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All Journal International Journal of Public Health Science (IJPHS) BALI MEDICAL JOURNAL (BMJ) journal of internal medicine INDONESIAN JOURNAL OF BIOMEDICAL SCIENCES E-Jurnal Medika Udayana Media Kesehatan Masyarakat Indonesia Universa Medicina Paediatrica Indonesiana CURRENT INTERNAL MEDICINE RESEARCH AND PRACTICE SURABAYA JOURNAL Public Health and Preventive Medicine Archive Journal of Global Pharma Technology Biomedika
Ketut Tuti Parwati Merati
Department Of Internal Medicine Faculty Of Medicine University Udayana/RSUP Sanglah
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Predictors of improved nutritional status among HIV/AIDS patients who received antiretroviral therapy (ART) at Sanglah General Hospital Denpasar Gusti Ayu Eka Utarini; Anak Agung Sagung Sawitri; Ketut Tuti Parwati Merati
Public Health and Preventive Medicine Archive Vol. 5 No. 2 (2017)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2017.v5.i2.p14

Abstract

Background and purpose: Antiretroviral therapy (ART) is associated with improved nutritional status among HIV/AIDS patients. This study aims to examine proportion, median time, incidence rate, and predictors of improved nutritional status among HIV/AIDS patients who received ART at Sanglah General Hospital Denpasar. Methods: A restrospective cohort study was conducted in Denpasar City. A total of 207 medical records of HIV/AIDS patients who received ART between 1st of January 2012 and 30th of June 2015 were included in the study. Kaplan Meier analysis was performed to calculate incidence rate and median time of improved nutritional status among HIV/AIDS patients. Sociodemographic characteristics and clinical variables included body mass index (BMI), body weight, haemoglobin level, CD4 count, HIV clinical stadium, ART regiments, and opportunistic infections (OIs). Data were analysed using cox proportional hazard model to identify predictors of improved nutritional status among HIV/AIDS patients. Results: As many as 65.22% of HIV/AIDS patients who received ART experienced an improvement in their nutritional status with the incidence rate of 9.1 per 100 person months and median time of 6.1 months. Multivariate analysis showed that predictors of improved nutritional status were BMI at ART initiation (AHR=1.34; 95%CI: 1.16-1.5), HIV clinical stadium (AHR=1.45; 95%CI: 1.02-2.06), CD4 count at ART initiation (AHR=0.89; 95%CI: 0.81-0.99) and the presence of diarrhoea (AHR=1.83; 95%CI: 1.06-3.14). Conclusions: Predictors of improved nutritional status among HIV/AIDS patients who received ART were BMI, HIV clinical stadium, CD4 count and diarrhoea.
Emotional support is the only social support associated with the quality of life of people living with HIV Ni Wayan Sri Rahayuni; Ketut Tuti Parwati Merati; Dewa Nyoman Wirawan
Public Health and Preventive Medicine Archive Vol. 7 No. 1 (2019)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2019.v7.i1.p08

Abstract

Background and purpose: The quality of life of people living with HIV is influenced by many factors, one of which is social support. Social support consists of four elements, namely information, instrumental, emotional and appraisal supports. Publication on the association between the quality of life of people living with HIV and the four elements of social support shows inconsistent results. The purpose of this study is to determine the association between the four elements of social support and the quality of life of people living with HIV. Methods: A cross-sectional survey was carried out at the WM Medika Clinic, Kerti Praja Foundation, Denpasar, Bali. Samples were people living with HIV who came to the clinic between July-August 2018 to take antiretroviral (ARV) drugs. The total number of samples was 92 patients selected through the convenience sampling. Data was collected by conducting individual interviews and consisted of respondent characteristics, quality of life, information, instrumental, emotional and appraisal supports. Data were analyzed using logistic regression to determine the association between social support and quality of life of people living with HIV. Results: Emotional support was the only element of social support found to be significantly associated with quality of life of people living with HIV with AOR=4.918 (95%CI: 1.268-19.082). Whereas the other three elements were not found to be related to the quality of life of people living with HIV, these were instrumental support (AOR=0.865; 95%CI: 0.228-3.278); information support (AOR=0.949; 95%CI: 0.248-3.637); and appraisal support (AOR=0.317; 95%CI: 0.095- 1.057). Conclusion: The quality of life of people living with HIV is found to be related to emotional support and is not found to be related to information, instrumental and appraisal supports. Emotional support needs to be addressed in order to further improve the quality of life of people living with HIV.
Factors associated to first line antiretroviral therapy (ART) failure among HIV/AIDS patients at Sanglah Hospital, Bali Cok Istri Sri Dharma Astiti; Anak Agung Sagung Sawitri; Ketut Tuti Parwati Merati
Public Health and Preventive Medicine Archive Vol. 5 No. 1 (2017)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2017.v5.i1.p02

Abstract

Background and purpose: The incidence of first line ART failure is increasing in the South East Asia region. The main referral hospital in Bali has recorded an increased use of second line ART due to the first line ART failure. This study aims to explore risk factors associated to first line ART failure. Methods: A case control study was conducted among people living with HIV and AIDS at Sanglah Hospital Denpasar who started first line ART between 2004 and 2013. Cases were those who diagnosed as having clinical treatment failure and still on treatment in 2015. Controls were those with no treatment failure. Sex and year of ART initiation were matched between case and control. Data were obtained from medical records that include initial regiments, HIV mode of transmission, the WHO HIV clinical stage, CD4 count, opportunistic infections, body mass index, hemoglobin level, and drug substitution at the beginning and during treatment. Risk factors were analysed using logistic regression. Results: Out of 68 HIV/AIDS patients with clinical ART failure, 72.1% were confirmed with immunological and 36.8% were confirmed with virological failure. Median time before treatment failure was 3.5 years. Factors associated to ART failure were HIV clinical stage IV (AOR=3.43; 95%CI: 1.65-7.13) and being widow/widower (AOR=4.85; 95%CI: 1.52-15.53). Patients with TB co-infection have a lower risk for treatment failure due to early diagnosis and treatment through TB-HIV program (AOR=0.32; 95%CI: 0.14-0.70). Conclusions: Higher HIV clinical stage at ART initiation increases the risk of treatment failure. HIV-TB co-infection indirectly reduces the risk of treatment failure.
Barriers and opportunities for implementing prevention of mother to child transmission (PMTCT) in Bangli District Ketut Espana Giri; Ni Made Sri Nopiyani; Ketut Tuti Parwati Merati
Public Health and Preventive Medicine Archive Vol. 5 No. 1 (2017)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2017.v5.i1.p14

Abstract

Background and purpose: HIV testing among pregnant women can reduce the risk of mother to child HIV transmission. The implementation of prevention of mother to child transmission (PMTCT) program in Bangli District is suboptimal. This study aims to explore challenges and opportunities for implementing PMTCT program from both user and provider perspectives. Methods: A qualitative approach was conducted in Bangli District between April and May 2016. Data were collected using in-depth interviews with 18 informants. All informants were purposively selected and covered of 10 pregnant women, two counsellors, two laboratory analysts, two head of public health centres, one disease control officer from Bangli District Health Office and one officer from Bangli District AIDS Commission. Data were analysed using thematic method. Results: Pregnant women chose to have ANC service at private midwife and obstetrician instead of public health centre. From health providers’ perspectives barrier of PMTCT implementation included lack of health human resources and a high level of stigma and discrimination related to HIV/AIDS in the community. This study revealed that there was an opportunity for PMTCT implementation in Bangli District due to positive attitudes and supports from husband and health provider toward HIV testing. Another opportunity is toinvolve village health cadres and community leaders in promoting HIV testing among pregnant women. Conclusions: Implementation of PMTCT program in health centre should include network of private practitioner and enhance village health cadres’ and community leaders’ participation.
Handwashing as a risk factor for increasing ventilator associated pneumonia (VAP) incidence at Sanglah Hospital, Denpasar, 2012 Abdul Azis; Anak Agung Sagung Sawitri; Ketut Tuti Parwati Merati
Public Health and Preventive Medicine Archive Vol. 1 No. 2 (2013)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2013.v1.i2.p04

Abstract

Ventilator associated pneumonia (VAP) is a lower respiratory tract nosocomial infection which frequently resulted from mechanical ventilation support of more than 48 hours in an intensive care unit (ICU). The incidence of VAP at Sanglah Hospital is 15.48 per 1000 days used still higher than the national standard of 10 per 1000 days used. Risk factors for VAP transmission include host condition, medical equipment hygiene and healthcare provider behaviors, including handwashing. This study aimed to analyze contributing risk factors for VAP incidence at Sanglah Hospital, specifically handwashing procedures. Study applied a case control design with 27 cases (those with VAP) and 54 controls (non-VAP), from similar gender and age backgrounds. Case control data was obtained from medical records of 2012. Data from healthcare providers (doctors and nurses attending to the study population) was obtained through interviewing using structure questionnaires and cross checking through assessment of medical records. The univariate and bivariate data was analyzed by chi square and multivariate by logistic regression. Findings indicated that the contributing factors are healthcare provider handwashing (OR=6.11; 95%CI: 1.54-24.25), length of hospital stay (OR=4.18; 95%CI: 1.36-12.81) and associated disease (OR=4.22; 95%CI: 0.98-18.25). Nurse behaviors contributed to VAP incidence (OR=4.69; 95%CI: 1.22-18.08). Doctors indicated difficulty in adhering to handwashing protocol (the 5 moment handwashing requirements) particularly before aseptic procedure (45,1% in cases and 66,3% in control). Study indicates that poor handwashing behaviors contribute to VAP incidence. There is a need for health promotion initiatives that encourage adherence to official handwashing protocol
Predictors of Loss To Follow Up and Mortality Among Children ≤12 Years Receiving Anti Retroviral Therapy during the First Year at a Referral Hospital in Bali Stefanie Juergens; Anak Agung Sagung Sawitri; Ketut Dewi Kumara Wati; I Wayan Gede Artawan Eka Putra; Tuti Parwati Merati
Public Health and Preventive Medicine Archive Vol. 4 No. 2 (2016)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2016.v4.i2.p03

Abstract

Background and purpose: Many HIV-infected children in Bali have started antiretroviral therapy (ART), but loss to follow up (LTFU) is a continuing concern, and the issue of childhood adherence is more complex compared to adults. Methods: This was a retrospective study among cohort of 138 HIV+ children on ART in Sanglah General Hospital, Denpasar, Bali from January 2010 to December 2015. Kaplan-Meier analysis was used to describe incidence and median time to LTFU/mortality and Cox Proportional Hazard Model was used to identify predictors. Variables which were analysed were socio-demographic characteristics, birth history, care giver and clinical condition of the children. Results: Mean age when starting ARV therapy was 3.21 years. About 25% experienced LTFU/death by 9.1 month resulting in an incidence rate of 3.28 per 100 child month. The higher the WHO stage, the higher the risk for LTFU/mortality along with low body weight (AHR=0.90; 95%CI: 0.82-0.99). Conclusion: Clinical characteristics were found as predictors for LTFU/ mortality among children on ART.
Predictors to Achieve Normal Nutrition Status: Longitudinal Study among HIV Children on Antiretroviral Treatment in Bali Haryadi; Anak Agung Sagung Sawitri; Ketut Dewi Kumara Wati; I Wayan Gede Artawan Eka Putra; Ketut Tuti Parwati Merati
Public Health and Preventive Medicine Archive Vol. 4 No. 2 (2016)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2016.v4.i2.p08

Abstract

Background and purpose: Malnutrition is common in children with HIV/AIDS. Antiretroviral therapy (ART) improves the nutritional status; however, information about predictors affecting the changes of nutritional status is limited and inconsistent. Methods: The retrospective survival study analyzed secondary data of 84 undernourished children receiving ART in Sanglah Central Hospital in 2010 to 2015. Demographic, clinical and socio-economic characteristics at ART initiation were linked to the achievement of normal nutritional status (z-score ≥ -2 SD). Kaplan Meier analysis was used to obtain the incidence rate and median time and cox proportional hazards models to identify its predictors. Results: Of the 73.81% of children achieved a normal nutrition status with the incidence of children achieving normal nutritional was 19 per 100 child months, and a median time of 4 months 10 days. Children with birth weight ≥2500 gr (AHR=5.41; 95%CI: 1.76-16.61), without candidiasis (AHR=3.72; 95%CI: 1.27-10.93), Clinical WHO Stage III (AHR=1.6; 95%CI: 1.08-4.24), Clinical WHO Stage II (AHR=4.49; 95%CI: 1.95-10.79) and early ART intiation (AHR=0.91; 95%CI: 0.83-0.98) were predictors to achieve normal nutritional status. Conclusion: Clinical characteristics of children are predictors of achieving a normal nutritional status.
Clinical Features of COVID-19 Patients at Udayana University Hospital During First Three Months of the COVID-19 Pandemic Cokorda Agung Wahyu Purnamasidhi; Ni Made Dewi Dian Sukmawati; Anak Agung Ayu Yuli Gayatri; I Made Susila Utama; I Ketut Agus Somia; Ketut Tuti Parwati Merati; Haruko Akatsu
Media Kesehatan Masyarakat Indonesia Vol. 18 No. 4: DECEMBER 2022
Publisher : Faculty of Public Health, Hasanuddin University, Makassar

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30597/mkmi.v18i4.20235

Abstract

COVID-19 exhibits a wide variety of symptoms, ranging from mild, moderate, severe, and critical respiratory dysfunctions up to death. Therefore, this study aimed to examine the demographic, clinical, and laboratory profile of COVID-19 patients admitted to Udayana University Hospital, Bali, during the first three months of the pandemic. Data were collected from the electronic medical records of 236 patients hospitalized from April to June 2020. The samples had a mean age of 40 years old, and they consisted of 58.50% male. Based on the records, the common clinical characteristics included fever (52.5%) and cough (47.5%), followed by less common traits, such as sore throat (18.2%), dyspnea (10.2%), flu (8.9%), and headache (3.8%). Laboratory results during admission showed an average lymphocyte count of 2.16 ± 2.19 × 109 cells/L and a neutrophil- lymphocyte ratio of 3.02 ± 3.41. The majority of patients were private corporation employees (30.51%), followed by migrant workers (21.19%). Furthermore, a fatality rate of 1.69% was recorded in the study hospital. These results were expected to provide epidemiological knowledge of COVID-19 patients, which can help clinicians to anticipate possible outcomes during treatment.
Inverse Correlation between Combination of Antiretroviral Therapy with the level of Serum Interleukin-6, Ferritin, and Hepcidin in HIV Patients with Anemia Chronic Disease I Ketut Agus Somia; Ketut Tuti Parwati Merati; I Made Bakta; Ida Bagus Putra Manuaba; Wayan Putu Sutirta Yasa; I Dewa Made Sukrama; Ketut Suryana; Rudi Wisaksana
Journal of Global Pharma Technology .
Publisher : Journal of Global Pharma Technology

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Background: The purpose of this study was to determine whether the cARV therapy correlates with the serum level of IL-6, ferritin, and hepcidin in HIV infected patients with ACD.Methods: A cross-sectional study conducted in HIV patients with ACD, aged 15-65 years with exclusion criteria such as chronic renal disease, chronic liver disease, treated for anemia in the last 3 months, taking iron supplements in the last 3 months, history of blood transfusion in the last 1 year, suffering from acute infection, tuberculosis infection, malignancy, hepatitis C virus infection, acute hypersensitivity reaction and pregnancy. Blood specimen examined by high sensitivity human IL-6 In vitro ELISA, DRG Hepcidin- 25 ELISA, serum ferritin by agglutination method and CD4 cell count by flow cytometry. Results: A total of 86 HIV patients with ACD consist of 42 subjects with experienced cARV and 44 subjects with naive cARV. There are several differences between cARV naïve and experienced cARV including: Hb (g/dl) [ 10.8 ( 9.88 – 11.75) Vs. 11.60 (11.00 – 12.34) p: 0.058 ], serum iron (mg/dl) [ 50.00 (31 – 66.8) Vs. 71.40 (56.00 – 108.00) p: 0.121 ), serum ferritin (ug/dl) [ 630 ( 194 – 1101) Vs. 195.40 (128.25 – 589.47) p: 0.008 ], IL-6 (pg/mL) [7.20 (3.88 – 10.76) Vs. 4.03 (1.69 – 8.49) p: 0.009), serum hepcidin (ng/mL) [45.54 (16.74 – 95.31) Vs. 23.35 (6.58 – 49.99) p: 0.007] , CD4 cell count (cell/uL) [31.5 (14.25 – 90.75) Vs. 307 (168.5 – 458.75) p : < 0.001)] There is a significant inverse correlation between the cARV therapy with level of serum IL-6 ( r: - 0. 285, p: 0.008), ferritin (r: - 0.321, p: 0.007) and hepcidin (r: - 0.293, p: 0.006). While there was a significant positive correlation between the cARV therapy with CD4 cell count (r: 0.676, p: 0.001). There was no correlation between the cARV therapy with serum iron levels ( r: 0.176, p: 0.121).Conclusion: There is an inverse correlation between the cARV therapy with serum level of IL-6, ferritin, and hepcidin in HIV patients with ACD.  Keywords: cARV, ACD, IL-6, Ferritin, Hepcidin.
HUBUNGAN PENGETAHUAN DAN PERSEPSI TERHADAP PERILAKU PENCEGAHAN HIV/AIDS PADA REMAJA DI SEKOLAH MENENGAH ATAS Mahardani, Putu Nandika Tungga Yudanti; Merati, Ketut Tuti Parwati; Kumbara, Cokorde Istri Yuliandari Krisnawardani; Widiana, I Gde Raka
E-Jurnal Medika Udayana Vol 11 No 11 (2022): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2022.V11.i11.P11

Abstract

HIV/AIDS masih menjadi urgensi di masyarakat. Penelitian mengenai pengetahuan dan persepsi remaja terhadap HIV/AIDS berikut hubungannya dengan perilaku pencegahan belum pernah dilakukan di Denpasar sebagai wilayah dengan kasus HIV/AIDS tertinggi di Bali. Adapun penelitian ini merupakan penelitian cross sectional analitik, dengan pengumpulan data dilakukan dengan kuesioner yang terdiri dari empat bagian dan disebarkan secara online melalui google form. Penelitian dilaksanakan pada SMA Negeri 2 Denpasar selama lima bulan, dari bulan Januari hingga Mei 2021. Dari 130 reponden penelitian dominan perempuan (76,9%) dengan median usia 16 tahun, ditemukan bahwa distribusi pengetahuan siswa terkait HIV/AIDS tergolong baik (45,4%), tingkat persepsi positif (64,6%), dan tingkat perilaku pencegahan positif (69,2%). Pengetahuan siswa memiliki hubungan signifikan dengan perilaku pencegahan dengan tingkat korelasi lemah (p= 0.011, r = 0.221, 95% CI 0.051 - 0.392), dan tidak ditemukan hubungan yang signifikan antara persepsi dan perilaku pencegahan HIV/AIDS, (p= 0.233, r = 0.105, 95% CI = -0.068 – 0.279). Pengetahuan juga memiliki hubungan signifikan terhadap persepsi siswa SMA mengenai HIV/AIDS dengan tingkat korelasi moderat (p = 0.000, r = 0.445, 95% CI = 0.288 ? 0.601). Analisis multivariat menunjukkan bahwa pengetahuan dan persepsi dapat memprediksi perilaku sebesar 4,9%. Adapun media edukasi yang paling banyak menjangkau siswa SMA adalah pembelajaran dalam kurikulum sekolah dengan aktor berupa guru. Penelitian berikutnya sebaiknya diarahkan dalam pencarian faktor-faktor lain yang lebih predominan dalam mempengaruhi perilaku pencegahan HIV/AIDS, khususnya terkait faktor pendukung dan pendorong, sebaiknya pada target demografis lainnya mengingat data pengetahuan, persepsi, dan perilaku pencegahan pada siswa SMA yang ditemukan tergolong tinggi. Kata kunci : HIV, AIDS, Pengetahuan, Persepsi, Perilaku
Co-Authors Abdul Azis Abdul Azis Agus Eka Darwinata Anak Agung Ayu Yuli Gayatri Artha Camellia Astiti, Cok Istri Sri Dharma Bagus Ngurah Putu Arhana Brad Otto Claire Ryan Cok Istri Sri Dharma Astiti Cokorda Agung Wahyu Purnamasidhi Dewa Gde Agung Budiyasa Dewa Nyoman Wirawan Dewa Nyoman Wirawan, Dewa Nyoman Dian, Ni Made Dewi Diksha, I Gusti Ngurah Ariestha Satya Dyah Kanya Wati Elizabeth Haryanti Gayatri, Anak Agung Ayu Yuli Gusni Rahma Handayani, Putu Novi Haruko Akatsu Haryadi Haryadi - I Dewa Made Sukrama I Gde Raka Widiana I Gusti Ayu Agung Elis Indira I Gusti Ngurah Kade Mahardika I K. Suata I Ketut Agus Somia I Made Bakta I Made Susila Utama I Nyoman Sutarsa I Wayan Gede Artawan Eka Putra I Wayan Gede Artawan Eka Putra, I Wayan Gede Artawan Eka I Wayan Putu Sutirta Yasa Ida Bagus Nyoman Putra Dwija Ida Bagus Putra Manuaba Irwanto Irwanto Junior, Darren Ketut Dewi Kumara Wati Ketut Espana Giri Ketut Espana Giri Ketut Ridana Wibawa Ketut Suryana Komang Agus Trisna Amijaya, Komang Agus Trisna Kumbara, Cokorde Istri Yuliandari Krisnawardani Made Yogi Oktavian Prasetia Made Yogi Oktavian Prasetia, Made Yogi Oktavian Mahardani, Putu Nandika Tungga Yudanti N. Sri Budiyanti Ni Made Dewi Dian Sukmawati Ni Made Sri Nopiyani Ni Wayan Sri Rahayuni Ni Wayan Winarti Nittaya Phanuphak, Nittaya Plamularsih Swandari Rahayuni, Ni Wayan Sri Rudi Wisaksana Saktivi Harkitasari, Saktivi Sawitri, Anak Agung Sagung Semadhi, Putu Gitanjani Mahadewi Shannon Turnbul Siahaan, Katrin Wilentina Stefanie Juergens Suteja, Richard Christian Utama, I Made Susila Utarini, Gusti Ayu Eka Yundari, Yundari