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Archive for the ‘Tuberculosis’ Category

Sejak gencarnya pemberlakuan Undang Undang Lalu Lintas Nomor 22 Tahun 2009, maka semua pada rajin makai helm. Alasannya sederhana takut ditilang (versi penulis). Berdasarkan peraturan tersebut denda yang harus ditanggung oleh pengendara tanpa helm adalah sebesar 250.000,- (wah seharga sebuah helm standar)


Hitung-hitungan angka kematian di jalan raya dikisaran 30 ribuan tiap tahunnya di negeri ini. Banyaknya angka “tutup usia” di jalan raya ternyata mampu menghisap kerugian 1-1,5 persen dari Grros National Product (GNP). Maklumlah, mayoritas korban kecelekaan adalah usia produktif. Angka kematian akibat kecelakaan lalu lintas masuk dalam daftar big four pembunuh negeri ini ditemani penyakit jantung, stroke,dan TBC.

Bagaimana posisi helm?

  1. 300 anak-anak mati tiap tahun karena trauma sepeda, 90% dari kematian tersebut merupakan akibat tabrakan dengan kendaraan bermotor, 80% kematian itu berhubungan dengan trauma kepala.
  2. Helm sepeda menurunkan risiko trauma kepala sampai 85%.
  3. Penggunaan helm sepeda secara universal akan menyelamatkan satu nyawa anak tiap hari dan mencegah satu trauma kepala setiap 4 menit.
  4. Hukum yang mengharuskan penggunaan helm pada anak menurunkan mortalitas sampai 80% pada area dimana hukum tersebut ditegakkan.
  5. Setiap duit yang digunakan untuk helm akan menghemat $2 (sekitar 18 ribu rupiah) dalam biaya pelayanan kesehatan 2.200 anak-anak yang trauma dalam kecelakaan yang berhubungan dengan sepeda dan mengalami cacat permanen. Helm dapat mencegah 1.300 trauma-trauma di atas. Hal ini setara dengan US $142 juta.
  6. Harga helm adalah lebih dari US $10 (wah, kayaknya ada kok yang berlogo SNI dengan harga yang lebih murah). Sementara estimasi biaya tahunan trauma dan kematian yang berhubungan dengan sepeda adalah US $8 milyar. Jadi jangan pernah sayang untuk beli dan memakai helm terbaik untuk melindungi kepala.

Namun
Adanya golongan anti-helm tetap berargumen bahwa angka kematian lalu lintas tidak bisa dialihkan ke isu “pakai helm atau ngak“. Salah satu alasan mereka tetap berargumen demikian karena munculnya kekhawatiran standarisasi helm merupakan peluang bisnis yang sengaja diciptakan. Selain itu banyaknya fakta di lapangan bahwa mayoritas yang meninggal di jalan raya disebabkan patahnya leher, jadi entah dia menggunakan helm atau tidak itu tidak dapat menjamin keselamatannya.

“Kami belum mengkajidata, tapi dari pengamatan umum terlihat kualitas cedera kepala memang bergeser setelah ada peraturan helm.”Ahli bedah saraf RS Umum Dr. Soetomo, Surabaya, dr. H.M. Saiid Dharmadipura

Jadi walaupun sebagian besar penderita cedera kepala secara fisik bisa sembuh, tapi secara mental rusak karena otak atau susunan saraf di kepalanya cedera. Tuh… masih mau disebut pake helm karena takut polisi. Sadar donk! Ini bukan sekedar nyaman atau tidak berkendara, ini adalah masalah hidup dan mati Bung. (diambil dari berbagai sumber)

Salam selamat

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Fighting TB means eradicating poverty
from The Jakarta Post

The fear of an avian influenza pandemic has tended to overshadow the fight against other diseases, such as HIV/AIDS and tuberculosis (TB). Indonesia has the third highest prevalence of TB in the world after India and China, with around 600,000 patients currently being treated and nearly 300 people dying daily from the disease. In line with World TB Day which falls on March 24, the World Health Organization’s chief officer on tuberculosis in Indonesia Firdosi R. Mehta gave an interview to The Jakarta Post’s Hera Diani.

Question: How alarming is the TB situation in Indonesia?

Answer: The prevalence rate has been reduced by about 40 percent since 1990, and the case detection rates or the number of smear-positive (infectious) cases detected every year has increased from 20 percent to 66 percent.

However, the number of cases is still alarming. An estimated almost quarter million, or 240,000 cases of all forms of TB occur every year.

Based on the 2004 household survey in 22,000 households in 30 provinces, there were big differences between eastern part of Indonesia, Java/Bali region and Sumatra. The national prevalence was 119, prevalence in Sumatra was 182, Java/Bali was 67 and Eastern Part was 250. Basically, there is a lot of TB in the eastern part, while the population is low over there.

In Sub-Saharan Africa, TB is being driven by HIV, and has become the common secondary infection with AIDS. Is that the case here?

It is not the case in Indonesia, but a glimpse of it is starting and we have to act now. HIV as you know is not a generalized problem in this country, it is a concentrated epidemic or mainly occurs in groups with high risk behavior, that is injecting drug users and commercial sex workers.

But in Papua, HIV is heading toward a generalized epidemic. In (provinces with a high HIV prevalence) Papua, Riau, Bali, West Java, East Java, and Jakarta, it appears that HIV is slowly having an impact on TB.

Has the government done enough to fight the disease?

I categorically say yes. The DOTS (Directly Observed Treatment Short Course), which sees health care workers closely monitoring patients to ensure they complete a short course of powerful drugs, is working well here. From 1997 through 2005, more than a million patients have been treated. Indonesia has contributed 5 percent of the number of cases treated in the world. This speaks well of the program as the number of patients treated drastically increases every year. There is no problem of drug availability either.

But many challenges remain. First of all, is the expansion of the hospital sector, because up to now, whatever has been achieved is mainly through implementing the TB program through the network of community health centers.

There are 1,200 hospitals, but only 29 percent have adopted the DOTS program. We need to empower the hospitals through training, equipment, monitoring, and supervision.

The second problem is addressing the problem of TB connected with HIV and multi drug resistance.

The last constraint is sustainable funding. We need to mobilize the local administrations to invest more to increase the government contribution. So far, the total cost for the TB program is $57 million per year. It is well funded basically, but it definitely needs more commitment and ownership at the local level.

TB is a disease of poverty. Fighting TB means fighting poverty.

Are there any success stories from other countries that we can learn from?

Peru has managed to come out of the list of 22 high burden countries, but only because the population there is low, unlike Indonesia.

However, Indonesia, and all members of the medical profession here, need to understand that anything that India, China and Indonesia do, contributes to accelerate the success of global efforts to control TB. Hopefully, we can meet the target of cutting global infections in half by 2015, and eliminate TB by 2050.

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TB and poverty

TB is a major killer of children in poor countries

Tuberculosis in children can be neglected. Paediatric TB does not have a high priority in many developing countries as fewer children than adults have the disease and children are not usually infectious, and often, limited resources mean that infectious cases have priority.

Vaccination is not 100% effective. The TB vaccine, BCG, does limit some of the severe forms of tuberculosis which are unique to young children, but by no means prevents them all. Tens of thousands “immunised” children in the developing world still suffer from tuberculosis meningitis and other forms of disease.

Children are highly susceptible to tuberculosis. The power to resist TB infection is normally poor in the first 5 years of life. The resistance can be further reduced by malnutrition, HIV, other childhood infections and worm infestations – all too common childhood conditions in poor countries. It has been estimated that as many as one third of the world’s population is infected with TB, and an estimated 20-50% of children who live in households where an adult has active tuberculosis become infected. Children are especially vulnerable to infection from household contacts as they are often held close and breathed on. The risk is particularly high in the developing world where family size is large, living quarters are crowded and more than half the population are children.

Traditional diagnosis of TB in children is ineffective. A vast number of children infected remain undiagnosed – creating a reservoir of future adult disease. Diagnosis is difficult in children, and often fatally delayed – early symptoms and signs of tuberculosis in children are common and easily missed. Lung TB is particularly difficult to diagnose early as children’s lungs react differently than adults, and they have little or no cough (thus not being able to provide sputum for testing) and, even if produced, microscopical examination only occasionally reveals the characteristic tubercle bacilli.

TB can have devastating long term effects on children who can be left deaf, blind and/or totally paralysed from TB meningitis, even after it is cured. Spread of infection to the bone can cause deformities of the spine (hunchback) or other permanent disabilities.

TB exacerbates poverty – it makes the patient and their family poorer because they may have to pay for treatment themselves, and even if TB drugs are free there is often a cost of travelling to clinics. If they cannot afford this they may default from treatment – leading to the added complications drug resistance. Children with TB lose out in the vital years of their education, which can affect their future wage-earning capacity.

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Directly Observed Therapy (DOT) for the Treatment of Tuberculosis

What is DOT?

DOT means that a trained health care worker or other designated individual (excluding a family member) provides the prescribed TB drugs and watches the patient swallow every dose.

 

Why use DOT?

  • We cannot predict who will take medications as directed, and who will not. People from all social classes, educational backgrounds, ages, genders, and ethnicities can have problems taking medications correctly.
  • Studies show that 86-90% of patients receiving DOT complete therapy, compared to 61% for those on self-administered therapy.
  • DOT helps patients finish TB therapy as quickly as possible, without unnecessary gaps.
  • DOT helps prevent TB from spreading to others.
  • DOT decreases the risk of drug-resistance resulting from erratic or incomplete treatment.
  • DOT decreases the chances of treatment failure and relapse.

Who can deliver DOT?

  • A nurse or supervised outreach worker from the patient’s county public health department normally provides DOT.
  • In some situations, it works best for clinics, home care agencies, correctional facilities, treatment centers, schools, employers, and other facilities to provide DOT, under the guidance of the local health department.
  • Family members should not be used for DOT. DOT providers must remain objective.
  • For complex regimens including IV/IM medications or twice daily dosing, home care agencies may provide DOT or share responsibilities with the local health department.
  • If resources for providing DOT are limited, priority should be given to patients most at risk. See the MDH DOT Risk Assessment form for help identifying high-priority patients.

How is DOT administered?

  • DOT includes:
    • delivering the prescribed medication
    • checking for side effects
    • watching the patient swallow the medication
    • documenting the visit
    • answering questions
  • DOT should be initiated when TB treatment starts. Do not allow the patient to try self-administering medications and missing doses before providing DOT. If the patient views DOT as a punitive measure, there is less chance of successfully completing therapy.
  • The prescribing physician should show support for DOT by explaining to the patient that DOT is widely used and very effective. The DOT provider should reinforce this message.
  • DOT works best when used with a patient-centered case management approach, including such things as:
    • helping patients keep medical appointments
    • providing ongoing patient education
    • offering incentives and/or enablers
    • connecting patients with social services or transportation
  • Patients taking daily therapy can usually self-administer their weekend doses.

How can a DOT provider build rapport and trust?

  1. “Start where the patient is.”
  2. Protect confidentiality.
  3. Communicate clearly.
  4. Avoid criticizing the patient’s behavior; respectfully offer helpful suggestions for change.
  5. Be on time and be consistent.
  6. Adopt and reflect a nonjudgmental attitude.

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