Introduction: Despite Indonesia’s commitment to Universal Health Coverage (UHC), adolescents involved in customary marriages often remain beyond the reach of state protection. This study explores the "multilayered exclusion" experienced by these couples in accessing maternal health services in Munti Gunung, Bali. Methods: This exploratory qualitative case study involved 16 purposively selected participants, including early-married adolescent mothers (n=5), family gatekeepers (husbands/in-laws, n=5), health workers (n=5), and a community leader (n=1). Data were collected through in-depth interviews and analyzed using thematic analysis to identify barriers across the socio-ecological spectrum. Results: Inductively derived from localized empirical data, this study presents 'Administrative Invisibility' as an emergent conceptual construct describing how the lack of civil marriage certificates systematically excludes newborns from the National Health Insurance scheme. This qualitative exploration indicates that structural vulnerability is mediated by rigid household hierarchies and a mismatch in institutional capacity within resource-constrained primary care services. To secure immediate healthcare, families and local administrative actors navigate this socio-legal limbo by employing pragmatically effective yet legally high-risk informal workarounds. Conclusion: Within this single-site qualitative scope, the intersection of customary child marriage and legal identity exclusion appears to form a compounded structural node within the multi-layered matrix of healthcare exclusion for newborns. Achieving health equity requires proactive, affirmative structural reforms, specifically, piloting a 'Conditional Humanitarian Enrolment' model powered by an API-driven digital bridging framework to formally decouple an infant’s constitutional right to healthcare from parental marital status, safely integrating immediate neonatal survival with long-term socio-legal safeguards.
Introduction: Type 2 diabetes mellitus (DM) is a non-communicable disease with increasing prevalence and low adherence globally. Therefore, this study aims to evaluate changes in medication adherence and glycemic control after a WhatsApp-based education and interactive reminders among outpatients receiving insulin therapy. Methods: A pre-experimental study used a prospective one-group pre-test-post-test design among outpatients receiving insulin in a hospital. The intervention included DM education at the initial meeting, followed by educational videos and weekly interactive reminders provided through WhatsApp for 6 weeks. Patient knowledge was assessed with Diabetes Knowledge Questionnaire (DKQ) and adherence to medication was assessed using Adherence to Refills and Medications Scale (ARMS). Glycemic control indices (fasting blood glucose (FBG), two hours of postprandial blood glucose (2hPPBG), glycated hemoglobin (HbA1c)) were measured before and after the intervention. Additionally, a paired t-test was used to measure the effect of the intervention on knowledge, adherence, and glycemic control indices. Results: Among the 122 patients who fulfilled the inclusion criteria, there was a significant increase in knowledge (p < 0.001), with the proportion of highly knowledgeable patients rising from 19.7% to 38.5%. The increase in adherence to medication from 30.3% to 39.3% was not statistically significant (p = 0.228). Glycemic control indices showed a significant improvement (p < 0.001), with mean HbA1C, FBG, and 2hPPBG decreasing from 8.63% to 7.85%, 152.18 mg/dl to 138.72 mg/dl, and 268.84 mg/dl to 228.66 mg/dl, respectively. Conclusion: Following the 6 weeks WhatsApp-based education and interactive reminders, improvement were observed in patient knowledge and glycemic control indices, but medication adherence did not change significantly. This study lacked a control group, the findings represent observed changes after the study period and require confirmation in controlled studies with longer follow-up.
Introduction: Pharmaceutical procurement represents a significant proportion of hospital expenditure, with drug inventory accounting for approximately 10-20% of of total hospital costs. The ABC-VEN analysis has been widely used to improve pharmaceutical inventory management, but evidence regarding its application in outpatient cardiology services within Indonesia’s National Health Insurance (JKN) system remains limited. This study aims to evaluate drug use patterns, pharmaceutical expenditure, and inventory priorities using ABC–VEN analysis in outpatient cardiology services under Indonesia’s National Health Insurance (JKN) system. Methods: A retrospective observational study was conducted using all outpatient prescriptions under the national health insurance program in the cardiology clinic from January to March 2020. The ABC method carried out the analysis of drug use patterns and cost. ABC-VEN matrix was formulated by combining the results of ABC and VEN analysis. Results: A total of 4.443 prescriptions contained 482.457 items from 125 types of drugs. Based on usage value, Classes A, B, and C accounted for 68%, 21%, and 11%, respectively, while based on invesment value, they accounted for 68%, 27%, and 5%. Class A drug usage and cost represent only 6% and 2% of total drug types. VEN analysis identified no Vital drugs, whereas Essential medicines accounted for 94% of total drug utilization and 98% of total pharmaceutical expenditure The ABC-VEN matrix showed drug usage in Categories I, II, and III at 34%, 60%, and 6%, with the corresponding drug costs for 68%, 30%, and 2%. Category I drugs represented 34% of total drug use but consumed 68% of total pharmaceutical expenditure, indicating substantial budget concentration in a limited number of essential high-cost medicines. Conclusion: The ABC analysis based on usage value and invesment value and VEN analysis shows differing patterns. Pharmaceutical expenditure in outpatient cardiology services was highly concentrated among a limited number of essential medicines. ABC–VEN analysis provides a practical framework for procurement prioritization, budget optimization, and strategic inventory control, thereby supporting more efficient pharmaceutical management and sustainable medication availability.
Introduction: Artisanal and small-scale gold mining (ASGM) is a major source of mercury contamination in aquatic environments, threatening ecosystems and human health. Conventional remediation is often costly and difficult to apply in resource-limited mining areas. Phytoremediation using aquatic macrophytes offers a low-cost alternative. This study compared observed water-phase mercury removal by Ipomoea aquatica, Pistia stratiotes, Nymphaea spp., and Eichhornia crassipes under standardized bench-scale laboratory conditions. Methodology: ASGM liquid waste with an initial dissolved mercury concentration of 0.00448 mg/L was used. Each species was tested in triplicate over a 14-day exposure period, with water samples analyzed on Day 0, Day 9, and Day 14. Mercury concentrations were measured using Atomic Absorption Spectrophotometry, and removal effectiveness was calculated as percentage reduction from baseline. Because biomass-normalized uptake, plant tissue mercury accumulation, and abiotic controls were not included, findings are interpreted as plant-associated water-phase reductions rather than definitive evidence of uptake mechanisms. Results: All species substantially reduced dissolved mercury, with clear interspecies variation. By Day 14, water hyacinth reduced mercury to 0.00003–0.00004 mg/L, corresponding to 99.11–99.33% removal. Lotus showed comparable performance, achieving 98.21–98.44% removal. Water spinach produced intermediate reductions of 85.04–94.42%, with an approximate mean of 89.17%, while water lettuce showed the lowest removal range of 83.71–86.38%, with an approximate mean of 84.89%. Reductions were evident by Day 9 and greatest by Day 14. Mechanistic interpretations related to root morphology, biomass, rhizosphere processes, or internal translocation should remain cautious because these parameters were not directly measured. Conclusion: Aquatic macrophytes can substantially reduce dissolved mercury in ASGM-contaminated liquid waste under bench-scale conditions. Water hyacinth showed the highest observed removal, followed closely by lotus. Field application requires ecological containment, safe biomass disposal, abiotic control assessment, effluent characterization, and further tissue-based uptake studies.
ntroduction: According to the Global Burden of Disease study, approximately 775,000 lives were lost prematurely in 2017 due to poor sanitation. In 2020, only 54% of the global population had access to safely managed sanitation. Therefore, this study aimed to explore cross-sector collaboration for improving sanitation access at "last mile" communities in South Sulawesi, Indonesia. Barriers to achieving Open Defecation Free (ODF) status were emphasized, with a focus on the dynamics between health centers (puskesmas) and village governments. Methods: This qualitative case study was conducted with key stakeholders who were directly engaged in the STBM program, such as managers, district government officers, health officers, as well as sub-district, village, and puskesmas heads. Focus group discussions (FGDs) and in-depth interviews were used to collect data. Analysis was conducted thematically to determine patterns and obstacles to collaboration. Results: There was no synergy between puskesmas and village governments in enhancing access to sanitation. Puskesmas operated by modifying the behavior of communities to construct their own latrines, while the village governments operated by providing financial support through village funds. This isolation led to community reliance on outside assistance as well as lowered ODF program effectiveness. FGDs also showed misconceptions among the stakeholders, and external influences on the pathogen spread to water and food sources (e.g., vectors (e.g., flies) spreading pathogens). Conclusion: The synergy between puskesmas and village governments was a critical obstacle to attaining the ideal level of sanitation access and ODF status in the last-mile communities. Enhancing partnership by considering integrated planning, better communication, and participation of the community is necessary. The study showed that the existence of vectors, such as flies, worsened the sanitation issues. This underscores the significance of integrated and sustainable cross-sector partnerships to enhance access to sanitation and control vectors.
