ABSTRACT
Objectives: The current vitamin A supplementation (VAS) program recording and reporting system in Indonesia faces inadequacies in terms of accuracy and completeness. This exercise was implemented to identify the bridge these gaps and inform the design of more accurate and efficient monitoring and reporting system. Methods: A review of existing forms and systems was undertaken and health workers and managers were interviewed to identify gaps. The tools were revised to overcome the gaps and field tested. Results: The key gaps identified were the absence of indicators to track stocks, VAS coverage among postpartum women and tracking of children who received VAS in both semesters. Recording forms also lacked parents’ name, severely limiting health workers’ ability to track children. The forms were revised to overcome these gaps. Errors were also identified in the roll up of numbers from health facility to the national level. In order to empower managers to identify and correct these errors, an easy to use tool was developed. Further, a tool to assess data quality across different dimensions of completeness, accuracy, timeliness and data use was developed. These improvements reportedly limited errors and facilitated the feedback loop toward implementing data and program improvements. The revised monitoring tools and the data quality and accuracy assessments were field tested and found to be easily usable by health personnel. Conclusions: Streamlining the information flow and empowering managers with simple tools can be very useful for them to initiate corrective action. The Government has initiated replication of these tools and methods in additional districts.
ABSTRACT
Background: Natural resistance associated macrophage protein (NRAMP) is a proton/ divalent cation transporter which play a role in iron trafficking in the phagosomes. Variations in NRAMP1 gene have been reported to be associated with susceptibility to tuberculosis (TB) because Mycobacterium tuberculosis (MTb), the causative agent of TB, compete with its host to uptake iron for its metabolism. The study aimed to describe the polymorphism of NRAMP among TB patients in Kupang, East Nusa Tenggara. Methods: This is a case-control study, cases were pulmonary TB, new patients, aged 15-55 years with sputum smear positive for acid fast bacili. Control were surrounding neighbours without symptoms and history of TB. All demographic information and blood sample were taken for polymorphism. PCR/RFLP method was performed to explore whether single nucleotide polymorphism D543N of NRAMP1 gene is associated with susceptibility to TB. Results: The study involved 64 pulmonary TB patients and 51 healthy controls. We observed a significant different in the distribution of NRAMP1 genotypes frequencies between TB patients and healthy controls (p = 0.014). Moreover, D543N polymorphism gave significant association only in male subjects. Though the numbers of the subjects are limited, D543N NRAMP1 polymorphism in endemic region in Kupang, the eastern part of Indonesia, seems to be associated with the susceptibility to TB. This is in contrary to studies reported in other part of Indonesia: i.e from west part (Jakarta, Bandung) and central part (Makassar). The population from Kupang may similar genetic background as African population, as Mycobacterium infected in population from Kupang is mostly Mycobacterium africanum. Increasing the number of subjects may enhance the power of the study and possibility to meet Hardy-Weinberg Equilibrium to detect the true associations of this polymorphism in susceptibility to TB. Conclusion: There was a significant difference of polymorphism NRAMP1 which more pronounced among male subjects, however this has not yet fulfilled the Hardy-Weinberg equilibrium.