Streamlining and Standardizing the Collection, Compilation and Use of VAS Program Indicators in the Government HMIS in Indonesia.

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.

Endoscopical appearances of nonsteroidal anti inflammatory drug (NSAID)-enteropathy.

Non Steroidal Anti Inflammatory Drugs (NSAID) have been associated with a sudden and sustained rise in the incidence of gastrointestinal ulcer complications. The aim of the study was to reveal the endoscopical abnormalities found in the duodenum & proximal jejunum due to NSAID. Thirty eight patients taking NSAID for their arthritis or rheumatism were included in this study. Gastro-duodeno-jejunoscopy was done with Olympus PCF-10. The endoscopical appearances of NSAID entero gastropathy were evaluated with a scoring system. The NSAID-entero-gastropathy appearances were endoscopically seen as hyperemia, erosion and ulcer. From all patient recruited, 7.9% complaint of diarrhea and 71.1% complaint of dyspepsia. Endoscopically, in the duodenal bulb we found 79% cases of hyperemia, 39.5% cases of erosion and 7.9% cases of ulcer. In the second part (descending part) of the duodenum we found 28.9% cases of hyperemia, 15.8% cases of erosion and 2.6% case of ulcer. In the jejunum, we found 7.9% cases of hyperemia, 2.6% case of erosion and no ulcer. It is concluded that the most frequent abnormal endoscopical appearances in NSAID- enteropathy was hyperemia. The most frequent site of NSAID-enteropathy abnormal findings was in the duodenal bulb.

The diagnostic value of combined risk factor analysis and radiological imaging in determining osteoporosis in post-menopausal women.

AIM: To determine the diagnostic value of risk factor analysis (age, duration of menopause, body mass index and physical activities) and radiological imaging (Singh index and cortical index of the femoral neck) in diagnosing osteoporosis in post-menopausal women. METHODS: The study was cross sectional on 64 post-menopausal women without secondary risk factor for osteoporosis. They were classified proportionally using the Singh index. Bone density was measured using DEXA (dual x-ray absorptiometry) on the femoral neck and lumbal 2-4 spine areas. The Singh index and cortical index of the femoral neck were evaluated using femoral neck antero-posterior x-ray. Physical activities were measured using a Historical leisure activity questionnaire. Bivariat statistical analysis was conducted using the t-test and chi-square, whereas multivariate analysis was conducted using multinomial logistic regression. RESULTS: There was a significant association (p<0.05) between bone density and age, body weight, height, body mass index, duration of menopause and Singh index. With multinomial logistic regression analysis, it was demonstrated that only Singh index, the duration of menopause and body mass index had the highest sensitivity and specificity. The score system algorithm could be utilized in two steps, the first was to diagnose osteoporosis and the second was to distinguish between osteopenia and normal bone. This score system had a sensitivity of 91.4% and a specificity of 89.6%, a positive prediction value of 91.4% in determining osteoporosis, and a sensitivity of 66.7%, a specificity of 89.1% and a positive prediction value of 70.6% in determining osteopenia, whereas the negative prediction value was 75%. CONCLUSION: The score system algorithm is the best method for determining osteoporosis in post-menopausal women. If there is osteopenia, evaluation using DEXA is then required. The score system algorithm cannot be used to follow up the therapy.

Microorganisms and parasites in chronic infective diarrhea.

AIM: To reveal the pattern of microorganisms in chronic infective diarrhea cases. METHODS: We examined all patients suffering from chronic infective diarrhea over a six year period The patients were examined physically and at the same time laboratory tests,colon enema X-ray and colonoscopy, ileoscopy, upper GI endoscopy and small bowel X-ray were performed. RESULTS: We found 138 (66. 7%) chronic infective diarrhea from 207 chronic diarrhea patients. Parasitic causes were Candida albicans (48.55%), Blastocystis hominis (6.52%), Entamoeba histolytica (3.62%), and Giardia lamblia (3.62%) etc. Bacterial causes were Pathogenic E. coli(34.78%), Aerobacter aerogenes (3.62%), Mycobacterium tuberculosis (3.62%), Geotrichum (1.45%), Shigella sonnei(0. 72%), Salmonella paratyphi (2.89%)etc. CONCLUSION: The most frequent microorganisms and parasites found in chronic infective diarrhea were pathogenic E.coli and Candida albicans.