Child Marriage Acceptability Index (CMAI) as an essential indicator: an investigation in South and Central Sulawesi, Indonesia.

BACKGROUND: Child marriage remains an important social issue in Indonesia. Child marriages were reported from 14.67% in 2008 to 10.82% in 2019. However, 22 out of 34 provinces in Indonesia still had high child marriage rates above the national average in 2019. This study aims to assess child marriage acceptability in the two locations in Indonesia by gender inequality, financial security, education rates, legal frameworks, dowry, and sexual and gender-based violence (SGBV). METHODS: This study used a quantitative approach with a cross-sectional study design. A total of 1000 respondents consisting of 500 households in Bone District, South Sulawesi and 500 households in Palu, Sigi, and Donggala District in Central Sulawesi participated in the study. Data analyses were conducted based on the Child Marriage Acceptability Index (CMAI) using the bivariate correlation, ANOVA (analysis of variance), and logistic regression. RESULTS: This study found several significant factors that contributed to child marriage acceptance in Central and South Sulawesi: household financial security (p = 0.016), dowry (p < 0.001) and legal frameworks (p = 0.017) based on ANOVA analysis. After conducting a bivariate correlation, dowry (p < 0.001) and sexual and gender-based violence (p < 0.001) remain significant factors. Dowry (p < 0.001), with expected B = 0.122, and sexual and gender-based violence (p < 0.001, with expected B = 0.064) remains significant after the linear regression analysis. CONCLUSIONS: Dowry practice and sexual and gender-based violence were the most significant factors contributing to child marriage acceptance in Central and South Sulawesi. There is a need to conduct interventions to prevent child marriage, including providing sexual and reproductive health education.

The effect of the heart rate lowering drug Ivabradine on hemodynamics in atherosclerotic mice.

The heart rate lowering drug Ivabradine was shown to improve cardiac outcome in patients with previous heart failure. However, in patients without heart failure, no beneficial effect of Ivabradine was observed. Animal studies suggested a preventive effect of Ivabradine on atherosclerosis which was due to an increase in wall shear stress (WSS), the blood flow-induced frictional force exerted on the endothelium, triggering anti-inflammatory responses. However, data on the effect of Ivabradine on WSS is sparse. We aim to study the effect of Ivabradine on (i) the 3D WSS distribution over a growing plaque and (ii) plaque composition. We induced atherosclerosis in ApoE-/- mice by placing a tapered cast around the right common carotid artery (RCCA). Five weeks after cast placement, Ivabradine was administered via drinking water (15 mg/kg/day) for 2 weeks, after which the RCCA was excised for histology analyses. Before and after Ivabradine treatment, animals were imaged with Doppler Ultrasound to measure blood velocity. Vessel geometry was obtained using contrast-enhanced micro-CT. Time-averaged WSS during systole, diastole and peak WSS was subsequently computed. Ivabradine significantly decreased heart rate (459 ± 28 bpm vs. 567 ± 32 bpm, p < 0.001). Normalized peak flow significantly increased in the Ivabradine group (124.2% ± 40.5% vs. 87.3% ± 25.4%, p < 0.05), reflected by an increased normalized WSS level during systole (110.7% ± 18.4% vs. 75.4% ± 24.6%, p < 0.05). However, plaque size or composition including plaque area, relative necrotic core area and macrophage content were not altered in mice treated with Ivabradine compared to controls. We conclude that increased WSS in response to Ivabradine treatment did not affect plaque progression in a murine model.

Controlling immune response and demyelination using highly potent bifunctional peptide inhibitors in the suppression of experimental autoimmune encephalomyelitis.

In this study, we investigated the efficacy of new bifunctional peptide inhibitors (BPIs) in suppressing experimental autoimmune encephalomyelitis (EAE) in an animal model. BPI [e.g. proteolipid protein-cyclo(1,8)-CPRGGSVC-NH2 (PLP-cIBR)] is a conjugate between the PLP139-151 peptide derived from proteolipid protein (PLP) and the cIBR7 peptide derived from domain-1 (D1) of intercellular adhesion molecule-1 (ICAM-1). PLP-cIBR is designed to bind to major histocompatibility complex (MHC)-II and leucocyte function-associated antigen-1 (LFA-1) simultaneously to inhibit the formation of the immunological synapse and alter the differentiation and activation of a subpopulation of T cells, thus inducing immunotolerance. The results show that PLP-cIBR is highly potent in ameliorating EAE, even at low concentrations and less frequent injections. Mice treated with PLP-cIBR had a higher secretion of cytokines related to regulatory and/or suppressor cells compared to phosphate-buffered saline (PBS)-treated mice. In contrast, T helper type 1 (Th1) cytokines were higher in mice treated with PBS compared to PLP-cIBR, suggesting that it suppressed Th1 proliferation. Also, we observed significantly less demyelination in PLP-cIBR-treated mice compared to the control, further indicating that PLP-cIBR promoted protection against demyelination.

Impact of a case management protocol for childhood pneumonia in a rural Zambian hospital.

This study aimed to assess the impact of adopting the WHO case management protocol for childhood pneumonia in a district hospital in rural Zambia. The subjects were children under 5 years of age with a diagnosis of pneumonia, admitted in the 9-month period following introduction of the WHO protocol. Management and outcome were compared with a historical control group admitted during the same period in the previous year. There were 158 children in the intervention group and 135 controls with similar age and sex distribution. Both groups were malnourished (mean weight-for-age Z score in subjects = -1.91, in controls = -1.83). There was no significant difference in the numbers receiving parenteral antibiotics or supplementary fluids in each group. However, children in the intervention group were significantly more likely to receive oxygen (odds ratio 4.7, 95% confidence interval 2.8-8.1, p < 0.0001). Mortality was significantly greater in the control group (case fatality rate, 25%) compared with the intervention group (case fatality rate, 15%; chi 2 = 4.6; p = 0.032). The introduction of the WHO protocol for management of childhood pneumonia and training of staff in its use was accompanied by a fall in mortality from this condition in a rural hospital. The improved survival rate may be related to the more frequent use of oxygen.