Articles
<![CDATA[Risk predictor for ma/aria in pregnancy and the role of chloroquine in /ow endemic area ]]>
<![CDATA[Iwan Dwiprahasto, Iwan Dwiprahasto]]>
<![CDATA[ Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 36, No 1 (2004) ]]>
Publisher : <![CDATA[Journal of the Medical Sciences (Berkala Ilmu Kedokteran) ]]>
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<![CDATA[Background: Pregnant women in malaria-endemic areas are uniquely susceptible to infection with Plasmodium falciparum and this susceptibility is greatest during first pregnancies. Malaria causes serious complications in pregnant women, especially in those who have a low level of acquired immunity before pregnancy.Objective: to assess the risk predictors for malaria during pregnancy and the role of chloroquine in low endemic area of malaria in Jepara districtDesign: A longitudinal study of all pregnant mother was carried out in Batealit and Mayong I subdistricts of Jepara district between June 1997-August 1999. All pregnant women were screened for peripheral parasitaemia through active surveillance. Women who had parasitaemia were treated with chloroquine for 3 days. Blood smears were then examined on days 4, 7, 14 and 21 after completion of the chloroquine course. All women irrespective of the blood smear results at enrolment were followed up once every two weeks until delivery.Results: Among 3099 pregnant women enrolled in the study, only 58 women had malaria infection, giving an incidence rate of 1.9/100 pregnant women. In this study low income is a significant risk predictor for malaria (OR= 11.03; 95%Cl: 3.91-31.08). Women who had reported a history of malaria or history of taking antimalarial drugs 6 months before their last menstrual period (LMP) showed an increased risk of developing malaria during pregnancy (OR= 10.56; 95%Cl: 4.57-23.72 and OR = 10.90; 95%Cl: 4.4825.61) respectively. Among those infected by P.falciparum and P. vivax and treated with chloroquine, complete parasite clearance was found in day 7.Conclusions: This study shows that low income, history of malaria within 6 months before LMP and history of taking antimalarial drugs within 6 months before LMP are best predictor for malaria in pregnancy in low endemic area. This study also shows that chloroquine is still effective for treating malaria falciparum in pregnancy in Batealit and Mayong I subdistricts, JeparaKeyword: malaria - pregnancy - low endemic area - risk-predictor - chloroquine]]>
<![CDATA[Drug use study for acute respiratory infection in children under 10 years of age ]]>
<![CDATA[Iwan Dwiprahasto, Iwan Dwiprahasto]]>
<![CDATA[ Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 37, No 04 (2005) ]]>
Publisher : <![CDATA[Universitas Gadjah Mada ]]>
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<![CDATA[Background: Acute respiratory infection (ARI) is the commonest illness in children and the leading cause of morbidity and mortality in many developing countries. It comprises approximately 50 % of all illness in children under five years. Even though usually viral in origin and of a self-limiting nature, various study indicate that antibiotic prescribing for ARI is inappropriately high.Objective: This study was aimed to assess general practitioners (GPs) prescribing pattern for acute respiratory infection in children seen in private practices.Method: This study is carried out in a cross sectional study design. Participants were GPs and pharmacies in Yogyakarta Special Province. Data on patient and measure of respiratory rate were obtained from GPs office and data on prescribing were searched at all pharmacies in the province. Result: All pharmacies and 92.27% of GPs participated in the study. The average number of drug item prescribed for children with ARI was 3.74. The most widely used drugs for ARI were antibiotics followed by paracetamol, ibuprofen, chlorpheniramine maleate, phenobarbital, vitamin-C, dextromethorphan, glyceryl guaiacolate, dexamethasone, prednisone, vitamin-B6, ephedrine HCI, vitamin BI, and vitamin B2. Medication error was commonly found in the study. More than 60% children with ARI received drugs in either overdose (27.51%) or under dose (41.12%). Wrong preparation were detected in 24.07% prescriptions. It was also found that more than one fifth of children with ARI received drugs in wrong frequency of administration. Risk predictor for prescribing antibiotics were fever, abnormal respiratory rate, and duration of common cold symptom of more than 2 days.Conclusion: ARI in children was often treated unnecessarily. Medication error was also commonly found in the treatment of children with ARI visiting GPs. Physicians must be encouraged to improve their prescribing practices by always catching up with current best research evidence. Key words: acute respiratory infection - inappropriate prescribing - medication error - general practitioners - emergence of resistance]]>
<![CDATA[Inappropriate use of antibiotics in the treatment of acute respiratory infections for the underfive children among general practitioners. ]]>
<![CDATA[Iwan Dwiprahasto, Iwan Dwiprahasto]]>
<![CDATA[ Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 29, No 02 (1997) ]]>
Publisher : <![CDATA[Universitas Gadjah Mada ]]>
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<![CDATA[Acute respiratory infection (ARI) is the commonest illness in children and the leading cause of morbidity and mortality in many developing countries. It comprises approximately 50% of all illness in children under five years. Unfortunately, most children are commonly treated inappropriately. A population based study involving all general practitioners (GPs) and pharmacies in Yogyakarta Special Province was carried out in June-July 1992 to provide data on antibiotic utilization for acute respiratory infection (ARI). One hundred and ninety one out of 207 GPs and all pharmacies participated in the study by completing structured form distributed during the study. Ninety three percent of patients with ARI seen by GPs were given antibiotic. Based on WHO criteria on ARI, only 7-14% of all patients were eligible to be given antibiotics. The most frequently used antibiotics for the underfives were ampicillin (38.8%) followed by cotrimoxazole (29.2%), amoxycillin (14.9%), and erythromycin (6.13%). Sixty three per cent of drug cost prescribed for the underfives children were accounted for by antibiotics. It can be concluded that inappropriate use of antibiotics was found in more than 75% patients under 5 years of age. In addition to poor indication for antibiotic use inappropriateness was also found in terms of dose, the length of antibiotic use, drug administration, and drug dosage form.Key words: ARI - innapropriate use of antibiotics - underfive children - general practitioners - prescribing pattern]]>
<![CDATA[Improving the use of antibiotics in primary health centres through a problem-based pharmacotherapy training approach ]]>
<![CDATA[Iwan Dwiprahasto, Iwan Dwiprahasto]]>
<![CDATA[ Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 35, No 3 (2003) ]]>
Publisher : <![CDATA[Universitas Gadjah Mada ]]>
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<![CDATA[Background: Inappropriate use of antibiotics in the treatment of common diseases such as acute respiratory infection (ARI) and diarrhoea has been the major health problems in primary health centres (PHCs). Beside increasing the risk of adverse event, excessive use of antibiotics has also led to bacterial resistance worldwide.Objective: To improve the quality of prescribing of Primary Health Centers (PHCs) physicians and paramedics particularly in the treatment of ARI and diarrhoea.Design: Prospective intervention study with control group involving 113 PHCs physicians in both arms. Thirteen districts were randomly selected for study area, in which intervention was carried out in 8 districts while 5 other districts as control group. A systematic problem-based approach of 3 days training were carried out in the intervention group using 3 sets of modules, followed by self monitoring & regular visit & feedback by a Training Team. Evaluation on prescribing was carried out 3 times, i.e at the 6th , 12th, &18th month after intervention.Results: More than 17 thousands and 8600 prescriptions for ARI and diarrhoea were collected during the study. There was a significant reduction in the use of antibiotics for ARI in the intervention group from 92.3 before the study, to 67.4, 52.8 and 39.5%, 6, 12, & 18 month after the study (p0.05). There has been significant antibiotics prescribing shift toward more rational choice in the intervention group 18 months after the study.Conclusions: A systematic problem-based pharmacotherapy training followed by self monitoring & regular visit & feedback significantly improved antibiotic prescribing for ARI and diarrhoea.Key words: antibiotics - prescribing - problem-based pharmacotherapy training - acute respiratory infection - diarrhoea]]>
<![CDATA[Drugs availability at districs level and the quality of prescribing in primary health care ]]>
<![CDATA[Iwan Dwiprahasto, Iwan Dwiprahasto]]>
<![CDATA[ Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 36, No 2 (2004) ]]>
Publisher : <![CDATA[Universitas Gadjah Mada ]]>
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<![CDATA[Background: An excessive use of drugs in primary health care is commonly unavoidable. This in part due to the limited knowledge of prescribers who are mostly paramedics and whose pharmacotherapeutic knowldges are limited. More than 90% patients with acute respiratory infection (ARI) and diarrhea received antibiotics and similar percentage of patients with muscle ache received injection unecessarily. Objective: To improve the availability of drugs at district level and to improve the quality of prescribing at primary health centers (PHCs).Design: Quasi experimental with pre and post test analysis and using a control group for comparison. An interactive, problem-based training intervention was carried out within 2 days period involving all PHCs and districts warehouses in three provinces, i.e West Kalimantan, West Sumater, and West Nusa Tenggara. Monitoring, supervision and feedback were carried out regularly upon completion of the inter- vention. This study involves 18 districts and 118 PHCs.Results: 11 .995 prescriptions were collected at baseline, 6 months and 1 year after intervention. An average number of drugs per prescription decreased significantly 1 year after intervention (p<0.05), while no improvement was found in the control group. The use of antibiotics for ARI decreased consis- tently and significantly 6 months and 1 year after intervention (p<0.05). The use of injection for muscle ache also significantly decreased 1 year after intervention (p<0.05). Drug availability at district level could be maintained at an ideal level (1 2-18 months) and no stock out was detected 1 year after the intervention.Conclusions: Interactive, problem-based training on rational use of drugs and training on managing drug supply could improve the quality of prescribing and drug availability at district level.Key words: drug availability - stock out - problem-based training - acute respiratory infection - diarrhea ]]>
<![CDATA[Drug use study for acute respiratory infection in children under 10 years of age ]]>
<![CDATA[Iwan Dwiprahasto Iwan Dwiprahasto]]>
<![CDATA[ Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 37, No 04 (2005) ]]>
Publisher : <![CDATA[Journal of the Medical Sciences (Berkala Ilmu Kedokteran) ]]>
Show Abstract
|
Download Original
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Original Source
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Check in Google Scholar
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Full PDF (180.256 KB)
<![CDATA[Background: Acute respiratory infection (ARI) is the commonest illness in children and the leading cause of morbidity and mortality in many developing countries. It comprises approximately 50 % of all illness in children under five years. Even though usually viral in origin and of a self-limiting nature, various study indicate that antibiotic prescribing for ARI is inappropriately high.Objective: This study was aimed to assess general practitioners' (GPs) prescribing pattern for acute respiratory infection in children seen in private practices.Method: This study is carried out in a cross sectional study design. Participants were GPs and pharmacies in Yogyakarta Special Province. Data on patient and measure of respiratory rate were obtained from GPs' office and data on prescribing were searched at all pharmacies in the province. Result: All pharmacies and 92.27% of GPs participated in the study. The average number of drug item prescribed for children with ARI was 3.74. The most widely used drugs for ARI were antibiotics followed by paracetamol, ibuprofen, chlorpheniramine maleate, phenobarbital, vitamin-C, dextromethorphan, glyceryl guaiacolate, dexamethasone, prednisone, vitamin-B6, ephedrine HCI, vitamin BI, and vitamin B2. Medication error was commonly found in the study. More than 60% children with ARI received drugs in either overdose (27.51%) or under dose (41.12%). Wrong preparation were detected in 24.07% prescriptions. It was also found that more than one fifth of children with ARI received drugs in wrong frequency of administration. Risk predictor for prescribing antibiotics were fever, abnormal respiratory rate, and duration of common cold symptom of more than 2 days.Conclusion: ARI in children was often treated unnecessarily. Medication error was also commonly found in the treatment of children with ARI visiting GPs. Physicians must be encouraged to improve their prescribing practices by always catching up with current best research evidence. Key words: acute respiratory infection - inappropriate prescribing - medication error - general practitioners - emergence of resistance]]>
<![CDATA[Risk predictor for ma/aria in pregnancy and the role of chloroquine in /ow endemic area ]]>
<![CDATA[Iwan Dwiprahasto Iwan Dwiprahasto]]>
<![CDATA[ Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 36, No 1 (2004) ]]>
Publisher : <![CDATA[Journal of the Medical Sciences (Berkala Ilmu Kedokteran) ]]>
Show Abstract
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Full PDF (162.116 KB)
<![CDATA[Background: Pregnant women in malaria-endemic areas are uniquely susceptible to infection with Plasmodium falciparum and this susceptibility is greatest during first pregnancies. Malaria causes serious complications in pregnant women, especially in those who have a low level of acquired immunity before pregnancy.Objective: to assess the risk predictors for malaria during pregnancy and the role of chloroquine in low endemic area of malaria in Jepara districtDesign: A longitudinal study of all pregnant mother was carried out in Batealit and Mayong I subdistricts of Jepara district between June 1997-August 1999. All pregnant women were screened for peripheral parasitaemia through active surveillance. Women who had parasitaemia were treated with chloroquine for 3 days. Blood smears were then examined on days 4, 7, 14 and 21 after completion of the chloroquine course. All women irrespective of the blood smear results at enrolment were followed up once every two weeks until delivery.Results: Among 3099 pregnant women enrolled in the study, only 58 women had malaria infection, giving an incidence rate of 1.9/100 pregnant women. In this study low income is a significant risk predictor for malaria (OR= 11.03; 95%Cl: 3.91-31.08). Women who had reported a history of malaria or history of taking antimalarial drugs 6 months before their last menstrual period (LMP) showed an increased risk of developing malaria during pregnancy (OR= 10.56; 95%Cl: 4.57-23.72 and OR = 10.90; 95%Cl: 4.4825.61) respectively. Among those infected by P.falciparum and P. vivax and treated with chloroquine, complete parasite clearance was found in day 7.Conclusions: This study shows that low income, history of malaria within 6 months before LMP and history of taking antimalarial drugs within 6 months before LMP are best predictor for malaria in pregnancy in low endemic area. This study also shows that chloroquine is still effective for treating malaria falciparum in pregnancy in Batealit and Mayong I subdistricts, JeparaKeyword: malaria - pregnancy - low endemic area - risk-predictor - chloroquine]]>
<![CDATA[Drugs availability at districs level and the quality of prescribing in primary health care ]]>
<![CDATA[Iwan Dwiprahasto Iwan Dwiprahasto]]>
<![CDATA[ Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 36, No 2 (2004) ]]>
Publisher : <![CDATA[Journal of the Medical Sciences (Berkala Ilmu Kedokteran) ]]>
Show Abstract
|
Download Original
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Original Source
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Full PDF (205.276 KB)
<![CDATA[Background: An excessive use of drugs in primary health care is commonly unavoidable. This in part due to the limited knowledge of prescribers who are mostly paramedics and whose pharmacotherapeutic knowldges are limited. More than 90% patients with acute respiratory infection (ARI) and diarrhea received antibiotics and similar percentage of patients with muscle ache received injection unecessarily. Objective: To improve the availability of drugs at district level and to improve the quality of prescribing at primary health centers (PHCs).Design: Quasi experimental with pre and post test analysis and using a control group for comparison. An interactive, problem-based training intervention was carried out within 2 days period involving all PHCs and district's warehouses in three provinces, i.e West Kalimantan, West Sumater, and West Nusa Tenggara. Monitoring, supervision and feedback were carried out regularly upon completion of the inter- vention. This study involves 18 districts and 118 PHCs.Results: 11 .995 prescriptions were collected at baseline, 6 months and 1 year after intervention. An average number of drugs per prescription decreased significantly 1 year after intervention (p<0.05), while no improvement was found in the control group. The use of antibiotics for ARI decreased consis- tently and significantly 6 months and 1 year after intervention (p<0.05). The use of injection for muscle ache also significantly decreased 1 year after intervention (p<0.05). Drug availability at district level could be maintained at an ideal level (1 2-18 months) and no stock out was detected 1 year after the intervention.Conclusions: Interactive, problem-based training on rational use of drugs and training on managing drug supply could improve the quality of prescribing and drug availability at district level.Key words: drug availability - stock out - problem-based training - acute respiratory infection - diarrhea ]]>
<![CDATA[Improving the use of antibiotics in primary health centres through a problem-based pharmacotherapy training approach ]]>
<![CDATA[Iwan Dwiprahasto Iwan Dwiprahasto]]>
<![CDATA[ Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 35, No 3 (2003) ]]>
Publisher : <![CDATA[Journal of the Medical Sciences (Berkala Ilmu Kedokteran) ]]>
Show Abstract
|
Download Original
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Original Source
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Check in Google Scholar
<![CDATA[Background: Inappropriate use of antibiotics in the treatment of common diseases such as acute respiratory infection (ARI) and diarrhoea has been the major health problems in primary health centres (PHCs). Beside increasing the risk of adverse event, excessive use of antibiotics has also led to bacterial resistance worldwide.Objective: To improve the quality of prescribing of Primary Health Centers' (PHCs) physicians and paramedics particularly in the treatment of ARI and diarrhoea.Design: Prospective intervention study with control group involving 113 PHCs' physicians in both arms. Thirteen districts were randomly selected for study area, in which intervention was carried out in 8 districts while 5 other districts as control group. A systematic problem-based approach of 3 days training were carried out in the intervention group using 3 sets of modules, followed by self monitoring & regular visit & feedback by a Training Team. Evaluation on prescribing was carried out 3 times, i.e at the 6th , 12th, &18th month after intervention.Results: More than 17 thousands and 8600 prescriptions for ARI and diarrhoea were collected during the study. There was a significant reduction in the use of antibiotics for ARI in the intervention group from 92.3 before the study, to 67.4, 52.8 and 39.5%, 6, 12, & 18 month after the study (p0.05). There has been significant antibiotics prescribing shift toward more rational choice in the intervention group 18 months after the study.Conclusions: A systematic problem-based pharmacotherapy training followed by self monitoring & regular visit & feedback significantly improved antibiotic prescribing for ARI and diarrhoea.Key words: antibiotics - prescribing - problem-based pharmacotherapy training - acute respiratory infection - diarrhoea]]>
<![CDATA[Inappropriate use of antibiotics in the treatment of acute respiratory infections for the underfive children among general practitioners. ]]>
<![CDATA[Iwan Dwiprahasto Iwan Dwiprahasto]]>
<![CDATA[ Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 29, No 02 (1997) ]]>
Publisher : <![CDATA[Journal of the Medical Sciences (Berkala Ilmu Kedokteran) ]]>
Show Abstract
|
Download Original
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Original Source
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Check in Google Scholar
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Full PDF (172.239 KB)
<![CDATA[Acute respiratory infection (ARI) is the commonest illness in children and the leading cause of morbidity and mortality in many developing countries. It comprises approximately 50% of all illness in children under five years. Unfortunately, most children are commonly treated inappropriately. A population based study involving all general practitioners (GPs) and pharmacies in Yogyakarta Special Province was carried out in June-July 1992 to provide data on antibiotic utilization for acute respiratory infection (ARI). One hundred and ninety one out of 207 GPs and all pharmacies participated in the study by completing structured form distributed during the study. Ninety three percent of patients with ARI seen by GPs were given antibiotic. Based on WHO criteria on ARI, only 7-14% of all patients were eligible to be given antibiotics. The most frequently used antibiotics for the underfives were ampicillin (38.8%) followed by cotrimoxazole (29.2%), amoxycillin (14.9%), and erythromycin (6.13%). Sixty three per cent of drug cost prescribed for the underfives children were accounted for by antibiotics. It can be concluded that inappropriate use of antibiotics was found in more than 75% patients under 5 years of age. In addition to poor indication for antibiotic use inappropriateness was also found in terms of dose, the length of antibiotic use, drug administration, and drug dosage form.Key words: ARI - innapropriate use of antibiotics - underfive children - general practitioners - prescribing pattern]]>
