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Journal of Current Health Sciences
Published by Utan Kayu Institute
ISSN : 28093275     EISSN : 28092236     DOI : https://doi.org/10.47679/jchs
Core Subject : Health, Science,
Journal of Current Health Sciences is a journal developed to disseminate and discuss the scientific literature and other research on the development of health, especially in nursing and midwifery. This journal is intended as a medium for communication among stakeholders on health research such as researchers, educators, students, practitioners of the Health Office, Department of Health, Public Health Service centre, as well as the general public who have an interest in the matter. This journal contains a script on Health Sciences that includes: Nursing Midwifery Environmental Health Mental health Community nursing Labor Health Public health critical care nursing Medical nursing Paediatric nursing
Articles 96 Documents
Informed Consent in Midwifery: Bridging Legal Requirements and Patient Communication Ayudiah, Febra; Putri, Yesi; Sulastri, Mepi
Journal of Current Health Sciences Vol. 4 No. 1: May 2024
Publisher : Utan Kayu Publishing

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47679/jchs.202465

Abstract

This study investigates the implementation of informed consent within the realm of independent midwifery, with a specific focus on the communication processes and legal obligations encountered in Midwife Nela’s practice. Despite the pivotal role of informed consent in safeguarding patient rights and ensuring ethical medical practice, a significant challenge persists due to the inadequate patient awareness regarding their rights as stipulated under the 1945 Constitution. This issue often results in patients entrusting midwives without a comprehensive understanding of potential risks. Employing a normative juridical approach, this research synthesizes both primary and secondary data to explore how informed consent is executed and the attendant challenges. The findings reveal that Midwife Nela’s practice is characterized by a personalized approach to patient communication and clarity in the conveyance of information, which distinctly supports the establishment of legal and therapeutic relationships between midwives and patients. The study further discusses the implications of these findings for the enhancement of informed consent practices in independent midwifery across Indonesia. It underscores the necessity for midwives to not only fulfill legal standards but also engage in effective communication, thereby facilitating patient autonomy and informed decision-making. Recommendations are provided for improving health policies and practices, which aim to strengthen the legal protections for both patients and healthcare providers in the midwifery sector.
Challenges and Solutions in B3 Waste Management at RSUD X: An Analysis Based on Ministerial Regulations Permana, Eko Adittya; Hardiana, Hedy
Journal of Current Health Sciences Vol. 4 No. 1: May 2024
Publisher : Utan Kayu Publishing

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47679/jchs.202466

Abstract

Hospital services provide significant benefits to the community and generate hazardous and toxic waste (B3) that poses high risks if not properly managed. B3 waste management in hospitals must comply with government regulations, such as Minister of Health Regulation No. 02 of 2023 and Minister of Health Regulation No. 07 of 2019. This study aims to analyze the effectiveness of B3 waste management policies at Hospital X and identify the factors affecting their implementation. The research employs a Realist Evaluation methodology using qualitative methods. Seventeen informants, selected through purposive sampling, including management heads, quality committee members, department heads, and field technical officers, were interviewed in-depth. The findings indicate challenges in implementing B3 waste management policies, such as a lack of trained personnel, inadequate infrastructure, and limited budget. While the policies based on Minister of Health Regulation No. 02 of 2023 and Minister of Health Regulation No. 07 of 2019 have been successfully implemented, there are still challenges that need to be addressed to achieve the desired targets. This study provides significant contributions to the development of more effective B3 waste management policies in the future. Abstrak: Kegiatan pelayanan di rumah sakit tidak hanya memberikan manfaat besar bagi masyarakat, namun juga menghasilkan limbah B3 yang berisiko tinggi jika tidak dikelola dengan baik. Pengelolaan limbah B3 di rumah sakit perlu mengikuti kebijakan pemerintah, seperti Permenkes Nomor 02 Tahun 2023 dan Permenkes Nomor 07 Tahun 2019. Penelitian ini bertujuan untuk menganalisis efektivitas kebijakan pengelolaan limbah B3 di Rumah Sakit X dan mengidentifikasi faktor-faktor yang mempengaruhi pelaksanaannya. Penelitian menggunakan metodologi Realist Evaluation dengan metode kualitatif. Sebanyak 17 informan yang dipilih secara purposive sampling, termasuk kepala manajemen, komite mutu, kepala ruangan, dan petugas teknis lapangan, diwawancarai mendalam. Hasil penelitian menunjukkan kendala dalam implementasi kebijakan pengelolaan limbah B3, termasuk kekurangan SDM yang terlatih, infrastruktur yang tidak memadai, dan anggaran yang terbatas. Kebijakan pengelolaan limbah B3 berdasarkan Permenkes No. 02 Tahun 2023 dan Permenkes No. 07 Tahun 2019 telah berhasil diimplementasikan, namun masih terdapat tantangan yang perlu diatasi untuk mencapai target yang diharapkan. Penelitian ini memberikan kontribusi penting bagi pengembangan kebijakan pengelolaan limbah B3 yang lebih efektif di masa mendatang.
Optimizing Drug Procurement with the MELIASI Application: A Collaborative Solution for Health Facilities Pratamarta, Meliasi Nora; Nurdan, Jon Hendri
Journal of Current Health Sciences Vol. 4 No. 1: May 2024
Publisher : Utan Kayu Publishing

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47679/jchs.202468

Abstract

The problem of drug shortages, where medications are unavailable or difficult to obtain, can significantly impact public health and disrupt the national health insurance system (JKN). This study aims to address this issue by developing the MELIASI (Multiple Link Collaboration) application as a collaborative solution among health facilities within a district. The research method used is qualitative, employing in-depth interviews with stakeholders involved in drug procurement management. The results show that weak collaboration among health facilities leads to suboptimal utilization of available drugs. The MELIASI application, still in the prototype stage, is expected to optimize drug distribution by leveraging surplus stocks from other health facilities. Implementing this application can reduce procurement wait times from an average of 7-14 days to just 2-3 days, enhance distribution efficiency, and ensure better drug availability across various health facilities. This study makes a significant contribution to pharmaceutical information management and offers a model that can be applied in other regions to improve drug availability. Additionally, the findings indicate that digital technology in drug procurement management can provide innovative solutions to address drug shortages and enhance overall public health. Abstrak: Masalah kekosongan obat adalah kondisi di mana obat tidak tersedia atau sulit didapatkan, yang dapat mempengaruhi kesehatan masyarakat dan mengganggu sistem penjaminan kesehatan nasional (JKN). Penelitian ini bertujuan untuk mengatasi masalah tersebut dengan mengembangkan aplikasi MELIASI (Multiple Link Kolaborasi) sebagai solusi kolaboratif antar fasilitas kesehatan di suatu wilayah kabupaten. Metode penelitian yang digunakan adalah kualitatif dengan teknik wawancara mendalam terhadap stakeholder terkait manajemen pengadaan obat. Hasil penelitian menunjukkan bahwa kolaborasi yang lemah antar fasilitas kesehatan menyebabkan tidak optimalnya penggunaan obat yang tersedia. Aplikasi MELIASI, yang masih dalam tahap prototipe, diharapkan dapat mengoptimalkan distribusi obat dengan memanfaatkan stok berlebih dari fasilitas kesehatan lain. Implementasi aplikasi ini dapat mengurangi waktu tunggu pengadaan obat dari rata-rata 7-14 hari menjadi hanya 2-3 hari, meningkatkan efisiensi distribusi, dan memastikan ketersediaan obat yang lebih baik di berbagai fasilitas kesehatan. Penelitian ini memberikan kontribusi penting dalam manajemen informasi kefarmasian dan menawarkan model yang dapat diterapkan di daerah lain untuk meningkatkan ketersediaan obat. Hasil ini juga menunjukkan bahwa penggunaan teknologi digital dalam manajemen pengadaan obat dapat memberikan solusi inovatif untuk mengatasi masalah kekosongan obat dan meningkatkan kesehatan masyarakat secara keseluruhan.
Determinants of Compliance with Iron Tablet Consumption Among Pregnant Women in Bengkulu: An Analysis of Knowledge, Occupation, and Demographic Factors Umami, Desi Aulia
Journal of Current Health Sciences Vol. 2 No. 1: 2022
Publisher : Utan Kayu Publishing

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47679/jchs.202270

Abstract

Iron tablets are crucial supplements required during pregnancy to prevent anemia and its complications. However, the coverage of iron tablet consumption among pregnant women at the Sukamerindu Community Health Center in Bengkulu City remains below the national target of 85%, with only 70.98% adhering to this recommendation. This study aims to identify the factors influencing compliance with iron tablet consumption among pregnant women in the region. An analytical observational study with a cross-sectional design was conducted, involving a population of 213 pregnant women with a sample of 101 women selected through accidental sampling. Primary data were collected using a questionnaire. Findings indicate significant effects of knowledge (p=0.000), education (p=0.000), occupation (p=0.000, OR=10.733), parity (p=0.000, OR=7.436), and age (p=0.000, OR=5.800) on compliance. Maternal parity emerged as a dominant factor affecting compliance (p=0.005, OR=6.428). From these results, enhancing pregnant women's knowledge about the importance of regular iron tablet consumption is crucial to reduce complication risks. This study provides essential insights into the dynamics of compliance and suggests the need for more focused approaches to improve compliance levels among pregnant women. Abstrak: Tablet Fe merupakan suplemen penting yang diperlukan selama kehamilan untuk mencegah anemia dan komplikasinya. Namun, cakupan konsumsi tablet Fe di kalangan ibu hamil di Puskesmas Sukamerindu, Kota Bengkulu, masih di bawah target nasional 85%, dengan hanya 70,98% yang mematuhi rekomendasi ini. Penelitian ini bertujuan untuk mengidentifikasi faktor-faktor yang mempengaruhi kepatuhan konsumsi tablet Fe di antara ibu hamil di wilayah tersebut. Sebuah penelitian observasional analitik dengan desain cross-sectional dilakukan, melibatkan populasi 213 ibu hamil dengan sampel 101 wanita yang dipilih melalui sampling aksidental. Data primer dikumpulkan menggunakan kuesioner. Temuan menunjukkan pengaruh signifikan dari pengetahuan (p=0.000), pendidikan (p=0.000), pekerjaan (p=0.000, OR=10.733), paritas (p=0.000, OR=7.436), dan usia (p=0.000, OR=5.800) terhadap kepatuhan. Paritas ibu terungkap sebagai faktor dominan yang mempengaruhi kepatuhan (p=0.005, OR=6.428). Dari hasil ini, meningkatkan pengetahuan ibu hamil tentang pentingnya konsumsi tablet Fe secara rutin diperlukan untuk mengurangi risiko komplikasi. Penelitian ini memberikan wawasan penting tentang dinamika kepatuhan dan menyarankan perlunya pendekatan yang lebih terfokus untuk meningkatkan tingkat kepatuhan di kalangan ibu hamil.
The Effectiveness of Warm Compresses in Reducing Dysmenorrhea Pain Among Adolescent Girls: A Pre-Experimental Study in Bengkulu, Indonesia Umami, Desi Aulia
Journal of Current Health Sciences Vol. 2 No. 2: 2022
Publisher : Utan Kayu Publishing

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47679/jchs.202271

Abstract

This study examines the effectiveness of warm compresses in reducing dysmenorrhea pain among adolescent girls. A pre-experimental one-group pre-post test design was used. The study was conducted at the Youth Posyandu in Tanjung Sanai I Rejang Lebong Village, Bengkulu, Indonesia, from June 6 to June 30, 2023. A total of 24 participants were selected using convenience sampling. Data were collected through a structured questionnaire and a standardized pain scale, validated through a pilot test. Pain levels were measured before and after applying warm compresses to the lower abdomen for 15-20 minutes, three times daily. Before the intervention, 54.2% of participants reported moderate pain, and 33.3% reported severe pain. After applying warm compresses, 50% of participants reported no pain, 29.2% reported mild pain, 16.7% reported moderate pain, and only 4.2% reported severe pain. The reduction in pain levels was statistically significant (p=0.000). Warm compresses significantly reduce dysmenorrhea pain in adolescent girls, shifting pain levels from moderate and severe to mild or none. This method is practical, accessible, and effective, offering a valuable non-pharmacological option for managing menstrual pain in young women. Abstrak: Studi ini mengkaji efektivitas kompres hangat dalam mengurangi nyeri dismenore pada remaja putri. Penelitian ini menggunakan desain pra-eksperimental dengan pre-post test satu kelompok. Penelitian dilakukan di Posyandu Remaja Desa Tanjung Sanai I Rejang Lebong, Bengkulu, Indonesia, dari 6 hingga 30 Juni 2023. Sebanyak 24 partisipan dipilih menggunakan teknik sampling kemudahan. Data dikumpulkan melalui kuesioner terstruktur dan skala nyeri standar, divalidasi melalui uji coba. Tingkat nyeri diukur sebelum dan sesudah penerapan kompres hangat di perut bagian bawah selama 15-20 menit, tiga kali sehari. Sebelum intervensi, 54,2% partisipan melaporkan nyeri sedang, dan 33,3% melaporkan nyeri parah. Setelah penerapan kompres hangat, 50% partisipan melaporkan tidak ada nyeri, 29,2% melaporkan nyeri ringan, 16,7% melaporkan nyeri sedang, dan hanya 4,2% melaporkan nyeri parah. Penurunan tingkat nyeri ini signifikan secara statistik (p=0,000). Kompres hangat secara signifikan mengurangi nyeri dismenore pada remaja putri, mengubah tingkat nyeri dari sedang dan parah menjadi ringan atau tidak ada. Metode ini praktis, mudah diakses, dan efektif, menawarkan pilihan non-farmakologis yang berharga untuk mengelola nyeri menstruasi pada wanita muda.
Family Experiences in Caring for Children with Stunting in Timor, East Nusa Tenggara, Indonesia: A Family-Centered Nursing Approach Suhardin, Saverinus; Suwetty, Awaliyah Muslimah; Lede, Meldy Emry Hamdany; Riantiarno, Flavianus; Mella, Orni; Banamtuan, Desi Adiyanti
Journal of Current Health Sciences Vol. 4 No. 1: May 2024
Publisher : Utan Kayu Publishing

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47679/jchs.202486

Abstract

Stunting is a critical global issue, particularly in developing countries such as Indonesia, where it significantly impacts children's health and development. This study aimed to explore the experiences of families in caring for children with stunting in Timor, Nusa Tenggara Timur, Indonesia. A qualitative phenomenological approach was employed, and nine families were selected through purposive sampling. Data were collected using in-depth interviews and observations over one month. Thematic analysis, supported by NVivo 14, was used to identify recurring themes. The study's findings are framed by the Family-Centered Nursing (FCN) theory, focusing on five key tasks: recognizing the problem, decision-making, caregiving capacity, modifying the environment, and utilizing healthcare services. Results indicated that while families recognized the issue of stunting, many attributed it to genetic factors. However, after guidance from healthcare workers, families engaged in available interventions, including attending Posyandu and participating in the government’s Supplementary Feeding Program. Families also expressed the need for educational reinforcement about stunting, particularly regarding its environmental and nutritional causes. Practical implications suggest the necessity of empowering families with skills to prepare complementary feeding using local resources and encouraging greater involvement of fathers in caregiving roles. Multisectoral approaches that involve healthcare, education, and social support are essential to effectively address stunting prevention. Abstrak: Stunting adalah masalah global yang krusial, terutama di negara berkembang seperti Indonesia, di mana hal ini memiliki dampak signifikan terhadap kesehatan dan perkembangan anak. Penelitian ini bertujuan untuk mengeksplorasi pengalaman keluarga dalam merawat anak dengan stunting di Timor, Nusa Tenggara Timur, Indonesia. Pendekatan fenomenologi kualitatif digunakan, dan sembilan keluarga dipilih melalui purposive sampling. Data dikumpulkan melalui wawancara mendalam dan observasi selama satu bulan. Analisis tematik, dengan dukungan NVivo 14, digunakan untuk mengidentifikasi tema yang berulang. Temuan penelitian ini dibingkai oleh teori Family-Centered Nursing (FCN), dengan fokus pada lima tugas utama: mengenali masalah, pengambilan keputusan, kapasitas perawatan, memodifikasi lingkungan, dan memanfaatkan layanan kesehatan. Hasil menunjukkan bahwa meskipun keluarga mengenali masalah stunting, banyak yang mengaitkannya dengan faktor genetik. Namun, setelah mendapatkan bimbingan dari tenaga kesehatan, keluarga terlibat dalam intervensi yang tersedia, termasuk menghadiri Posyandu dan berpartisipasi dalam Program Makanan Tambahan pemerintah. Keluarga juga menyatakan perlunya penguatan edukasi tentang stunting, terutama terkait dengan penyebab lingkungan dan gizi. Implikasi praktis menunjukkan perlunya memberdayakan keluarga dengan keterampilan untuk menyiapkan makanan pendamping ASI menggunakan sumber daya lokal dan mendorong keterlibatan yang lebih besar dari ayah dalam peran pengasuhan. Pendekatan multisektoral yang melibatkan kesehatan, pendidikan, dan dukungan sosial sangat penting untuk secara efektif menangani pencegahan stunting.
Triglycerides and Acne: Assessing the Impact of Blood Lipid Levels on Acne Severity in Young Adults Wardani, Erika Martining; Nugroho, Riezky Faisal
Journal of Current Health Sciences Vol. 4 No. 2: November 2024
Publisher : Utan Kayu Publishing

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47679/jchs.202469

Abstract

Acne vulgaris is a common chronic inflammatory skin condition that predominantly affects adolescents and young adults. This study aimed to examine the relationship between elevated blood triglyceride levels and the incidence and severity of acne vulgaris in young adults. A cross-sectional design was utilized, involving 85 patients aged 17-25 years from a cosmetic clinic in Surabaya, Indonesia. Triglyceride levels were measured and classified into two categories: normal (less than 150 mg/dL) and high (more than 150 mg/dL). The severity of acne vulgaris was assessed using the Global Acne Grading System (GAGS). Statistical analysis using the chi-square test revealed a significant association between elevated triglyceride levels and the incidence of acne vulgaris (p = 0.03). However, no significant correlation was found between triglyceride levels and acne severity (p = 0.09). These findings suggest that while elevated triglyceride levels may increase the risk of developing acne vulgaris, other factors such as hormonal, genetic, and lifestyle elements may play a more prominent role in determining acne severity. Clinically, reducing triglyceride levels through dietary interventions or pharmacological therapies may serve as a preventive measure for acne vulgaris. Further research is required to explore the mechanisms underlying this relationship and the potential role of lipid management in acne treatment.
The Influence of Medication Non-Adherence on the Occurrence of Drug-Resistant Tuberculosis Handayani, Reni Stefhanie; Hendarwan, Harimat; Ratri, Teja
Journal of Current Health Sciences Vol. 4 No. 2: November 2024
Publisher : Utan Kayu Publishing

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47679/jchs.202474

Abstract

Drug-resistant tuberculosis (DR-TB) presents a significant challenge to global TB control efforts, with medication non-adherence identified as a major contributing factor. This study aimed to investigate the influence of medication non-adherence on the occurrence of DR-TB in Serang City, Indonesia. Utilizing an observational analytic study with a case-control design, the research included 76 TB patients, comprising 38 DR-TB cases and 38 drug-sensitive TB controls. Data were collected from secondary sources and validated questionnaires and analyzed using univariate and bivariate methods, including Chi-square tests and Odds Ratios (OR). The findings revealed a significant relationship between medication non-adherence and DR-TB, with an OR of 11.56, indicating that non-adherent patients are 11.5 times more likely to develop DR-TB compared to adherent patients. However, demographic factors such as age, occupation, and education did not significantly influence the incidence of DR-TB. The study concludes that medication non-adherence is a critical risk factor for the development of DR-TB, underscoring the need for targeted interventions to improve treatment adherence, particularly through educational campaigns and community-based support. Health authorities are encouraged to implement intensive educational programs focused on the risks of non-adherence and ensure that TB treatment is accessible and supported by community health workers. Policymakers should allocate sufficient resources to these initiatives to effectively reduce the incidence of DR-TB.
Enhancing Maternal Comfort: The Impact of Endorphin Massage Therapy on Reducing Preoperative Pain and Anxiety in Primigravida Mothers Undergoing Cesarean Section Azissah RS, Danur; Rustandi, Handi; Nuh, Yalta Hasasnudin; Suyanto, Jipri
Journal of Current Health Sciences Vol. 4 No. 2: November 2024
Publisher : Utan Kayu Publishing

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47679/jchs.202484

Abstract

Pain and anxiety are significant challenges for primigravida mothers undergoing cesarean sections, with potential adverse effects on both maternal and neonatal outcomes. Endorphin massage therapy has emerged as a non-pharmacological intervention to mitigate these challenges by promoting the release of endorphins, which act as natural analgesics and anxiolytics. This study aimed to evaluate the effectiveness of endorphin massage therapy in reducing preoperative pain and anxiety levels in primigravida mothers scheduled for cesarean sections in Lubuklinggau, Indonesia. A quasi-experimental design was employed, involving 21 primigravida mothers divided into intervention and control groups. The intervention group received endorphin massage therapy, administered twice daily for three consecutive days prior to the cesarean section. Pain and anxiety levels were measured using the Numeric Rating Scale (NRS) and the Hamilton Anxiety Rating Scale (HARS), respectively. Statistical analyses were conducted to compare the pre- and post-intervention scores. The study found a significant reduction in both pain (mean difference: -4.3; 95% CI: -1.92 to -8.71; p < 0.001) and anxiety levels (mean difference: -8.3; 95% CI: -2.1 to -11.2; p < 0.001) in the intervention group compared to the control group. The reduction in anxiety was more pronounced than in pain, indicating the potent anxiolytic effect of endorphin massage therapy. Endorphin massage therapy significantly reduces preoperative pain and anxiety in primigravida mothers undergoing cesarean sections, particularly in alleviating anxiety. This non-pharmacological intervention could be a valuable addition to standard peripartum care, offering a safe, cost-effective alternative to pharmacological treatments. Further research with larger sample sizes is recommended to confirm these findings and explore long-term outcomes.
Estimating The Prevalence of Non-Communicable Diseases and Adherence to Dietary Habits And Physical Activity Among Healthcare Professionals in The Middle East And North Africa Regions Abdelhalim, Nada; Eltewacy, Nael Kamel; Owais, Tarek A.; Salman, Saif; Hamza, Nouran; Islam, Sheikh Mohammed Shariful; Collaborators, EARG
Journal of Current Health Sciences Vol. 4 No. 2: November 2024
Publisher : Utan Kayu Publishing

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47679/jchs.202485

Abstract

The rising number of fatalities linked to food, exercise, and non-communicable illnesses has sparked interest in studying their effects. In society, Healthcare Professionals (HCPs) symbolize health and wellbeing. However, the incidence of chronic illness and healthy habits among Middle East and North Africa (MENA) HCPs remains unclear. To determine the prevalence of chronic diseases and adherence to healthy dietary habits and physical activity among HCPs in the MENA region. Algeria, Egypt, El Yemen, Iraq, Jordan, Kuwait, Libya, Palestine, Saudi Arabia, Sudan, and Syria HCPs (physicians, dentists, nurses, pharmacists, and nutritionists) participated in multicenter cross-sectional research. April to June 2022 data on diet and exercise habits was collected using a pre-tested self-administered questionnaire. Demographics, risk factors, medical history, and nutrition and exercise were included in the questionnaire. HCP diet and exercise were examined using multivariable regression models. A study of 7130 HCPs (mean age 28.6 ± 7.8 years, 57.5% females) was conducted. Physicians held 56.8% of the sample population, followed by pharmacists, nurses, dentists, and nutritionists. Cardiovascular disease (CVD) affected 33.1% of individuals. Alcohol, pork, soda, sugar, and smoking raised the risk of non-communicable diseases. Nutritionists were the most active HCPs. About half of dietitians (45.3%) walked 150 minutes or more per week, while 14.7% and 25.9% did 150 minutes or more of moderate and 75 minutes or more of intense exercise, respectively. HCPs in MENA had high rates of CVD and risk factors such smoking, alcohol, pork, soda, sugar, and less exercise. MENA HCPs must be aware of the significant incidence of these risk factors to enhance health behavior.

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