. Therefore, broader extent of studies are sugested to maximize the results

HBV DNA Load & HBeAg Zou et al (2012) explains the significance of maternal HBV DNA load to the risk of immunoprophylaxis failure. HBV DNA level of <1 million doesnʼt appear as a significant risk factor. HBV DNA level ranges, from 1 – 9,99 million, 10 – 99,9, and >= 100 million, appears as a risk factor for immunoprophylaxis failure (OR = 5,63, 2,62, 7,98, respectively). Yin et al (2012) states that HBV DNA is a major risk factor (RR = 22,583). High HBV DNA load increases the chance of HBV infiltrating the placental barrier (Bai et al, 2007). It is also associated with the presence of HBeAg (Belopolskaya et al, 2015). Hence, Lu et al (2017) affirms that HBeAg is a risk factor for HBV immunoprophylaxis failure. According to Pan et al. (2015), HBeAg is an immunoregulatory antigen in a human infected by HBV and may pass through the placenta. HBeAg can only be significant for HBV infection diagnosis in the presence of HBV DNA load in the maternal serum. Without HBV DNA load, the infant will lose HBeAg within 6 months of age. This is why HBV DNA load is the most common and major risk factor for HBV immunoprophylaxis failure.

Figure 4. Hepatitis B virus structure

Implication of this study 1. This study can be a basis to encourage a renewal of the previous guideline on immunopraphylaxis therapy among HBV-infected mothers and neonates, therefore sigficantly lowering the number of Hepatitis B infection cases 2. Furthermore, this study can also be used to promote HBV DNA load and HBeAg screenings in HBV-infected pregnant women.

CONCLUSION Hepatitis B immunoprophylaxis failure among mother-to-child transmitted infection are caused by a number of risk factors. This review conclude that it is mainly due to HBV DNA load and HBeAg, which are found in the maternal serum. Therefore, screenings in pregnant women regarding these factors are essential to avoid failures in order to prevent further cases of HBV infections

REFERENCES Bai, H., Zhang, L., Ma, L., Dou, X.-G., Feng, G.-H., & Zhao, G.-Z. (2007). Relationship of hepatitis B virus infection of placental barrier and hepatitis B virus intra-uterine transmission mechanism. World Journal of Gastroenterology : WJG, 13(26), 3625–3630. Belopolskaya, M., Avrutin, V., Firsov, S., & Yakovlev, A. (2015). HBsAg level and hepatitis B viral load correlation with focus on pregnancy. Annals of Gastroenterology : Quarterly Publication of the Hellenic Society of Gastroenterology, 28(3), 379–384. Ding, Y., Sheng, Q., Ma, L., & Dou, X. (2013). Chronic HBV infection among pregnant women and their infants in Shenyang, China. Virology Journal, 10(1), 17. https://doi.org/10.1186/1743-422x-10-17 Lee, L. Y., Aw, M., Rauff, M., Loh, K.-S., Lim, S. G., & Lee, G. H. (2015). Hepatitis B immunoprophylaxis failure and the presence of hepatitis B surface gene mutants in the affected children. Journal of Medical Virology, 87(8), 1344–1350. https://doi.org/10.1002/jmv.24193 Liu, C.-P., Zeng, Y.-L., Zhou, M., Chen, L.-L., Hu, R., Wang, L., & Tang, H. (2015). Factors Associated with Mother-to-child Transmission of Hepatitis B Virus Despite Immunoprophylaxis. Internal Medicine, 54(7), 711–716. https://doi.org/10.2169/internalmedicine.54.3514

Lu, Y., Zhu, F.-C., Liu, J.-X., Zhai, X.-J., Chang, Z.-J., Yan, L., … Li, J. (2017). The maternal viral threshold for antiviral prophylaxis of perinatal hepatitis B virus transmission in settings with limited resources: A large prospective cohort study in China. Vaccine, 35(48), 6627–6633. https://doi.org/10.1016/j.vaccine.2017.10.032 Pan, C. Q., Duan, Z., Bhamidimarri, K. R., Zou, H., Liang, X., Li, J., & Tong, M. J. (2012). An Algorithm for Risk Assessment and Intervention of Mother to Child Transmission of Hepatitis B Virus. Clinical Gastroenterology and Hepatology, 10(5), 452–459. Wang, C., Wang, C., Jia, Z.-F., Wu, X., Wen, S.-M., Kong, F., … Niu, J.-Q. (2016). Protective effect of an improved immunization practice of mother-to-infant transmission of hepatitis B virus and risk factors associated with immunoprophylaxis failure. Medicine, 95(34), e4390. Wen, W.-H., Chang, M.-H., Zhao, L.-L., Ni, Y.-H., Hsu, H.-Y., Wu, J.-F., … Chen, H.-L. (2013). Mother-to-infant transmission of hepatitis B virus infection: Significance of maternal viral load and strategies for intervention. Journal of Hepatology, 59(1), 24–30.

World Health Organizatioin. (2017, July 7). Hepatitis B vaccines: WHO position paper - July 2017. Retrieved from: http://apps.who.int/iris/bitstream/handle/10665/255841/WER9227.pdf?sequence=1 Yin, Y., Wu, L., Zhang, J., Zhou, J., Zhang, P., & Hou, H. (2013). Identification of risk factors associated with immunoprophylaxis failure to prevent the vertical transmission of hepatitis B virus. Journal of Infection, 66(5), 447–452. Zhang, L., Gui, X., Wang, B., Ji, H., Yisilafu, R., Li, F., … Liu, X. (2014). A study of immunoprophylaxis failure and risk factors of hepatitis B virus mother-to-infant transmission. European Journal of Pediatrics, 173(9), 1161–1168. https://doi.org/10.1007/s00431-014-2305-7 Zou, H., Chen, Y., Duan, Z., Zhang, H., & Pan, C. (2011). Virologic factors associated with failure to passive-active immunoprophylaxis in infants born to HBsAg-positive mothers. Journal of Viral Hepatitis, 19(2), e18–e25.

Systematic Review of Antibiotic Prophylaxis Efficacy in Clean Surgery and Minimally Invasive Surgery: A Step Towards Reducing Antimicrobial Resistance Anthonius Yongko1 Brenda Cristie Edina2 Lowilius Wiyono3 Andi Gunawan Karamoy4 ABSTRACT Aim: This systematic review aims to evaluate the effectivity of prophylaxis antibiotic on clean surgery and minimally invasive surgery. Background: The use of antibiotics as preoperative prophylaxis in clean surgery has risen by 73% in the past 5 years and cause increasing resistance towards antimicrobial drugs. However, some studies claimed the use of antibiotics are not effective to reduce surgical site infection (SSI). Methods: We did a systematic review from PubMed, Science Direct, and EBSCOHost, in which included studies were assessed by The Cochrane Collaborationâ&#x20AC;&#x2122;s Tool for assessing risk of bias and analysed qualitatively. Results and Discussion: There are 4 studies in that state the use of antibiotic prophylaxis in reducing infection are not significant, while one study contradicts the notion. Risk biases of the data are compared, and the trend shows the use of antibiotic prophylaxis in reducing infection in clean or minimally invasive surgery is not significant. In conclusion, antibiotic prophylaxis is not a requirement for these surgery. Recommendation: There are several alternatives that can be used to reduce the incidence of SSIs and antibiotic resistance in clean surgery, such as perioperative hair removal, skin preparation, maintaining normothermia, glucose control, the use of prophylactic intraoperative wound irrigation, and the use of antimicrobial sutures. Conclusion: Antibiotic prophylaxis is not a requirement for these surgery.

Preventable Risk Factors and Recommended Protective Factors Associated with Rotavirus Diarrhea among Children Under-Five: Systematic Review of Large Case-Control Study Alice Tamara*, Jeremy Rafael Tandaju, Metta Dewi, Brenda Cristie Edina * alicelie_96@hotmail.com, +6281808201918

Background and Aim: Child-death is chronic health problem worldwide. Hourly, 15,000 children under-five (U-5) die â&#x20AC;&#x201C; 9% are diarrhea-based and mainly rotavirus-caused. Rotavirus diarrhea (RD) kills 453,000, including 10,888 Indonesian children annually. Although various preventions have been taken, its prevalence and mortality rate are still high. Thus, we conducted a systematic review to identify the predictor and protective factors in reducing its prevalence and mortality rate. Method: A systematic review of large case-control studies of children under-five with RD was conducted at Pubmed and EBSCOhost (n=467). Eleven eligible studies involving 10,248 respondents were assessed with STROBEâ&#x20AC;&#x2122;s Criteria for further review. Results and Discussion: Top-3 risk factor group contributing to U-5 RD were identified: 1)

Being outside home is notably predisposing children to RD, including day-care center

attendance (OR=6.0), travelling (OR=3.97), and hospitalization (OR=3.81). 2)

Poor immune system which is depicted by low birth weight (OR=6.00), low maturity

(OR=12.10) prematurity (OR=5.20), being wasted (OR=9.00) and consuming no breastmilk (OR=2.27), is proven to enhance the risk of RD. 3)

Inadequate hygiene and sanitation expand the risk factor by having water contamination

(OR=6.92), un-facilitated defecation (OR=2.7), and toilet-sharing (OR=1.6). Furthermore, left garbage (OR=3.2), no soap and towels (OR=1.6) yet determining. Additionally, such protective factors as breastmilk feeding was found to show a favorable effect in reducing RD risk by exclusive breastfeeding (OR=0.44). Conclusion: Being outside home, poor immunity, and inadequate hygiene and sanitation were acknowledged as major risk factors of U-5 RD, supported by other factors founded along review. Breastmilk is agreed as main protective factor. Hence, reviewers recommend caregivers and HCW to take care of children at home, support good nutritional status of children and mother, maintain great water sanitation and promote exclusive breastmilk for every neonate. By these preventive measurements, the mortality rate of RD in children U-5 is expected to reduce.

Regional Chairperson Elvira Lesmana rcindonesia@amsa-international.org +6285811240637

Asian Medical Students’ Conference 2018

Inadequate use of personal protective equipment as a risk factor of surgical site infection Kresanti Dewi Ngadimin1, Maharani Zaini1, Septhendy1

Abstract Aim. To review one of the risk factors in surgical site infection (SSI) by finding the relation between nurse knowledge on PPE and incidence of SSI. Background. Surgical site infection is one of the most common infection with prevalence of 5-34% globally. In Indonesia, prevalence of SSI is one of the highest with prevalence of 10% and only lower than Brazil and Vietnam. SSI can be caused by contamination from external environment to the patient. One of the factor affecting this incidence is inadequate use of PPE among the health personnel. However, this issue has not been addressed especially in developing countries. Material and methods. Literature review was done systematically from reliable journal databases such as Google scholar, ProQuest, Scopus, and PubMed. Literature searching was done using “Surgical Site Infection” AND “Personal Protective Equipment”; and limited by published year, human study, topic relatability, and data availability. Finally, 9 journals were included in systematic review. Results. Inadequate usage of PPE among health personnel especially nurses in hospital increase the incidence of SSI. PPE usage is affected by the local setting, local needs, and resource limitations of health care facilities combined with intensive education, auditing and surveillance strategies to address this issue. The usage of PPE such as surgical mask especially in surgical setting is recommended as it decreases the number of incidence in post-surgical infection. The most affecting health personnel correlating with infection is the nurse as they have the most exposure with patients.

Conclusion. PPE usage lowers the incidence of SSI, therefore PPE usage in surgery is crucial to prevent SSI to occur. It is suggested for health care personnel especially nurses to wear proper PPE in any surgical procedure. Keywords: infection, personal protective equipment, surgery, surgical site infection Author Contact:

Kresanti Dewi Ngadimin Kresanti.dewi@gmail.com +628135206000

Regional Chairperson Contact: Elvira Lesmana rcindonesia@amsainternational.org +6285811240637

I nadequat eUseofPer sonalPr ot ect i veEqui pment asaRi skFact orofSur gi calSi t eI nf ect i on Kr esant iDewiNgadi mi n,Mahar aniZai ni,Sept hendy 1

I nt r oduct i on Sur gi cals i t ei nf ect i on( SSI )i soneoft he mos t common i nf ect i on wi t h pr eval enceof534% gl obal l y. I nI ndones i a, pr eval enceofSSIi soneof t hehi ghes twi t hpr eval enceof1 0% and onl yl owert han Br azi land Vi et nam. h j k h SSIcan be caus ed by cont ami nat i on f r om ext er nal envi r onment t o t he pat i ent . Oneoft hef act oraf f ect i ngt hi s i nci dence i si nadequat e us e ofPPE amongt heheal t hper s onnel . However , t hi si s s ue has not been addr es s ed es peci al l yi ndevel opi ngcount r i es .

Tabl e1 .Syst emat i csear choft heusageofPPEandi nci denceofSSI

Resul t s

Obj ect i ve To r evi ew t he r el at i on bet ween us age ofPPE es peci al l yi n nur s es and t he i nci dence ofs ur ger ys i t e i nf ect i on

Mat er i alandMet hods Keywor ds: : i nf ect i on, per s onal pr ot ect i ve equi pment , s ur ger y, s ur gi cals i t ei nf ect i on

Thi s PPE usage i s af f ect ed by t he l ocalset t i ng,l ocalneeds,and r esour cel i mi t at i onsofheal t h car ef aci l i t i escombi ned wi t hi nt ensi ve educat i on,audi t i ng and sur vei l l ancest r at egi est o addr esst hi si ssue. TheusageofPPE especi al l yi n sur gi calset t i ng i sr ecommended asi t decr easest henumberofi nci dencei npostsur gi cali nf ect i on.

Di scussi on Accor di ng t o a st udy conduct ed by Ahsan etal ,t he usage of pr ot ect i veequi pmenti sr el at edwi t hemer gi ngnumberofsur gi cal si t ei nf ect i on.However ,t he bi ggestef f ectwas shown f r om t he st udy conduct ed by Bar aka et al as i t showed si gni ﬁcance r educt ance of sur gi calsi t ei nf ect i on r at es whenever i nf ect i on cont r olpr ogr am was i mpl ement ed.The most af f ect i ng heal t h per sonnelcor r el at i ng wi t hi nf ect i on i st henur seast heyhavet he mostexposur ewi t hpat i ent s.

Suggest i on Educat e heal t h car e per sonnel t hei mpor t anceofPPEusage Fur t herr esear ch on t her el at i on bet ween usage on PPE and i nci denceofSSI

Concl usi on PPE usage l ower st he i nci dence ofSSI I ti s suggest ed f or heal t h car e per sonnel especi al l y nur ses t o wearpr operPPE i n anysur gi cal pr ocedur e

Ref er ences

Fi gur e1 .Summar yofdat asear chi ngandi ncl usi on

1 . Baker ,A.W . ,et al( 201 6) .Epi demi ol ogy of Sur gi calSi t eI nf ect i on i n a Communi t yHospi t alNet wor k.I nf ect i onCont r ol&Hospi t alEpi demi ol ogy,37( 05) , 51 9–526.ht t ps: / / doi . or g/ 1 0. 1 01 7/ i ce. 201 6. 1 3 2. Thu,T.( 201 6) .sur gi calsi t ei nf ect i ons:whatar et hegaps ?.Canadi anJour nalOf I nf ect i onCont r ol ,31 ( 1 ) ,1 823.ht t p: / / dx. doi . or g/ 1 0. 1 31 40/ RG. 2. 1 . 4249. 6408 3.Kennedy,L.( 201 3) .I mpl ement i ng AORN r ecommended pr act i cesf orst er i l e t echni que. AORN Jour nal , 98( 1 ) , 1 4–23; qui z 23–26. ht t ps: / / doi . or g/ 1 0. 1 01 6/ j . aor n. 201 3. 05. 009

VIDEOGRAPHY AND WHITE PAPER

All of PCC Asian Medical Students’ Conference 2018 v i d e o s w i l l b e a c c e s i b l e i n A M S A- I n d o n e s i a o ﬃ c i a l y o u t u b e c h a n n e l

https://www.youtube.com/user/AMSAIndonesia

W H I T E

P A P E R

ASIAN MEDICAL STUDENTS’ CONFERENCE 2018 ASIAN MEDICAL STUDENTS’ ASSOCIATION – INDONESIA WHITE PAPER AND VIDEOGRAPHY

PREVENT INFECTION BY CHEW-ING

by: Abi Prasetya Nadia Eastherina Nurtanto Shohifa Dzauqiah Sari Shafira Yasmine Anshari

1. Introduction Indonesia is currently experiencing a change in the prevalence of disease. The biggest cause of death in this century is non-communicable disease. It is different from the previous century; which infectious disease become the main cause of death. However, we cannot rule out infectious disease. If we put it aside, infectious disease can be re-emerging disease and become harder to control.

One of the infectious disease that we cannot put aside is acute respiratory infection (ARI). ARI is disease that happen in our respiratory tract as a result of pathogen infection and also the main cause of morbidity and mortality in infectious disease (World Health Organization(WHO), 2014). ARI is divided into two groups depending on the main organ affected. First, acute upper respiratory infection group (AURI) and second, acute lower respiratory infection group (ALRI). ARI begins with heat accompanied by one or more symptoms, such us: sore throat or swallow pain, cold, dry cough or phlegm (Badan Penelitian dan Pengembangan Kesehatan, 2013). The most common causes of AURI are viruses such as rhinoviruses, coronavirus, influenza and respiratory syncytial virus (RSV), while ALRIs are commonly caused by bacteria such as Streptococcus pneumonia and Haemophilus influenza (Public Health England (PHE), 2015).

Around 4 million people in the world die each year because of ARI, 98% because of lower respiratory tract infections (World Health Organization(WHO), 2014). It is leading overall cause of death in developing countries and also the greatest single contributor to the overall burden of disease in the world, measured by DALY lost (Ferkol & Schraufnagel, 2014).

According to Indonesia Basic Health Research 2013, ARIs period prevalence is 25%. It is not much different with Indonesia Basic Health Research 2007, which stated that ARIs period prevalence is 25,5%. ARIs period prevalence is calculated over last 1 month. Nusa Tenggara Timur (41,7%), Papua (31,1%), Aceh (30%), Nusa Tenggara Barat (28,3%), and Jawa Timur (28,3%) are five provinces in Indonesia with the highest ARI (Badan Penelitian dan Pengembangan Kesehatan, 2013).

2. Problem Discussed Acute Respiratory Infection (ARI) is highly transmitted. ARI is mostly transmitted through three ways; droplet transmission, airborne transmission, and contact transmission (Public Health England (PHE), 2015). It can infect a healthy person by inhalation of virus-loaded droplets into

the respiratory tract, by direct contact for example hand shaking, or by indirect contact with infected individuals via contaminated objects (Wong et al., 2016). According to the 2014 WHO guideline, respiratory hygiene, hand hygiene, and the use of personal protective equipment is strongly advised while being in close range with an infected person (World Health Organization(WHO), 2014). Hand hygiene must be performed in WHO five moments and also after taking off PPE. Patients must use proper respiratory hygiene and coughing etiquette by using their elbow to cover their mouth while sneezing and coughing, using a disposable tissue to cover mouth and nose when coughing, sneezing, wiping, and blowing their nose and disposing them in a bin (Public Health England (PHE), 2015). But in Indonesia, WHO guideline, respiratory hygiene, hand hygiene, and the use of personal protective equipment have not been applied properly. In the use of good and correct personal protective equipment, the frequency distribution of disobedient officers is greater, i.e., 54.7% compared with obedient officers, i.e., 45.3% (Zahara, Effendi, & Khairani, 2017). In the habit of washing hand properly and correctly, the frequency distribution of respondents who did not wash hands with soap is greater (61.25%) compared with hand washing using soap (38.25%), whereas 86.25 respondents have the abilities of adequate facilities for wash hands with soap (Jelantik & Astarini, 2013). On observation of 5 moment of hygiene in one hospital in Indonesia which provide adequate hand washing facilities, at 30 times observation, there are 11 times not doing 5 moment of hygiene (Dhani, Ulfa, & Setyonugroho, 2017).

3. Proposed Solution Preventing ARI transmission is the most important things, considering that ARI is and highly transmitted. Good prevention ARI is essential to prevent ARI for becoming a global health threat. It also foster health security worldwide. According to the 2014 WHO guideline, respiratory hygiene, hand hygiene, and the use of personal protective equipment, cough etiquette, hand hygiene, equipment for protection, and waste disposal is strongly advised. All of those strategies can reduces the risk of transmission of respiratory pathogens to health-care workers and other people interacting with the patients.

Society need to be involved in ARI preventing, because society awareness can help to foster the prevention of ARI and also break the chain of infection. To improve society awareness, we propose to promote the prevention of infection with a campaign slogan and acronym: â&#x20AC;&#x153;Prevent Infection by CHEW-ingâ&#x20AC;?. CHEW is an acronym of cough etiquette, hand hygiene, equipment for protection, and waste disposal. CHEW is an acronym that is easy to remember, therefore it is easier to be shared and implemented by the general public.

4. Conclusion Acute respiratory infection (ARI) is one of the infectious disease that become the main cause of morbidity and mortality. Around 4 million people in the world die each year because of ARI (World Health Organization(WHO), 2014). In Indonesia ARIs period prevalence is 25% (Badan Penelitian dan Pengembangan Kesehatan, 2013). Acute Respiratory Infection (ARI) is highly transmitted and mostly transmitted through three ways; droplet transmission, airborne transmission, and contact transmission Preventing ARI transmission is the most important things, considering that ARI is highly transmitted. Good prevention ARI is essential to prevent ARI for becoming a global health threat. It also foster health security worldwide.

According to the 2014 WHO guideline, cough etiquette, hand hygiene, equipment for protection, and waste disposal is strongly advised. But in Indonesia, cough etiquette, hand hygiene, equipment for protection and waste disposal have not been applied properly. Hence, in ARI preventing strategy, society need to be involved, because society awareness can help to foster the prevention of ARI and break the chain of infection. To improve society awareness, we suggest to promote the prevention of infection with a campaign slogan and acronym: “Prevent Infection by CHEW-ing”. CHEW is an acronym of cough etiquette, hand hygiene, equipment for protection, and waste disposal. CHEW is an acronym that is easy to remember, therefore it is easier to be shared and implemented by the general public.

5. Recommendation Government, especially ministry of health is needed to define the policies and procedure. Obedience and awareness of health-worker and society has the main role to support the success of this campaign. Those strategies can reduce, but can’t eliminate, the possibility of suffering acute respiratory infection. Therefore, the appropriate implementation of this campaign requires cooperation from all those parties.

6. References Badan Penelitian dan Pengembangan Kesehatan. (2013). Riset Kesehatan Dasar (RISKESDAS) 2013. Laporan Nasional 2013, 1–384. https://doi.org/1 Desember 2013 Dhani, L. R., Ulfa, M., & Setyonugroho, W. (2017). Infection Control Risk Assesment ( ICRA ) DI Unit Hemodialisa Rumah Sakit PKU Muhammadiyah Gamping, 1(1), 150–156.

Ferkol, T., & Schraufnagel, D. (2014). The global burden of respiratory disease. Annals of the American Thoracic Society, 11(3), 404–406. https://doi.org/10.1513/AnnalsATS.201311-405PS Jelantik, I., & Astarini, I. (2013). Hubungan pengetahuan, sikap dan ketersediaan sarana dengan kebiasaan cuci tangan pakai sabun untuk mencegah diare dan ispa pada ibu rumah tangga di kelurahan Ampenan Tengah kota Mataram. Media Bina Ilmiah, 53(9), 1689–1699. https://doi.org/10.1017/CBO9781107415324.004 Public Health England (PHE). (2015). Infection control precautions to minimise transmission of acute respiratory tract infections in healthcare settings, (October). Wong, V. W. Y., Cowling, B. J., Aiello, A. E., Kong, H., Region, S. A., Kong, H., … Carolina, N. (2016). Hand hygiene and risk of influenza virus infections in the community: A systematic review and meta-analysi. Epidemiol Infect, 142(5), 922– 932. https://doi.org/10.1017/S095026881400003X.Hand World Health Organization(WHO). (2014). Infection prevention and control of epidemicand pandemic-prone acute respiratory infections in health care. WHO Guidelines, 1– 156. Retrieved from http://apps.who.int/iris/bitstream/10665/112656/1/9789241507134_eng.pdf?ua=1 Zahara, R. A., Effendi, S. U., & Khairani, N. (2017). Kepatuhan Menggunakan Alat Pelindung Diri ( APD ) Ditinjau dari Pengetahuan dan Perilaku pada Petugas Instalasi Pemeliharaan Sarana Dan Prasarana Rumah Sakit ( IPSRS ), 2(2), 153– 158.

7. Contact details of Regional Chairperson Name Email

: Elvira Lesmana : rcindonesia@amsa-international.org Phone

number : +6285811240637

THE IMPORTANCE OF DIPHTHERIA VACCINE AND INCREASED AWARENESS OF HOAX ABOUT DIPHTHERIA VACCINE AS INFECTION CONTROL TO IMPROVE QUALITY OF LIFE FOR CHILDREN IN INDONESIA

Maria Harin, Maulana Wildan S., Nico Savero, Yogesvara. th

2 year medical student, 2nd year medical student, 2nd year medical student, 2nd year medical student

THE IMPORTANCE OF DIPHTHERIA VACCINE AND INCREASED AWARENESS OF HOAX ABOUT DIPHTHERIA VACCINE AS INFECTION CONTROL TO IMPROVE QUALITY OF LIFE FOR CHILDREN IN INDONESIA Maria Harin, Maulana Wildan S., Nico Savero, Yogesvara. 2th year medical student, 2nd year medical student, 2nd year medical student, 2nd year medical student

INTRODUCTION Diphtheria is an infectious tropical disease caused by Corynebacterium diphtheriae.

Diphtheria can be transmitted through patientâ&#x20AC;&#x2122;s or carrierâ&#x20AC;&#x2122;s droplet. The clinical manifestation of diphtheria is not caused by the presence of the bacteria, instead caused by its exotoxin. The pathogenicity of diphtheria results from an invasion of toxigenic bacteria at local tissue of the throat preceded by colonization and proliferation, and from protein synthesis inhibition induced by the diphtheria toxin [1]. In 2014, the prevalence of diphtheria in Indonesia is on position three after India and Nepal. The prevalence escalation is noticed in 2010 until 2012, and had been decreased in 2013 and 2014 [2]. Based on Indonesia Health Profile 2016, 415 diphtheria cases were found and 24 of them lead to mortality. East Java is province with the highest number of cases, that is 209 cases followed by West Java with 133 cases [3]. Presence of diphtheria outbreak is related with immunity gap. Immunity gap is about gap or immune void among populations in the region. This immune void can be happened because of accumulation of group which is susceptible towards diphtheria, this group usually does not get immunization or may be they get uncomplete immunization. Recently, in some region in Indonesia, there are rejections toward immunization. This causes the low immunization scope factors [4]. Diphtheria commonly happens on children, but it is not impossible for adult to get diphtheria. According to the Ministry of Health of the Republic of Indonesia 2016, 59% of diphtheria cases occur in the age group of 5-9 years and 1-4 years. In the age group 10-14 years, 11% of diphtheria cases, and 28% of cases in the age group 15 years and over. Based on the proportion of diphtheria cases by age group, it can be seen that children under the age of 10 have the greatest percentage. Of all the extraordinary cases of diphtheria, 51% were not vaccinated [3]. Besides, according to InfoDATIN released by Ministry of Health of the Republic of Indonesia 2016, routine immunization scope of diphtheria in Indonesia reached 93,1% [5]. In fact, success of diphtheria prevention by immunization must be reached 95% [4].

Based on data, it is known that the high number of incidence in Indonesia is caused by the low awareness of vaccination. Low levels of vaccination can be caused by several things, one of which is a lot of hoax news circulating about the vaccine. The era of globalization makes everyone able to access various information only through their gadgets. According to IDAI (Indonesia Pediatrician Association), people should deal with fake news or hoax about diphtheria and also immunization wisely. The truth of every news should be evaluated. We should always prove the truth of all news in social media before sharing it to others [6]. The Internet is a very complete medium for information. There is a lot of misinformation about vaccination that can be found over the internet. It was found that websites accessed by some people provide information that the vaccine is toxic and cause idiopathic disease. Some of the diseases associated with vaccines are AIDS, asthma, autism, cancer, diabetes, fibromyalgia, leukemia, lupus, sudden infant death syndrome, and others. Some anti-vaccine websites promote alternative medicines such as herbs, this idea is rooted in the desire to "back to nature" (on 88% of sites). Morality, religion, and ideology also enter as an excuse, 25% of websites argue reluctantly for vaccines because of religious principles, 38% of sites mention that vaccines are immoral [7]. These reasons are related to one another. A solution is needed to minimize the spread of misinformation about the vaccine so as to raise awareness of the importance of vaccination that ultimately aims to improve the quality of life of children to adulthood. II.

PROBLEM DISCUSSED In the previous section has presented some data about the high number of cases of diphtheria

in Indonesia from year to year. Of all cases that have been described, some patients managed to recover from diphtheria and some others died from this disease. Diphtheria can be categorized into 2 categories, namely probable cases and confirmed cases. Probable cases are cases that showing symptoms of fever, swallowing pain, white membranes in the throat (pseudomembrane), frequent neck swelling and shortness of breath accompanied by sound (stridor) [8]. Confirmation cases are probable cases accompanied by positive laboratory confirmation results of Corynebacterium diphtheria or there is an epidemiological relationship with other confirmed cases [8]. Based on the Guidelines for the Immunization and Surveillance Guidance in the Response of Disease Outbreaks, if there is one case of diphtheria, can be cases of probable diphtheria and confirmed diphtheria cases can be defined as Extraordinary Occurrences (outbreak) and should be addressed to reduce morbidity, death , as well as disease transmission rates Thus, this type of illness requires immediate management. Compared to treatment for the healing process of diphtheria patients, it is better to take precautions [9].

One of the preventive measures was mentioned in the previous section, it is vaccination. Vaccination or immunization is a way of preventing infectious diseases given to infants, children and adults by providing bacterial or virus antigens that have been weakened or switched off with the aim of stimulating the body's immune system to form antibodies, thereby preventing or reducing the consequences of transmission of infectious diseases that can be prevented by vaccination [5]. The Government of Indonesia proclaimed the diphtheria immunization as one of the basic mandatory immunization program to prevent the outbreak of this disease. Diphtheria vaccine is combined with pertussis and tetanus (DTP) in its application. According to the Indonesian Association of Pediatricians in 2017, DTP vaccine is given to 2-month-old neonates (DTP 1), 3 months (DTP 2), 4 months (DTP 3), followed by 18 months (DTP 4) and 5 years (DTP 5), then at the age between 1012 years (DTP 6), and at the age of 18 years (DTP 7). The first DTP vaccine is given as early as 6 weeks. DTPw or DTPa vaccine or a combination with other vaccines can be given. If the DTPa vaccine is given then the interval follows the recommendation of the vaccine, which are at the age of 2, 4, and 6 months. For children older than 7 years are given Td or Tdap vaccine. While for DTP 6 can be given Td / Tdap at the age of 10-12 years and booster Td are given every 10 years [10]. Government programs and immunization schedules that have been prepared are socialized to the wider community. In fact, the implementation of the program did not fully work. According to the Ministry of Health of the Republic of Indonesia 2016, 59% of diphtheria cases occur in the age group of 5-9 years and 1-4 years. In the age group 10-14 years, 11% of diphtheria cases, and 28% of cases in the age group 15 years and over. Based on the proportion of diphtheria cases by age group, it can be seen that children under the age of 10 have the greatest percentage. Of all the extraordinary cases of diphtheria, 51% were not vaccinated [3]. Some people do not get vaccination due to several factors. One factor that may have a correlation with low levels of vaccination is the spread of hoax about vaccinations circulating in the community. Any information can be obtained easily through the internet and not infrequently the information uploaded to a site does not guarantee the real facts. As already explained, there are websites that disseminate information about the adverse effects of vaccines. Information about the vaccine that can cause autism, disability, death and so on is expressed without a clear research base, even some of the websites are spreading information that is destined for personal gain such as selling herbal medicines. Internet usage statistics show approximately 74% of Americans and 72% of Canadians are online [11]. An estimated 75-80% of users search for health information online [12]. Of these users, 70% say the information they encounter online influences their treatment decisions [13].

III.

PROPOSED SOLUTION Based on the description above, it is concluded that vaccination brings many benefits in order

to prevent diphtheria. As example in Ukraine, Diphtheria vaccine has 98.2% effectivity against the disease [14], as in Indonesia, the newest vaccine (Hb-DPt-HiB) has more than 90% effectivity. The effectivity can be monitored as seroprotection rate in correlation with the increase of antibody response [15]. But many people still hesitate to do vaccination because of their low awareness, ignorance and false knowledge about immunization. In this era of globalisation, social media and internet are development of technologies which help people to communicate with each other easily and sharing information. The nature of the Internet allows any and all opinions to spread widely and instantaneously. Individuals and groups gain exposure online without being filtered or reviewed. Over half (52%) of users believe “almost all” or “most” information on health websites is credible; yet the availability of inaccurate and deceptive information online has labelled the Internet a “modern Pandora’s box” [7]. Unluckily, there are a lot of unresponsible people who make false information or hoax to benefit theirselves in a certain way, including wrong information about diphtheria vaccination such as vaccination makes autism, disability, and bring disease to person who get injected. This kind of message usually has an ending like a chain-message which encourage people to share it to their beloved persons so that the number of people who declined vaccination is increased. So we proposed a solution that encourage people to be more selective in selecting information they read and shared based on the truth of the information through this video, especially about diphtheria vaccination. The way to sort the right information is to look at the source of the information. Do not easily trust information with dubious sources, when receiving such information, it would be nice to re-check the relevant information in trusted sources such as journals, or information issued by the authorities. If the information is found to be false, do not disseminate the information to others, otherwise if the information is true, then the dissemination of information can be done. The habit to recheck every information obtained cannot be acquired instantly. Habituation from early of age need to be done. This method can be applied in forms of informal education from parents to children in family environment or even in formal education in the nearly future. It would be nice if curriculum for our student in primary school can be added critical thinking subject, which can train them to be more selective in receiving any information from any source. Then it is expected that they can learn re-checking information obtained habit in the early age. Since the dissemination of hoax about vaccination can be categorized as one of the urgency in Indonesia, we can proposed a short term solution while the habitual of re-checking information obtained is in progress. It is important to take a proactive action through health campaign regarding vaccination by health care provider. Health care provider can explain how vaccine works and how important it is to prevent some diseases. The simple explanation like vaccination is like school for our immune system, we introduce antigen to our immune system so that our immune system is well

prepared if the real antigens are attacking our body. It is important too to explain that the doses given in vaccine is not enough to make a bad reaction just like the real antigen do. In short, vaccination in crucial in preventing some diseases and its safety is ensured. Regarding to the dissemination of hoaxes, government or any authorized organization can make some kind of application or web to facilitate people to check whether the information they obtained is hoax or not. It is important because of what mentioned before that over half (52%) of internet users believe “almost all” or “most” information on health websites is credible [7]. It will be hard for people to categorized which source is credible and which one is not. With the facilitation provide by the government which work like a hoax filter, information obtained can be rechecked first by experts before it is sent to others. Automatically, the dissemination of hoax will be reduced. IV.

CONCLUSION Immunization achievements in 2015 in Indonesia have not reached 95%, whereas the

prevention of diphtheria with immunization is said to be successful when it reaches 95% [4]. In some areas of Indonesia there is a rejection of immunization caused by various things. The sheer number of fake news and widespread antivaksin movements on the internet affects the low rate of vaccination. According to IDAI (Indonesia Pediatricians Association), people need to address the news slant or gossip or hoax regarding diphtheria and immunization wisely. Every news needs to be evaluated in truth, even from people we fully trust. It is suggested that news on social media or mass media is not directly disseminated before it is verified [6]. Therefore, the habit of rechecking the news obtained is indispensable to the people of Indonesia. With critical thinking, it can be overcome. With the addition of critical thinking subjects at the primary school level, children will have the culture to think critically in dealing with all the information they get, including checking the truth of dubious information. But it is not easy to implement such a policy in a short periode, meanwhile to overcome the current problems, health campaign regarding vaccination by health care provider can be used to increase the awareness of vaccination and later, implementation of hoax filter that can be used to check the truth of news circulating, especially about diphtheria vaccine can be taken into account to facilitate people in categorizing which one is hoax and is not. It is time to clear the hesitancy about the safety of diphtheria vaccination since it has already been scientifically proven. This way, we can reduce the spread of false information and automatically increasing the number of people who want to get vaccinated. If this solution works, we can build herd immunity against diphtheria and we are one step ahead in eradicating diphtheria in this world.

RECOMMENDATION In order to change people’s behaviour, it’s important to look after what is underlying their

reasons behind that behaviour. In our proposed solution, we focused on perceived of benefit and perceived of severity behind the vaccination. First, in doing health campaign about the importance of diphtheria vaccination, it is important to emphasize how effective vaccine is in order to prevent diphtheria. Data from many researches and even showing off the condition of other developed countries which used vaccination to protect their people can be used to support the impact on increasing the perceive of benefit regarding vaccination. On the other side, by presenting the complication of diphtheria, how diphtheria can cause death in example, we can raise the perceived of severity in people regarding diphtheria. The same method can be implemented on increasing the critical thinking aspect later when critical thinking subject is implemented in primary school curriculum. While for the hoax filter provided by the government, this program is not-so-easy to be implemented since programming experts and health experts are needed. Expertise is not the only one needed in this program because this program need to be maintained for the time being. People who have the same interest in health, vaccination to be precise, is needed because reading all people’s message while waiting for the programmer to perfect this program (until this program can work by its own by using data programmed into it) is not an easy work to do. But having the same interest will make they enjoy this work to the fullest while contributing to the eradication of diseases. By solving problem from its underlying reason, it is expected to be able to change someone’s behavior for the better. People’s behavior determines their decision, and their decision determines their life in the future. VI.

REFERENCES

1. Mulyastuti, Y., Siwipeni I.R., Sunarno S., Sanarto S., Eddy B. W. (2017). Short Communication: Investigation of Diphtheria in Indonesia: dtxR and tox genes analysis of Corynebacterium diphtheriae collected from outbreaks. 18(2): 784-787. 2. Rahman, F.S., Arief H., Fransisca S. 2016. Outbreak Investigation of Diphtheria Outbreak in Geneng and Karangjati Ngawi 2015. Jurnal Wiyata. 3(2): 199-213. 3. Kementerian Kesehatan Republik Indonesia. 2017. Profil Kesehatan Indonesia Tahun 2016. Page 174-175. 4. http://www.depkes.go.id/article/view/17120500001/-imunisasi-efektif-cegah-difteri.html. Published on December, 3rd 2017. 5. Pusat Data dan Informasi Kementerian Kesehatan Republik Indonesia. 2016. Situasi Imunisasi di Indonesia. Page 5-6.

6. http://www.idai.or.id/artikel/seputar-kesehatan-anak/kejadian-luar-biasa-difteribagaimanaorang-tua-bersikap. Published on December 28th 2017. 7. Kata, Anna. (2009). A postmodern Pandora’s box: Anti-vaccination misinformation on the Internet. Department of Anthropology, Chester New Hall, McMaster University. 28(2010): 1709-1716. 8. Alfina, R., Muhammad Atoillah I. 2015. Factors Related to the Active Role of the Volunteer in the Crawl Probale Case of Diphtheria. Jurnal Berkala Epidemiologi. 3(3): 353-365. 9. Kemenkes RI. 2013. Berdasarkan Buku Petunjuk Teknis pelaksanaan Imunisasi dan Pelaksanaan Surveilans dalam Penanggulangan KLB Difteri, in Rahman, F.S., Arief H., Fransisca S. 2016. Outbreak Investigation of Diphtheria Outbreak in Geneng and Karangjati Ngawi 2015. Jurnal Wiyata. 3(2): 199-213. 10. Indonesia Pediatricians Association (IDAI). 2017. Jadwal Imunisasi Anak Usia 0-18 Tahun. 11. Internet

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telecommunications reports, http://www.internetworldstats.com/stats14.htm; 2009 [accessed 29.10.09], in Kata, Anna. (2009). A postmodern Pandora’s box: Anti-vaccination misinformation on the Internet. Department of Anthropology, Chester New Hall, McMaster University. 28(2010): 1709-1716. 12. Pew

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http://www.pewinternet.org/~/media//Files/Reports/2008/PIP_Health_Aug08.pdf; 2008 [accessed 26.04.09], in Kata, Anna. (2009). A postmodern Pandora’s box: Anti-vaccination misinformation on the Internet. Department of Anthropology, Chester New Hall, McMaster University. 28(2010): 1709-1716. 13. Pew Internet & American Life Project. The online health care revolution: how the Web helps Americans take better care of themselves, http://www.pewinterinternet.org/~/media//Files/Reports/2000/PIP_Health_Report.pdf; 2000 [accessed 29.05.09], in Kata, Anna. (2009). A postmodern Pandora’s box: Anti-vaccination misinformation on the Internet. Department of Anthropology, Chester New Hall, McMaster University. 28(2010): 1709-1716. 14. Chen, R.T., et al. 2000. Ukraine, 1992: First Assessment of Diphtheria Vaccine Effectiveness during the Recent Resurgence of Diphtheria in the Former Soviet Union; JID 2000;181 (Suppl 1). 15. Rusmil et al. (2015). The immunogenicity, safety, and consistency of an Indonesia combined DTP-HB-Hib vaccine in expanded program on immunization schedule. BMC Pediatrics; 15:219.

ANTIBIOTIC RESISTANCE IN INDONESIA: FIGHT ANTIBIOTIC RESISTANCE WITH HADAPI

By:

Muhammad Revi Ramadhan, Novelina Gracea, Azzura Jasmine Simanullang, Adisty Aulia Kamarani 2th year medical student, 2nd year medical student, 2nd year medical student, 2nd year medical student

ANTIBIOTIC RESISTANCE IN INDONESIA: FIGHT ANTIBIOTIC

RESISTANCE WITH HADAPI Muhammad Revi Ramadhan, Novelina Gracea, Azzura Jasmine Simanullang, Adisty Aulia Kamarani 2th year medical student, 2nd year medical student, 2nd year medical student, 2nd year medical student

Introduction

Indonesia is a tropical country where it has a high enough number of cases of infectious and tropical diseases. Where the diseases are easily contagious and can be very dangerous such as tuberculosis, cholera, diarrhea and others.

Infection itself is a process of invasion and multiplication of microorganisms such as bacteria, viruses and parasites. Specific for bacterial infection can be treated with antibiotics. Antimicrobials are probably one of the most successful forms of chemotherapy in the history of medicine. Because antibiotics are still believed to be the only ones that can fight bacteria. (Aminov, 2010)

In Indonesia, antibiotics can be very easy to get anywhere even without a prescription. And because of its accessibility, it is making people even lazier to go to doctors and ask for medical professionalâ&#x20AC;&#x2122;s opinion, that leads to consuming it without any vigilance that is harmful for body.

The problem can be called antibiotic resistance. Which based on WHO, antibiotic resistance occurs when bacteria change in response to the use of these medicines. And antibiotic resistance is one of the biggest threats to global health, food security, and development today. (WHO, 2017)

II.

Problem Discussed

Antibiotic resistance occurs naturally, but misuse of antibiotics in humans and animals is accelerating the process. (WHO, 2017) With its evolving era, many bacteria are evolved that cause them to resist against certain antibiotics, causing this to be a serious problem. Where until now, there has not found new medicine that can really be effective against bacteria. Most of antibiotics are the only drugs that are believed to be resistant. In case of resistance, there has not made any substitute that can cope with this problem. (WHO, 2017) Bacteria can be called antibiotic-resistant when they infect humans or animals that can cause them to be harder to treat than those that are non-resistant. The infection itself can occur in all classes, ages and races.

A growing number of infections - such as pneumonia, tuberculosis, gonorrhea, and salmonellosis - are becoming harder to treat as antibiotics used to treat them become less effective. In addition, antibiotic resistance leads to higher medical costs, prolonged hospital stays, and increased mortality. (WHO, 2017)

Antibiotic resistance is a world problem that becomes a concern in all countries. Based on WHO (antimicrobial resistance) global report surveillance, Southeast Asia has the highest case in antibiotic resistance in the world, especially Staphylococcus aureus with resistance to methicillin.(WHO, 2014) Reports of the on antimicrobial resistance review suggest that if there is no effective cure global action, it can kill 10 million lives worldwide each year by 2050, and this number will exceed cancer deaths of 8.2 million lives, resulting in a total loss of up to 100 trillion US Dollar.(O’Neil, 2016)

Indonesia, which is a tropical and developing country, is known to still not having advanced health services and in terms of community itself in the level of awareness for health and knowledge are still low. So the antibiotic and adherence itself are also big problems and burdensome for Indonesia. Data show in Indonesia there are 135.000 deaths per year due to antibiotic resistance based on survey at 6 Hospital in Indonesia in year 2013. (Universitas Airlangga, 2015) Meanwhile, according to research RSUD dr Sutomo Surabaya 2000-2004 and RSUP dr. Karyadi Semarang there are some Multiple Drug Resistance (MDR), Methicillin-resistant Staphylococcus aureus (MRSA), and Extended Spectrum Beta Lactamases (ESBL) and 30-40% usage of antibiotic not according to indication.(Kemenkes RI, 2015)

Incorrect consumption factors, poor aid in developing countries, free antibiotic sales at kiosks, stalls, antibiotic reserve storage at home are the reasons of antibiotic resistance. Also, it is all because people’s awareness regarding the urgency of this issue and knowledge about what to treat and not to with antibiotics, such as common infections caused by virus (colds, flu, most sore throats, most coughs and bronchitis (“chest colds”), many sinus infections, many ear infections), are still low.

III.

Proposed Solution

One of the major contributing factors of antibiotic resistance is peopleâ&#x20AC;&#x2122;s awareness about it and what are common diseases that actually donâ&#x20AC;&#x2122;t need antibiotic as the cure. So, we are proposing a simple tagline summarizing solutions and reminder for people, which is HADAPI: 1. Hindari pemakaian sembarangan or Avoid careless treatment of antibiotic 2. Antibiotik bukan satu-satunya solusi or Antibiotic is not the only solutions for disease (patient may only need to take a rest and have a healthy meal) 3. Diminum sendiri, jangan dibagi-bagi or Consume it by yourself, dont share it with other people even though the symptoms you have with them can be similar 4. Antibiotik harus dihabiskan or Antibiotics need to be consumed as prescribed by your physicians because maybe the symptoms are gone already, but there is still a possibility that the bacteria are still remaining, hiding, and evolving their mechanism to fight antibacteria. So it is better for you to take the medication properly. 5. Perlu resep dokter untuk konsultasi or The use of antibiotics needs to be consulted with health professionals. 6. Ingat! Mencegah lebih baik dari pada mengobati or Remember! Prevention is better than cure.

IV.

Conclusion

Until now, antibiotic resistance is a major health problem in the world. Based on the definition by CDC, Antibiotic resistance is the ability of bacteria to resist the effects of an antibiotic. Antibiotic resistance occurs when bacteria change in a way that reduces the effectiveness of drugs, chemicals, or other agents designed to cure or prevent infections. The bacteria survive and continue to multiply, causing more harm. (CDC, 2017) Actually, bacteria naturally evolve and modify their mechanism to fight against antibiotic, but, with antibiotic resistance, this process is accelerated. This happens when the usage of antibiotic is not right, for example when people take antibiotic for common virus diseases. It can occur when peopleâ&#x20AC;&#x2122;s accessibility to buy antibiotics are easy and knowledge about the usage of it is not adequate enough. By solution we are proposing, which is HADAPI, we are hoping that people will understand easily about antibiotic resistance, its importance, and how to prevent it.

Recommendation

This program will focus on empowering the local peopleâ&#x20AC;&#x2122;s knowledge towards antibiotic resistance by providing education and spreading this HADAPI jargon. We believe that this program will work well if there is a solid work-relationship between local primary health care center, health care professionals themselves, and the local institution, also the citizens itself.

VI.

References

Aminov, R. I. (2010). A Brief History of the Antibiotic Era: Lessons Learned and Challenges for the Future. Frontiers in Microbiology, 1, 134. http://doi.org/10.3389/fmicb.2010.00134 Centers for Disease Control and Prevention. Antibiotic Prescribing and Use in Doctor's Offices. (2017, December 07). Retrieved April 01, 2018, from https://www.cdc.gov/antibioticuse/community/about/antibiotic-resistance-faqs.html Kementerian Kesehatan Republik Indonesia. (2015, August 5). PENGGUNAAN ANTIBIOTIK BIJAK DAN RASIONAL KURANGI BEBAN PENYAKIT INFEKSI. Retrieved April 01, 2018, from http://www.depkes.go.id/article/print/15081100001/penggunaan-antibiotik-bijak-dan-rasionalkurangibeban-penyakit-infeksi.html O'Neil, J. (2016). Tackling Drug-Resistant Infections Globally. Retrieved April 1, 2018. Universitas Airlangga. (2015). Mendunia, Level Resistensi Antibiotik Melewati Ambang Batas. Retrieved April 01, 2018, from http://fk.unair.ac.id/archives/2015/12/08/mendunia-level-resistensiantibiotikmelewati-ambang-batas.html WHO. (2014). Antimicrobial resistance: Global report on surveillance. Geneva, Switzerland: World Health Organization. WHO. (2017, November). Antibiotic resistance. Retrieved March 31, 2018, from http://www.who.int/mediacentre/factsheets/antibiotic-resistance/en/

Regional Chairperson AMSA-Indonesia Elvira Lesmana rcindonesia@amsa-international.org +6285811240637

HAJJ PILGRIMAGE AND INFECTION CONTROL IN INDONESIA: INTEGRATED SOLUTION TO CURRENT PROBLEM WHITE PAPER

ASIAN MEDICAL STUDENTSâ&#x20AC;&#x2122; ASSOCIATION INDONESIA 2018

Introduction As the world's largest population of Muslims, Indonesia every year sends the most pilgrims to

Mecca by far. In 2016, Indonesia sends 168.800 pilgrims and the quota increase in 2017 to 221.000 pilgrims and currently there are 3.2 million of Indonesians in the waiting list for Hajj. 1 During the Hajj, more than two million travelers from over 183 countries throughout the world gather in Mecca. As one of the most geographically and ethnically diverse mass gatherings in the world, the limited space of ritual sites is difficult to expand significantly to accommodate larger numbers of pilgrims. The challenges for overcrowding and space congestion with their physical, environmental, and health hazards has the potential to amplify the risk of disease transmission.2 Indonesia is a very large country with 250 million people, more than 14,000 islands and over 5000 kilometres in length. It is a massive piece of real estate and the Indonesian government struggles to provide adequate health care services across every island.3 The challenges and and limitations of infection control are imposed by geography and economics. The attention towards infectious disease in Indonesia is very lacking compared to the attention towards the non-communicable disease due to extraordinary occurrence of illness not occuring as frequent.4 Therefore then it is safe to say that appropriate strategies for infection

should be applied for the potentially high risk of transmission from Hajj because the currect system of infection control still havenâ&#x20AC;&#x2122;t covered the whole archipelago. Through this paper we would like to highlight some problems regarding the implementation of the current system for disease surveillance and infection control of K3JH (Kartu Kewaspadaan Kesehatan Jamaah Haji/Health Alert Card for Hajj Pilgrims) and our proposed solution to counter the issue. II.

Problem Discussed Coughed droplets and aerosols easily spread infection among people living in proximity, therefore,

respiratory infections are very common among pilgrims. Epidemics of influenza and meningococcal meningitis have occurred repeatedly. Lower respiratory infections are frequent and Pneumonia was found to be the most common cause of hospitalization among pilgrims.6 Moreover, other than Indonesia, 50% of Hajj pilgrims are coming from countries with the highest Tuberculosis frequency such as India, Pakistan, and South Africa which are ranked first, fifth, and seventh respectively in the latest TB report.5 Incidents of Tuberculosis are increasing each year. About one third of the worldâ&#x20AC;&#x2122;s population is infected with tuberculosis (TB) bacteria, and the Southeast Asian nations is the major contributor for those cases. Indonesia is 2nd largest contributor for tuberculosis cases after India. As many as 690,000 TB cases in Indonesia may not be detected or reported. Such unreported and undetected cases could result in more than 100,000 deaths.5 One of the highest risk of acquiring M. tuberculosis infection for Indonesian is during the Hajj season.6 Another risk for transmissions are meningococcal disease, in which its transmission is potential within crowded environments and occassionally experienced during Hajj, as most cases of the 2000 outbreak of meningococcal disease are found in Saudi Arabia.7 Possible health threat to pilgrims also include food and waterborne diseases due to the possible breaches of food hygiene standards, shortage of clean water, the presence of mildly ill and asymptomatic carriers of pathogenic bacteria and viruses, and the preparation of large number of meals that may be poorly stored by pilgrims.8 Additionally, the disease that gained most attention for Hajj pilgrimage is MERS-CoV (Middle East Respiratory Syndrome Corona Virus). The disease raises concern as transmission in home countries after travelling to MERS-CoV country has been reported, e.g. United Kingdom, France, and South Korea.8 The risks of communicable diseases acquired after Hajj pilgrimage should get more attention from the Indonesian government as well as the healthcare providers. This problem should considered largely not only for introduction of new endemic species, but also because the effect of the introduction of new microbial strain to the gene composition in the gene pool. These strain will also in turn affect the virulence of the

whole species by interacting with other existing strain by transduction. The current surveillance system for infection after Hajj pilgrimage is K3JH (Kartu Kewaspadaan Kesehatan Jamaah Haji/Health Alert Card for Hajj Pilgrims) specifically for MERS-CoV. The K3JH/HAC is given after the arrival of Hajj pilgrims in their homeland and should be returned in 14 days after the arrival to the local Puskesmas (Public Health Clinic) for the last check-up. The 14 days surveillance is taken according to the incubation period of MERSCoV. If the pilgrim is not infected, the K3JH/HAC will be reported to the public health clinic of the central region.9 There are two critical points for the implementation of the K3JH/HAC system that we find problematic. The first one would be the exclusivity of the K3JH/HAC that is merely focusing on MERSCoV for the time being. It is not strategic for the government to focus only on the Hajj pilgrimage before they depart to Saudi Arabia, therefore we think that such surveillance that covers holistic health check-ups is ideal for infection control and prevention. With the possible transmission of other infectious diseases and short-term surveillance, we question the effectivity of this system to eradicate incidents for diseases imported from the Hajj. The second problem that we found is that the surveillance system of K3JH is not thoroughly controlled by the government. Given the fact that some pilgrims are not well-informed about the recollection of the K3JH/HAC after their arrival resulting in some of the cards left unreturned thus the surveillance is not properly conducted by the local public health clinic. This leads to our next point that the tracking of K3JH/HAC is lacking supervision and reports to the Ministry of Health of Indonesia, that the reports of those cards are not sufficient to prove whether this system is effective for a surveillance of infectious disease. 10,11,12,13 The inefficacy of this surveillance could result in undetected or unreported cases of disease and the infection control cannot be conducted properly. We would like to highlight this problem given that the current prevention and control for infection in Indonesia is already there but is not thoroughly organized and controlled, thus we fear that the existence of possible risks from Hajj pilgrimage will create even more catastrophic environment for disease transmission from the Hajj season. III.

Proposed Solution Having all our main concerns for this system settled, we would like to propose our solution. First,

further and more holistic surveillance system for other possible and urgent infections should be conducted, such as Tuberculosis, Hepatitis A, etc. This system includes additional phase for check-ups. The first recollection or check-up would be the current 14 days program, with the addition of 1month check-up. Those additions are proper for the screening purposes of Hepatitis A and Tuberculosis respectively.5,14 The visit for check-ups and recollection of K3JH/HAC should be fitting to other possible diseases that are not mentioned above. Therefore, additional content for the K3JH/HAC is required.

Secondly, to increase supervision for each Hajj pilgrims we would like to encourage public health clinic in primary healthcare settings to implement â&#x20AC;&#x2DC;mapping systemâ&#x20AC;&#x2122;. This system is similar to the already existing mapping system for pregnant women near the public health clinic to anticipate for the birth and to control the health of the mother and the baby. The public health clinic would map out the Hajj pilgrims in that region along with the departure and arrival from Hajj, address, and contact details, therefore this data will be used to control the recollection of K3JH/HAC and the check-ups. With the partnership from the public health clinic and the Ministry of Religious Affairs of Indonesia, this data should be collected the moment Hajj pilgrims are verified to participate in the pilgrimage. To inform the Hajj pilgrims, we would like to propose the SMS (Short Message Service) system to remind the Hajj pilgrims 3 days prior to their schedule to recollect the K3JH/HAC as well as to have health-check up in the local public health clinic. This SMS system should be conducted by the public health clinic staffs or doctors because they are responsible of the Hajj pilgrims in their region. We believe that this system is feasible and effective to inform the hajj pilgrims and at least one member of their family. IV.

Conclusion

There are many potential health hazards for the Hajj pilgrims. Indonesia as the country with the highest number of Hajj pilgrims each year should increase the infection and prevention control due to the amplification of risks for disease transmission during the Hajj season. The current health service for Hajj already covers the health check-ups prior to the departure but not so much for the returning Hajj pilgrims. The current K3JH/HAC system are focusing only on the infection of MERS-CoV, and not covering the other potential diseases such as Tuberculosis, Pneumonia, Hepatitis A and B, etc. Therefore, the improvement of the system for surveillance and screening purposes should be conducted, by a holistic approach to the check-ups and as well as the supervision of the K3JH/HAC through the mapping system for each Hajj pilgrims near the public health clinic in each region and the proliferation of information about the K3JH/HAC recollection and check-ups through the SMS (Short Message Service) that is currently trending to spread information and gather attention should be conducted by the staffs or doctors of the public health clinic, therefore the Hajj pilgrims will be more motivated to come and recollect the K3JH/HAC, therefore infection control will be easier to be conducted and supervision for this policy will be easier to be evaluated.

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AN INTEGRATED DATABASE SYSTEM TO PROVIDE DEPENDABLE DATA REQUIRED IN THE EFFORT OF INFECTION CONTROL

Edwin Setyawan, Kenvin Marfian, Marcia Pragita Harsyani, Priscilia Agatha ASIAN MEDICAL STUDENTSâ&#x20AC;&#x2122; ASSOCIATION INDONESIA

An Integrated Database System to Provide Dependable Data Required in The Effort of Infection Control

Edwin Setyawan, Kenvin Marfian, Marcia Pragita Harsyani, Priscilia Agatha Asian Medical Students’ Association

Introduction In the medicine world, infection has been known as an inevitable problem. Being ranked at number three in the world’s mortality causes, infectious disease has become one of the world’s biggest health concerns. As a developing country, the number of infections-related deaths per year in Indonesia while being treated in health care facility has reached over 40,000 occurrences per year on respiratoryrelated cases only. The nation’s Ministry of Health has included infection as one of the nation’s ‘triple burden’, along with non-communicable disease and resurfacing disease. These epidemiological proof and governmental interference show how vital infection problem actually is in Indonesia, yet the management for the cases still shows evident shortcomings, presumably because of incompatible strategies.

To cure an infection, a physician must prescribe antibiotics. It is known that the effects of antibiotics would only be effective if the drugs being prescribed were consumed completely. If one’s antibiotics treatment was not completed there is 32,6% chance that the bacteria causing the infection would learn to adapt to the antibiotics’ bactericide effects, which will result in a condition known as antibiotics resistancy. Patients might also develop antibiotics resistancy by themselves through genetics. On the other hand, a misdiagnosis from the physician who might assume that a patient’s symptoms require antibiotics medication may also causes antibiotics resistancy. Therefore patients’ compliance, patients’ genetics, and physicians’ ability to choose effective drugs are the three aspects that we have to consider in understanding the cause of this matter. In Indonesia, reported antibiotics resistancy cases reach roughly 480.000 new cases per year. This number has been linked to a data from Litbangkes that shows that 27,8% of Indonesian households own unprescribed antibiotics at home. Indonesia’s Ministry of Health has intiated several programs and projects to maximize infection control, yet it is in fact rather difficult to evaluate whether these efforts have reached their goals. The lack of accessible and dependable data also aggregate the problem of evaluating the program in order to truly recognize the underlying reason of infection-related issues in this country. A sufficient and effective tool to keep track of patient’s compliance and history of previous infections might be able to resolve this problem. Therefore, an integrated system to collect data could be applied in order to support better evaluations in the future.

Problem Discussed

According to Riskesdas (Riset Kesehatan Dasar) 2013, the incidence of airborne infectious diseases such as URTI are high, with a relatively similar incidence rate between 2007 and 2013 (25.5% in 2007 and 25% in 2013). The incidence and prevalence of pneumonia are high in several regions in Indonesia such as Nusa Tenggara (4.6% and 10.3%), Papua (2.6% and 8.2%), Central Sulawesi (2.3% and 5.7%), West Sulawesi (3.1% and 6.1%) and South Sulawesi (2.4% and 4.8%). West Java, South Java and Jakarta had the highest case fatality rate of pneumonia in 2016.

Infectious diseases could spread through food, water, etc. One of the infection-related diseases that still has a high prevalence rate in Indonesia is diarrhea, with Papua, South Sulawesi, Aceh, West Sulawesi and Central Sulawesi as the regions with the highest rate. Another infectious disease that still has a high prevalence in Indonesia is hepatitis, with a prevalence of 1.2% in 2013, twice the number in 2007. Infectious diseases that spread via an animal vector, in this case, malaria, is also a serious health issue in several regions in Indonesia such as Papua, Nusa Tenggara, West Papua, Central Sulawesi and Maluku.

Reflecting on the numbers shown above, infections-related diseases should be one of our main focus in the medical world that should be worked upon, not only by health workers, but everyone. We have to reinforce the public awareness of antibiotics usage and antibiotics resistance.

From recent studies, there are two aspects that should be evaluated in antibiotics usage: (1) quantity, which include the appropriateness of dosage and the duration of therapy; and (2) quality, which include the inspection of medical records by independent reviewers who use a standardized format to assess antibiotics prescription. From these aspects, some mistakes may arise, such as prescribing inappropiate dosage because of suboptimal interval or route of administration, inadequate duration of therapy, or ineffectual type of antibiotics.

With an estimated population of 258 million people, Indonesia is the fourth most populous country in the world while economically, it is categorised as a lower-middle income country. Studies from the 1990s reported that 21% and 36% of S. pnemumonia infection in Indonesia are penicilin- and erythromycin-resistant respectively. In 2001, E. coli from rectal samples showed remarkably high resistance to ampicilin (73%), trimethoprim-sulfamethoxazole (56%) and ciprofloxacin (22%). Over the past decade the emergence of ESBL (Extended Spectrum Î˛ Lactamase) producing bacteria and carbapenem resistant Enterobacteriaceae has become a worldwide threat to public health.

The challenges of antimicrobial resistance that Indonesia faces are similar to many other economically low-middle income countries. Some main factors that contribute to the problem of

antimicrobial resistance are unnecessary prescription of antibiotics by physicians and high rates of self medication. Several contextual factors influencing antibiotics usage are known, including a weak policy enforcement, poor governance, lack of education, and an overly easy access to cheap antibiotics.

Based on the analysis and monitoring of antimicrobial resistance (AMR) in Indonesia in 2016, Indonesiaâ&#x20AC;&#x2122;s Ministry of Health had specified seven indicators which correspond to seven focus to improve analysis and evaluation of antibiotics resistance in Indonesia and developed by South-East Asia Region (SEARO). The indicators are: (1) AMR action plan in line with GAP-AMR; (2) AMR awareness raising; (3) national AMR surveillance; (4) antimicrobial stewardship and surveillance of antimicrobial use and consumption in the community; (5) infection prevention control in healthcare settings; (6) research and innovation to combat AMR; (7) and One Health engagement.

From these focus, Indonesia has only achieve phase 2 (programme installation) and phase 3 (initial implementation) which means that there are still more works to be done. We need indicators to know whether or not the system has run well, and those indicators must include multidisciplinary participants in order to realize a comprehensive One Health approach. So far, the Indonesian government has made some efforts to overcome antibiotics resistance, from conducting extensive researches on antibiotics usage to establishing health programs. The researches mainly seek to analyze the progress of antibiotics resistance containment and control, while the most specific program related to infection-control that the nationâ&#x20AC;&#x2122;s Ministry of Health has established in hospitals all over the country is the PPRA (Program Pengendalian Resistensi Antimikroba). This program contains details from the Regulation of the Ministry of Health, No 8 in 2015. This regulation specify the formulation of an antimicrobial resistance control committee called KPRA (Komite Pengendalian Resistensi Antimikroba), with the following details:

secara luas baik di fasilitas pelayanan

Chapter 1 Verse 3 : Antimicrobial Resistance

kesehatan dan di masyarakat.

This regulation also mentions the components of the PPRA executive team: Control Committee, hereinafter abbreviated KPRA, is the committee which is formed by

Chapter 8 Verse 1: The PPRA executive team in

the Ministry of Health in order to control the

hospitals as describe in chapter 7 verse 2 at least

widespeard use of antimicrobials in healthcare

consists of:

facilities and society.

a. Representative clinician of the functional

Pasal 1 Ayat 3: Komite Pengendalian

medical staff (SMF, Staf Medis Fungsional)

Resistensi Antimikroba yang selanjutnya

b. Nursing;

disingkat KPRA adalah komite yang dibentuk

c. Pharmaceutical installation;

oleh Kementerian Kesehatan dalam rangka

d. Clinical microbiology laboratory;

mengendalikan

e. Infection prevention control (PPI, Pencegahan

penggunaan

antimikroba

Pengendalian Infeksi) committee/team;and f. Pharmacy and therapy committee/team (KFT, Komite Farmasi dan Terapi).

ayat (2) paling sedikit terdiri atas unsur: a. Klinisi perwakilan SMF/bagian; b. Keperawatan; c. Instalasi farmasi;

Pasal 8 Ayat 1: Keanggotaan tim pelaksana

d. Laboratorium mikrobiologi klinik;

Program Pengendalian Resistensi Antimikroba

e. Komite/tim Pencegahan Pengendalian Infeksi

rumah sakit sebagaimana dimaksud dalam Pasal 7

(PPI); dan

f. Komite/tim Farmasi dan Terapi (KFT). From those efforts that has already been undertaken, we have gained an overview of the state of the nationâ&#x20AC;&#x2122;s antimicrobial resistance by identifying the bacteria that have been resistant to current drugs, the number of people who experiences antimicrobial resistance, and their spread. The main difficulty in our efforts of overcoming antibiotics resistance until now is the lack of an up-to-date, sufficient, and accessible infection-related data in Indonesia. Researches have been few and far between, and they mostly focus on limited regions.

The World Health Organization (WHO) had arranged a program that sought to tackle the problems related to infection control, which is called IPCP (Infection Prevention and Control Programme). IPCP has eight core components:

For this paper, we want to focus our attention to one of the core components mentioned, which is the health-care associated infection surveillance. This component stresses the importance of data collection through AMR surveillance, so that timely feedbacks to health care workers and stakeholders could be continually reviewed throughout the national networks.

As a member of the WHO, Indonesia should implement all the core components mentioned above in every level of health care facilities. However, most hospitals in Indonesia are still not realize how important data about information of antimicrobial resistance is. Furthermore, as we have also already mentioned, researches have been patchy, sporadic, and limited in their scope, usually conducted by only the large university or hospital laboratories. The absence of an integrated data collection system means that the data acquired from previous researches are not easily accessible for further evaluations.

Proposed Solutions Refering to the problems being discussed, we can see clearly that infection still remains to be one of the most formidable health problems in Indonesia. We need to keep unfolding new studies about it in order to improve our health care system and we need to keep promoting infection control, on any of its forms. All countries in the world have their own health management and their own way of how to deal with health issues according to their geographical and demographical configurations, including Indonesia.

However, Indonesia oftentimes referring to the programs that WHO had set, in order to carry out its health care system, which one of them is the IPCP. There are eight components in IPCP. And in this case, we put the highlight on the epidemiologic surveillance aspect.

We are all too aware, however, of how the government have tried to developed several programs to cope with the issue. The thing that is still being our concerned is whether or not these programs have been well evaluated, comprehensively and thoroughly during and after their enforcements. A solution that weâ&#x20AC;&#x2122;re proposing here is that we need to have an established and integrated system to evaluate the data. We need resources that we can trust and an approachable access to them at all times.

Recommendation We have tried to elucidate the importance of an integrated system in our effort of controlling infection, particularly in the aspect of epidemiologic surveillance. Following that manner we recommend a method that takes full advantage of the digital era/information age. Some useful medical-related smartphone apps have been developed in recent years, such as medication reminder apps. Our method takes the form of a simple, yet integrated, database system. A user friendly app for smartphones or PCs will be used as a data entry software. Data input could be done by any registered physicians or health workers through the app. Every inputted data will be sent to the main server straightaway so the database could be regularly processed and updated.

Furthermore, we recommend that this database should be accessible to everyone, so that every person or institution could use the data for their own purposes. We hope that this integrated system could serve as a dependable provider of current infection-related epidemiologic data throughout the country and as a platform to stimulate more and more researches, whether by independent medical students or established research groups. We also hope that the government could also maximize this app potential by using it to evaluate the Ministry of Health programs in infection control so that further programs throughout the nation could be directed more precisely and accordingly.

The components of this app include: diagnosis, prescribed antibiotics, lab results (optional), patientâ&#x20AC;&#x2122;s compliance (the app would notify the patient to take the prescribed antibiotics, and the patient could interactively respond by tapping the notification to signal his/her completion of antibiotics consumption), and the result of the treatment (the patient would have to visit the physician for further assessment, and the physician will have to determine whether the patient has fully recovered or not). We humbly admit that this is still far from perfect and the implementation of this system will not be an easy job, but we hope that the basic idea of an integrated database system could be taken into consideration in our efforts of tackling infection-related problems.

Conclusion An integrated database system is needed to give dependable resource in order to control infection spread in Indonesia. We truly hope that the aforementioned recommendations that we proposed can be applied into regular medical practice on daily basis. Therefore, finally we can provide a simple and accessible-to-all data system that will help improve the quality of our health care management and enhance our attempt of controlling infection in Indonesia.

Contact Details Elvira Lesmana rcindonesia@amsa-international.org +6285811240637

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