Irrational antibiotic prescription is common in developing countries, including in Indonesia. The aims of this study were to evaluate antibiotic prescription patterns and the factors related to the rationale for antibiotic prescriptions in community health centers in Depok City, Indonesia. The study employed a cross-sectional design in eleven primary health centers in Depok City, Indonesia. The sample consisted of 28 physicians and 788 oral antibiotic prescriptions, 392 of which were evaluated for rationality according to local guidelines issued by the Ministry of Health Republic of Indonesia from October to December 2012. Data were analyzed with chi-square tests and logistic regression analysis. The most widely prescribed antibiotics were amoxicillin (73.5%) and co-trimoxazole (17.4%). The most frequent diseases were acute pharyngitis (40.2%) and non-specific respiratory infection (25.4%). Approximately 220 of the 392 prescriptions did not meet the criteria for rational antibiotic prescriptions with regard to antibiotic selection (22.7%), duration of administration (72.3%), frequency of administration (3.2%), or duration and frequency of administration (1.8%). Physicians who had attended training for rational drug use were 2.01 times more rational than physicians who had never attended training. Physicians with a short working period (i.e., <7 years) were 3.95 times more rational in prescribing antibiotics than physicians who had been working for longer periods (i.e., >7 years). Most antibiotics were prescribed irrationally. Training for rational drug use and length of practice were factors related to the rationality of antibiotic prescriptions. Suitable interventions are urgently required to encourage the rational prescription of antibiotics in the PHCs.
BackgroundMalaria is a leading health threat for low to middle-income countries and around 1.8 billion people in the Southeast Asian region and 870 million people in the Western Pacific region remain at risk of contracting malaria. Traditional medicine/traditional healer (TM/TH) use is prominent amongst populations in low- to middle-income countries and constitutes an important issue influencing and potentially challenging effective, safe and coordinated prevention and treatment strategies around malaria. This paper presents the first critical review of literature on the use of TM/TH for malaria prevention and treatment in low- to middle-income countries in the Asia-Pacific region.MethodsA comprehensive search of English language, peer-reviewed literature reporting TM and/or TH use for malaria or among people in malaria-endemic areas in low- to middle-income Asia-Pacific countries published between 2003 and 2014 was undertaken.ResultsTwenty-eight papers reporting 27 studies met the inclusion criteria. Prevalence of TM/TH use for malaria treatment ranged from 1 to 40.1%. A majority of studies conducted in rural/remote areas reported higher prevalence of TM/TH use than those conducted in mixed areas of urban, semi-urban, rural, and remote areas. Those utilizing TM/TH for malaria are more likely to be: women, people with lower educational attainment, people with lower household income, those with farming occupations, and those from ethnic minorities (identified from only three studies). The majority of adult participants delayed seeking treatment from a health centre or conventional providers while initially practicing TH use. The most common reasons for TM/TH use for malaria across the Asia-Pacific region are a lack of accessibility to conventional health services (due to geographical and financial barriers), faith in traditional treatment, and the perception of lower severity of malaria symptoms.ConclusionThis review has provided crucial insights into the prevalence and profile of TM/TH use for malaria. Those managing and providing conventional programmes, treatment and care for malaria in the Asia-Pacific should remain mindful of the possible use of TM/TH amongst community members and patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-015-0593-7) contains supplementary material, which is available to authorized users.
BackgroundThe level of traditional medicine use, particularly Jamu use, in Indonesia is substantial. Indonesians do not always seek timely treatment for malaria and may seek self-medication via traditional medicine. This paper reports findings from the first focused analyses of traditional medicine use for malaria in Indonesia and the first such analyses worldwide to draw upon a large sample of respondents across high-risk malaria endemic areas.MethodsA sub-study of the Indonesia Basic Health Research/Riskesdas Study 2010 focused on 12,226 adults aged 15 years and above residing in high-risk malaria-endemic provinces. Logistic regression was undertaken to determine the significant associations for traditional medicine use for malaria symptoms.FindingsApproximately one in five respondents use traditional medicine for malaria symptoms and the vast majority experiencing multiple episodes of malaria use traditional medicine alongside free antimalarial drug treatments. Respondents consuming traditional medicine for general health/common illness purposes every day (odds ratio: 3.75, 95% Confidence Interval: 2.93 4.79), those without a hospital in local vicinity (odds ratio: 1.31, 95% Confidence Interval: 1.10 1.57), and those living in poorer quality housing, were more likely to use traditional medicine for malaria symptoms.ConclusionA substantial percentage of those with malaria symptoms utilize traditional medicine for treating their malaria symptoms. In order to promote safe and effective malaria treatment, all providing malaria care in Indonesia need to enquire with their patients about possible traditional medicine use.
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