The effect of COVID-19 on women's experiences of pregnancy, birth and postpartum in Indonesia: a rapid online survey.

BACKGROUND: The interrelationship of psychological and social factors in the current COVID-19 pandemic has been highlighted in research mainly focused on the global north. The impact of lockdowns can exacerbate psychological distress and affect access to services. Less is known about the psychosocial impact on women in the context of lower-middle income countries (LMICs); the aim of this study was to capture the impact of COVID-19 on women's experiences of pregnancy, birth and postpartum in Indonesia. METHODS: We conducted a rapid cross-sectional online survey of women across all 34 provinces in Indonesia to capture participants' experiences. Data were collected between 10th July to 9th August 2020 including demographics, effects on general and mental health and impact on service use. Descriptive statistics and thematic analysis were used to analyse responses, including those women who self-identified with a pre-existing mental health problem. RESULTS: Responses were obtained from 1137 women, this included pregnant women (n = 842) and postpartum women (n = 295). The majority of women (97%) had accessed antenatal care during their pregnancy, but 84% of women reporting feeling fearful and anxious about attending visits, resulting in some women not attending or changing provider. A small number (13%) were denied the presence of a birth companion, with 28% of women reporting that their babies had been removed at birth due to protocols or baby's health. Feeling anxious was a common experience among women (62%) during their pregnancy, birth or postnatal period, with a small number (9%) feeling depressed. Lockdown measures led to tensions within personal and family relationships. CONCLUSIONS: Women in Indonesia reported that the pandemic added an increased burden in pregnancy, birth and post-partum period: physically, psychologically, spiritually and financially. Maternity services were disrupted and health insurance cover lacked responsiveness, which either directly or indirectly impacted on women's choices, and equal access to care. Given the longevity of the current pandemic there is a need to develop tailored supportive interventions for women and their families and develop bespoke training for midwives and other relevant health professionals.

Investigating the Relationship between Knowledge and Hepatotoxic Effects with Medication Adherence of TB Patients in Banyumas Regency, Indonesia.

Tuberculosis (TB) still remains the burden in Indonesia. One of the factors that may influence the treatment success of TB is patient's adherence. However, the hepatotoxicity of the TB medicine may decrease the patient's adherence. Our study's aim is to investigate the relationship between the patient's knowledge and the hepatotoxicity with medication adherence of TB patients in Banyumas Regency. This study was conducted at one Community Lung Health Center and two hospitals in Banyumas Regency, Purwokerto, Center of Java, Indonesia. The respondents were 91 TB patients with hepatotoxicity characterized by an increased aspartate transaminase (AST) and alanine aminotransferase (ALT). The level of the patients' knowledge about the hepatotoxicity effect was determined using a questionnaire. The patients' adherence was determined using the Medication Adherence Rating Scale -5 (MARS) questionnaire and pill count methods. Most of the patients were male (53.8%), the age was in the range of 18-29 years old (3.5%), they have no smoking history (59.3%), and their last education majorly was senior high school (46.2%). Most TB patients had poor knowledge (47.3%) and the hepatotoxic effect often appeared in grade 1 (61.5%). The TB patients with a good and moderate level of knowledge were 17.6% and 35.2%, respectively. The TB patients with moderate and severe hepatotoxicity were 39.4% and 1.1%, respectively. The measurement of the level of respondents' adherence using MARS-5 showed that 51.6% of patients had good adherence. We determined the rest of the drug-using pill count method, which resulted in 62.6% of patients adhering to taking antituberculosis drugs. TB patients with a sufficient knowledge and those with mild hepatotoxicity show the higher adherence (p < 0.001). There is a significant relationship between a high level of the patient's knowledge about hepatotoxicity effect, less severity of the hepatotoxic effect, and increased patient adherence in taking the medication.