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The International Journal of Medical Science and Health Research

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ISSN : 30481376 EISSN : 30481368 DOI : -

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The International Journal of Medical Science and Health Research, published by International Medical Journal Corp. Ltd. is dedicated to providing physicians with the best research and important information in the world of medical research and science and to present the information in a format that is understandable and clinically useful. Committed to publishing multidisciplinary research that spans the entire spectrum of healthcare and medicine access, The American Journal of Medical Science and Health Research aims at an international audience of pharmacists, clinicians, medical ethicists, regulators, and researchers, providing an online forum for the rapid dissemination of recent research and perspectives in this area.

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Articles 529 Documents

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Preeclampsia as a Risk Factor for Future Cardiovascular Disease : A Comprehensive Systematic Review Riski Amira; Putri Rahmi Maharani; Robby Rachman; Kevin Habib Alhuda
The International Journal of Medical Science and Health Research Vol. 39 No. 1 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/mpf92f04

Introduction: Preeclampsia (PE) affects 2–8% of pregnancies and is a leading cause of maternal morbidity. While its acute risks are well-recognized, emerging evidence suggests PE leaves a lasting imprint on maternal cardiovascular health. However, the magnitude of risk for specific cardiovascular outcomes, the role of PE severity and recurrence, and the underlying mechanistic pathways remain incompletely synthesized. Methods: This systematic review synthesizes 80 studies (cohort, case-control, meta-analyses, systematic reviews) identified through structured screening. Inclusion required documented PE diagnosis, a normotensive control group, cardiovascular outcomes (events or risk factors), ≥1 year postpartum follow-up, and separate analysis of PE. Data were extracted on composite cardiovascular disease (CVD), cardiovascular mortality, hypertension, stroke, subclinical atherosclerosis, cardiac dysfunction, endothelial function, and metabolic factors. Results: Women with prior PE have approximately double the risk of composite CVD (RR 2.33, 95% CI 1.95–2.78) and cardiovascular death (RR 1.97–2.29) [1,5]. Heart failure risk is highest (RR 2.47–4.19) [1,6,7]. Chronic hypertension risk is increased 3- to 4-fold (RR 3.70) [2,29]. Stroke risk rises approximately 1.8- to 2-fold [4,43]. Severe, early-onset, or recurrent PE confers substantially higher risk (e.g., severe PE: RR 5.36 for cardiac disease) [5]. Subclinical atherosclerosis (CIMT SMD 0.63; CAC OR 1.57) [16], persistent endothelial dysfunction (impaired FMD) [13], adverse metabolic profiles (higher BP, BMI, lipids, insulin resistance) [18], and subclinical left ventricular dysfunction (worse GLS) [15,20] are consistently observed. Risk emerges within 1–3 years and persists for decades [3]. Discussion: PE acts as both a marker of pre-existing cardiovascular susceptibility and an independent vascular injury event (“two-hit” model). The dose-response relationship with severity/recurrence and the early onset of risk support causality. Heterogeneity across studies is largely explained by differences in PE subtype, follow-up duration, and measurement techniques. Current guidelines recognize PE as a CVD risk factor, yet postpartum screening and prevention remain underutilized. Conclusion: Preeclampsia is a significant, independent, and dose-dependent risk factor for future CVD, hypertension, stroke, and cardiovascular mortality. Risk manifests through persistent endothelial dysfunction, accelerated atherosclerosis, and adverse metabolic remodeling. Early postpartum intervention and long-term surveillance are urgently needed.

Multidisciplinary Emergency Management of Severe Maternal Polytrauma With Early Fetal Demise and Delayed Sepsis: A Rare Case Report Rochmanita Safitri; Erika Kusuma Santoso
The International Journal of Medical Science and Health Research Vol. 39 No. 1 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/p2kv3q78

Introduction: Trauma during pregnancy poses significant diagnostic and therapeutic challenges, as physiological adaptations can obscure early signs of instability and increase both maternal and fetal vulnerability. High-energy blunt trauma often results in multisystem injuries involving the pelvis, thorax, diaphragm, and long bones. When these injuries occur in mid-pregnancy, the risk of intrauterine fetal demise rises sharply, and the complexity of maternal stabilization frequently delays obstetric intervention. Clear guidance on long-term management remains limited, especially when fetal demise is retained during recovery from extensive surgical trauma. Case Illustration: A pregnant woman in mid-gestation sustained severe multisystem injuries following high-impact blunt trauma. Her injuries included pelvic ring disruption, femoral and tibial fractures, hemothorax requiring thoracic drainage, and a left-sided traumatic diaphragmatic hernia with herniation of abdominal organs into the thoracic cavity. Early intrauterine fetal demise was identified shortly after resuscitation. She underwent thoracoabdominal surgery and orthopedic fixation, achieved postoperative stabilization, and was discharged in improving condition. Several days, she developed progressive abdominal pain, systemic deterioration, and severe sepsis. Imaging and clinical evaluation suggested that the retained fetal tissue, combined with prior thoracoabdominal and orthopedic injuries, contributed to the delayed infectious complication. She underwent uterine evacuation and intensive management, leading to eventual clinical improvement. Discussion: This case illustrates how multisystem trauma in pregnancy can generate a prolonged and unpredictable clinical trajectory. The need to prioritize maternal stabilization often necessitates delaying uterine evacuation, yet retained fetal demise, especially in patients recovering from major surgery, may predispose to delayed sepsis. This interplay between trauma physiology, surgical recovery, and obstetric timing highlights a critical gap in current guidelines. The case underscores the importance of multidisciplinary coordination, extended monitoring beyond initial discharge, and heightened vigilance for delayed infectious complications. Conclusion: Severe maternal trauma with concurrent pelvic, thoracic, and diaphragmatic injuries requires individualized, maternal-centered care. When fetal demise occurs, timing of evacuation must balance surgical risk with the potential for long-term complications. This case emphasizes the need for structured follow-up and clearer clinical pathways to prevent delayed sepsis in similar high-risk presentations.

Analysis of Activity-Based Costing (ABC) Implementation for Inpatient Operational Cost Control in 2025 Ongky Harianto; Ermi Girsang; Sri Lestari Ramadhani Nasution
The International Journal of Medical Science and Health Research Vol. 39 No. 1 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/13z7dt40

Background: Hospitals require accurate cost information to set service tariffs, prepare budgets, and control operational costs. At RS Pratama Krayan, inpatient tariff determination may still create cost distortion because it has not fully applied an activity-based approach. Objective: This study aimed to analyze the implementation of Activity Based Costing (ABC) in controlling inpatient operational costs at RS Pratama Krayan, North Kalimantan, in 2025. Method: This study employed a quantitative descriptive method with a case study approach. Data were collected through documentation and interviews, then analyzed using ABC procedures, including activity identification, cost pooling, cost driver determination, activity rate calculation, and cost allocation to each inpatient class to obtain the unit cost. Results: The findings identified nine major cost activities with a total inpatient operational cost of IDR 2,744,000,000. Activity rates were calculated using inpatient days, room area, and electricity consumption as cost drivers. ABC calculation produced inpatient unit costs per day of IDR 179,494 for VIP, IDR 107,782 for Class I, IDR 88,608 for Class II, and IDR 86,881 for Class III. All values were lower than the existing tariffs, with reductions of 48.7% for VIP, 46.1% for Class I, 50.8% for Class II, and 42.1% for Class III. Conclusion: The implementation of ABC provides more detailed, proportional, and transparent inpatient cost information and can serve as a basis for tariff evaluation and hospital operational cost control.

What Is The Prevalence of Acute Cardiovascular Events among Elderly Hajj Pilgrims (≥60 Years), and What are The Associated Risk Factors? : A Systematic Review Hafiz Anugrah Mursyid; Yessica Sheila Sitompul
The International Journal of Medical Science and Health Research Vol. 39 No. 2 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/dqbmkn79

Introduction: The Hajj pilgrimage, attracting millions of Muslims annually, involves elderly participants (≥60 years) who face significant cardiovascular risks due to advanced age, comorbidities, and extreme environmental conditions. Despite cardiovascular disease being the leading cause of Hajj-related mortality, the precise prevalence of acute cardiovascular events among elderly pilgrims and their associated risk factors remain poorly quantified. This systematic review aimed to determine the prevalence of acute cardiovascular events among elderly Hajj pilgrims (≥60 years) and identify associated risk factors. Methods: A systematic review of 58 observational studies, systematic reviews, and meta-analyses was conducted. Studies were included if they involved Hajj pilgrims aged ≥60 years, reported cardiovascular outcomes during the Hajj period, and provided quantifiable data. Data extraction focused on study characteristics, elderly pilgrim demographics, cardiovascular event definitions, prevalence rates, and risk factor associations. Data sources included SISKOHATKES (Indonesian Hajj health information system), hospital records, and mortality registries. Results: Mortality data showed that 81% of Hajj deaths occurred in pilgrims ≥60 years (3), with cardiovascular causes accounting for 38-42% of all deaths (1,2). Cardiovascular risk factor prevalence among elderly pilgrims was extremely high: hypertension (71.34%), hyperglycemia (43.76%), and hypercholesterolemia (59.46%) (8). Age ≥60 years was the dominant risk factor for mortality (adjusted OR range: 3.1–8.1) (3,10,11). Diabetes mellitus showed the strongest association with mortality in some cohorts (RRa=18.7) (3), while hypertension (OR=2.03–3.7) (3,10,13), dyslipidemia (OR=1.82) (13), and male gender (OR=1.87) (10) were consistently significant. Hajj-specific factors, including heat stress (independent predictor of MACE, p=0.001) and dehydration (independent predictor of mortality, p=0.009) (15), emerged as critical triggers. High-risk health status (risti) classification demonstrated strong associations with mortality (OR=7.83) (27) and morbidity (Exp(B)=19.745) (40). Discussion: The cardiovascular burden in elderly Hajj pilgrims results from a convergence of high comorbidity prevalence, age-related physiological vulnerability, and extreme environmental stressors. The absence of direct prevalence estimates reflects methodological limitations in current surveillance systems. The interaction between traditional risk factors and Hajj-specific triggers—particularly heat exposure during the physically demanding Armuzna (Arafah, Muzdalifah, Mina) phase—provides a mechanistic framework explaining both elevated baseline risk and annual mortality variability. The paradoxical finding that AMI pilgrims had worse outcomes despite fewer traditional risk factors (19) underscores the importance of environmental triggers. The extreme diabetes-related mortality risk in 2023 likely reflects synergistic effects of heat stress and operational failures. Integrated risk stratification using functional capacity (6MWT) and composite high-risk classification offers the most evidence-based screening approach. Conclusion: Elderly Hajj pilgrims face a 3- to 8-fold increased mortality risk compared to younger pilgrims, driven primarily by cardiovascular disease in the context of near-universal risk factor burden. Pre-departure screening should prioritize integrated risk assessment incorporating age, comorbidities, and functional capacity, while during-Hajj interventions must focus on heat exposure mitigation and early recognition of cardiovascular events in this vulnerable population.

What is The Association Between Honeycombing Appearance on CT and Life Expectancy in Patients with Scleroderma? A Comprehensive Systematic Review I Dewa Gede Satwika Putra; Wyka Faulani Hafizah Nur
The International Journal of Medical Science and Health Research Vol. 39 No. 2 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/kp8zbv06

Background: Systemic sclerosis (SSc) is a chronic autoimmune connective tissue disease with high morbidity and mortality, primarily driven by interstitial lung disease (ILD). Honeycombing on computed tomography (CT) represents irreversible fibrotic lung damage, but its precise relationship with life expectancy remains incompletely defined. Methods: This systematic review synthesized evidence from 80 studies (198 individual cohorts in the primary meta-analysis) examining the association between honeycombing appearance on CT and survival outcomes in SSc patients. Data extraction focused on honeycombing assessment methods, patient characteristics, survival statistics, hazard ratios (HRs), and confounding factors. Results: Honeycombing prevalence in SSc-ILD cohorts ranged from 37.2% to 41.9%, with higher frequency in limited cutaneous SSc. The systematic review by Haekal Mahargias et al. (2026) demonstrated that honeycombing was associated with a 2- to 3-fold increased mortality risk, with HRs ranging from 1.72 (95% CI 1.38–2.14) to 4.64 (95% CI 1.68–12.81). This association persisted after adjusting for age, gender, pulmonary function tests, and scleroderma subtype. Landini et al. (2022) found honeycombing extent was an independent predictor of respiratory mortality but not overall mortality. Radiographic progression (≥2% increase in quantitative ILD scores) predicted worse long-term survival (p=0.014 after adjustment). Baseline forced vital capacity (FVC) ≥70% was a strong protective factor (OR=0.039, 95% CI 0.002–0.616, p=0.02). Discussion: Honeycombing represents irreversible fibrotic damage that outperforms ground-glass opacities in prognostic value. The association with mortality is partially mediated by pulmonary function decline, particularly FVC. Methodological heterogeneity in honeycombing assessment limits definitive conclusions. Current therapies (nintedanib, cyclophosphamide, mycophenolate) stabilize lung function but do not reverse established honeycombing. Patients with extensive honeycombing (≥50% lung involvement) are often excluded from therapeutic trials, creating selection bias. Conclusion: Honeycombing on CT is a significant independent predictor of increased mortality in SSc-ILD, particularly respiratory-specific death. Standardized CT scoring systems with validated inter-rater reliability are urgently needed. Future prospective studies should examine honeycombing progression dynamics and develop honeycombing-specific therapeutic algorithms.

Total Hyphema with Light Perception Vision Managed by Anterior Chamber Washout: A Case Report Rofwiun; Nurul Elyana
The International Journal of Medical Science and Health Research Vol. 39 No. 2 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/3v9v6s38

Introduction Ocular trauma represents a major etiology of monocular blindness and visual morbidity, frequently requiring emergent ophthalmological evaluation to prevent permanent deficits.1 Traumatic hyphema, defined as the presence of blood within the anterior chamber, typically arises from blunt or penetrating force that disrupts the vascular integrity of the iris or ciliary body.3 While most hyphemas are self-limiting, high-grade presentations (Grade III and IV) pose a significant risk for secondary complications such as ocular hypertension, secondary glaucoma, and corneal blood staining.5 The management of these cases is particularly complex in the immediate postoperative period following intraocular surgery, where the structural stability of the eye is already compromised.8 Case Illustration A 64-year-old male presented with a chief complaint of sudden vision loss, severe ocular pain, and redness in the right eye (OD) after an accidental hand strike during sleep. The patient was one week postoperative following a Small Incision Cataract Surgery (SICS). Initial examination revealed a visual acuity of light perception (LP), an intraocular pressure (IOP) of 21.9 mmHg, and a Grade IV total hyphema with evidence of fibrin clots. Slit-lamp biomicroscopy confirmed corneal edema and a hazy anterior chamber. Despite three days of intensive conservative management using postural therapy, topical steroids, anti-glaucoma agents, and systemic antifibrinolytics, the visual acuity did not improve. Consequently, a surgical anterior chamber washout was performed. Discussion Total hyphema, often referred to as an "eight-ball" hyphema when clotted and deoxygenated, necessitates a careful balance between medical observation and surgical intervention.3 In this case, the recent surgical history and the stagnant nature of the clotted blood increased the risk of permanent endothelial damage and optic neuropathy.6 The choice of an anterior chamber washout as a minimally invasive procedure was pivotal in evacuating the blood and restoring aqueous dynamics.8 Pharmacological support using Indonesian-branded medications such as Bralifex Plus and Hyaloph, combined with comprehensive antioxidant supplements like Asta Plus and Retivit Plus, facilitated the recovery of the ocular surface and neuroprotection.13 Conclusion Anterior chamber washout is an effective and safe intervention for non-resolving total hyphema in the early postoperative phase.8 Prompt surgical evacuation, when medical therapy fails to produce clinical improvement within 72 hours, is essential to prevent irreversible complications and ensure significant visual recovery.6

Soft Tissue Mobilization Techniques in The Rehabilitation of Soccer-Related Myofascial Tears : A Comprehensive Systematic Review Resaka Yudha Prawira; Bagas Ryan Kusuma
The International Journal of Medical Science and Health Research Vol. 40 No. 1 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/6af9yv31

Introduction: Myofascial tears are prevalent in soccer, often leading to significant recovery times and high reinjury rates. Soft tissue mobilization (STM) techniques, including instrument-assisted soft tissue mobilization (IASTM) and myofascial release (MFR), are widely used in rehabilitation, yet their specific efficacy for soccer players with myofascial tears remains unclear. This systematic review synthesizes evidence on the effectiveness of STM for this specific population and injury type. Methods: A systematic review was conducted, screening 80 sources that investigated STM techniques in populations including soccer players or athletes with musculoskeletal conditions. Studies were included if they reported on outcomes such as pain, range of motion (ROM), strength, function, or return-to-play. Data on study design, participant characteristics, interventions, and outcomes were extracted and synthesized. Results: The review revealed significant heterogeneity in study quality and findings. For soccer players, specific evidence supports the use of MFR and IASTM for improving hamstring flexibility (2,4,5,62) and restoring hip ROM (8). Positive effects on pain and pressure pain thresholds were also observed (1,3,7). However, the largest and most rigorous meta-analyses (9,31) found no clinically meaningful benefit of IASTM for pain or function when added to other treatments, citing very low-quality evidence. A sham-controlled trial suggested that non-specific effects may account for much of the observed benefit (10). For return-to-sport, structured, exercise-based programs (11,12) showed stronger evidence than STM alone. Discussion: The evidence for STM in soccer myofascial tears is strongest for short-term ROM improvements and as an adjunct to exercise for pain management. Positive soccer-specific findings are often from studies targeting specific deficits like hamstring tightness (2,4,5) or myofascial trigger points (7). The discrepancy between these and null meta-analyses likely stems from differences in study quality, outcome measures, and the pooling of heterogeneous populations and techniques (9). Notably, STM appears to produce effects comparable to other manual techniques, suggesting the mechanical stimulus itself is key (37,70,74). The most robust return-to-sport outcomes are achieved through comprehensive, exercise-based, multifactorial rehabilitation programs (11,13,14). Conclusion: Soft tissue mobilization techniques, including MFR and IASTM, can be effective adjuncts in the rehabilitation of soccer players with myofascial injuries, particularly for improving range of motion and managing pain. However, they should not be considered standalone treatments. Their greatest value is within a structured, exercise-centered rehabilitation program that includes progressive loading and sport-specific functional training. Future high-quality, sham-controlled trials in homogenous soccer player populations with specific myofascial tears are needed.

An Evidence-Based Approach to the Diagnosis and Management of Seborrheic Dermatitis: A Systematic Review Lisa Anggraini
The International Journal of Medical Science and Health Research Vol. 40 No. 1 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/2w2r9t25

Introduction: Seborrheic dermatitis (SD) is a prevalent, chronic inflammatory skin disorder with a significant impact on patient quality of life. Its pathogenesis is multifactorial, involving an interplay between Malassezia yeast, host immune response, and skin barrier integrity. While numerous treatments exist, an updated synthesis is needed to integrate novel therapies into the clinical management algorithm. This systematic review aims to critically appraise and synthesize high-level evidence from randomized controlled trials (RCTs) on the efficacy and safety of interventions for SD in adolescents and adults. Methods: A systematic search of PubMed, Google Scholar, Semanthic Scholar, Springer, Wiley Online Library was conducted to identify RCTs evaluating pharmacological or procedural interventions for SD. Studies were selected based on pre-defined inclusion criteria. Data on study design, patient characteristics, interventions, and outcomes were extracted. The methodological quality of included studies was assessed using the Cochrane Risk of Bias tool. Results: Seventeen RCTs met the inclusion criteria. The evidence confirms the efficacy of first-line topical therapies, including antifungals (ketoconazole, ciclopirox) and anti-inflammatory agents (corticosteroids, calcineurin inhibitors). Ketoconazole 2% formulations are consistently superior to vehicle (e.g., treatment success of 25.3% vs. 13.9%, P=0.0014) and prophylactic use reduces relapse. Ciclopirox demonstrates non-inferiority and, in some cases, superiority to ketoconazole in maintenance phases. The novel phosphodiesterase-4 (PDE-4) inhibitor, roflumilast 0.3% foam, demonstrated significantly higher rates of Investigator Global Assessment (IGA) Success compared to vehicle at week 8 (79.5% vs. 58.0%; P<0.001) with a favorable safety profile. For recalcitrant disease, oral itraconazole was significantly more effective than placebo in improving severity scores (P=0.023) and reducing recurrence (P=0.003). Other therapies, including lithium salts and tea tree oil, also showed significant efficacy in controlled trials. Discussion: The therapeutic landscape for SD is evolving from a primary focus on microbial control to a dual approach that also targets host inflammation. The high efficacy and safety of roflumilast foam, the first new mechanism of action approved for SD in over two decades, facilitates a paradigm shift from reactive flare management to proactive, long-term maintenance of clearance without the risks of chronic corticosteroid use. Conclusion: The management of SD should be stratified based on disease severity and location. Topical antifungals and the novel PDE-4 inhibitor roflumilast represent effective and safe first-line options. Short-term topical corticosteroids are useful for managing acute flares, while calcineurin inhibitors serve as steroid-sparing alternatives. Systemic antifungals are reserved for severe, refractory cases. This review provides an evidence-based framework to guide clinicians in optimizing therapeutic strategies for this chronic condition.

Challenges in Treating Syphilis in Rural Areas : A Comprehensive Systematic Review Reza Agustiantwo Putra; Fenny
The International Journal of Medical Science and Health Research Vol. 40 No. 1 (2026): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/t520g967

Introduction: Syphilis, a curable sexually transmitted infection, continues to cause substantial morbidity, including congenital syphilis (CS), due to treatment failures. Rural areas face unique, compounded barriers. This review synthesizes evidence on challenges and solutions for syphilis treatment in rural settings. Methods: A systematic review of 80 peer-reviewed studies (2000–2026) from databases including PubMed, Cochrane, and global health sources. Inclusion criteria: rural/remote settings, focus on syphilis treatment barriers (not just screening), any study design with ≥10 participants, and specific syphilis outcomes. Data extraction covered diagnostic delays, treatment access, system barriers, patient factors, and interventions. Results: Key findings: (1) Diagnostic delays: Offsite testing in rural South Africa caused median 34-day treatment delays [1]; onsite immunochromatographic strip (ICS) testing achieved 89.4% correct diagnosis/treatment vs. 60.8% offsite [2]. (2) Treatment access: Benzathine penicillin G (BPG) shortages affected 41% of countries, causing referral delays and alternative suboptimal treatments [3]. (3) Healthcare system failures: Inadequate prenatal care contributed to 23–47% of CS cases [6,7]; only 64.8% of pregnant women completed all three BPG doses [1]. (4) Social determinants: Housing instability (OR 3.42) and substance use (42% of CS cases) were strongly associated with CS [7]. (5) Interventions: Point-of-care (POC) testing reduced treatment delays by 16 days [17] and improved treatment rates from 51.1% to 95.2% [12]; conditional cash transfers increased treatment completion from 45% to 78% [5]; alternative antibiotics (ceftriaxone, doxycycline) showed high efficacy but resistance limits azithromycin [54]. Discussion: Rural syphilis treatment failures arise from interlocking barriers: geographic isolation, laboratory dependency, BPG supply chain fragility, inadequate prenatal care, and social vulnerabilities. Successful interventions address multiple levels simultaneously: POC testing + immediate treatment + financial support + partner services. Alternative regimens are promising but not first-line in pregnancy. Conclusion: Eliminating CS in rural areas requires integrated, multilevel strategies: universal POC testing with same-day treatment, strengthened BPG supply chains, conditional cash transfers, and addressing social determinants (housing, substance use). Policy changes allowing non-physicians to treat syphilis and decentralization of services are critical.

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Equity Tower. 49th Floor. Sudirman Street. Special Region of Jakarta, Indonesia

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Kota adm. jakarta selatan,

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