Combining an experiential learning model and interprofessional peer-mentoring to improve maternal and neonatal health: Lessons learned from Indonesia.

Background: High maternal-neonatal mortality rate in the East Nusa Tenggara Timur Province, Indonesia, has raised a concern about improving quality health care and prevention. A task force team consisting of the district health office and the corresponding hospital implemented an interprofessional peer mentoring for improving maternal-neonatal health initiative involving various health professionals and community members. This study assesses the effectiveness of the interprofessional peer-mentoring program in improving health-care workers' capacity and community members' awareness of maternal-neonatal health in the primary care setting. Methods: A mixed-methods action research was conducted to measure the effectiveness of the peer-mentoring program. The task force appointed 15 personnel to be trained as peer mentors for 60 mentees from various professions. Peer mentors' perceptions of knowledge and skills improvement were measured before and after the training program. A reflective logbook was then developed to document mentoring activities. Surveys and logbook observations were performed to measure the effectiveness of the 8-month peer-mentoring program. Mentees' capacity and perception were measured before and after the mentoring program. Quantitative data were analyzed using the descriptive statistics and Wilcoxon's paired-rank test, whereas open-ended responses and log-book reflection were analyzed using the content analysis. Results: The peer-mentor training program improved peer mentors' knowledge and readiness from 3.64/5.00 to 4.23/5.00 (P < 0.001). Moreover, mentees viewed the program as effective in improving self-confidence and working capacity in maternal-neonatal health services from 3.47/5.00 to 3.98/5.00 (P < 0.001). Open-ended responses and a reflective logbook revealed that both mentees and peer mentors gained positive learning experiences. Seniority might become an obstacle to the mentoring process since peer mentors reported barriers in engaging elderly mentees due to seniority issues. Discussion: The interprofessional peer-mentoring program was effective in improving both mentors' and mentees' knowledge, self-confidence, and working capacity in maternal-neonatal primary health services and experiential learning. Further observation of the long-term outcomes of the program should be undertaken.

Anthropometric Outcome of Primary Unilateral Cleft Lip Repair in Indonesia.

OBJECTIVE: This study aimed to measure and analyze the outcome of primary unilateral cleft lip repair. DESIGN: Observational cohort study. SETTING: Surabaya Cleft Lip and Palate (CLP) Center, a major referral center for the Eastern part of Indonesia, affiliated with a tertiary center. PATIENTS, PARTICIPANTS: From 69 patients who met the inclusion criteria, we excluded 31 patients who were more than 2 years of age and were operated on by junior residents under supervision. INTERVENTIONS: We performed anthropometric measurements of the patients on photographs taken before, immediately after, and a year after the surgery. MAIN OUTCOME MEASURE(S): This study measured nasal width, vertical lip height, horizontal lip length, and philtral height ratios. RESULTS: While nasal width and philtral height ratios decreased significantly (P = .000 and P = .000, respectively) reaching symmetry immediately after surgery, the horizontal lip length, and vertical lip height ratios remained unchanged (P = .862 and P = .981, respectively). A year after surgery, the nasal width and horizontal lip length ratios increased significantly (P = .017 and P = .006, respectively), while philtral height and vertical lip height ratios remained unchanged (P = .927 and P = .138, respectively). There was no difference in the ratios based on the initial size and completeness of the cleft. CONCLUSION: In Surabaya CLP Center, the symmetry of nasal width, philtral height, horizontal lip length, and vertical lip height were achieved by the unilateral cleft lip repair despite the initial size and completeness of the cleft.

Stunted girl: A heartbreaking case report of underdiagnosed and untreated posterior ankyloglossia.

INTRODUCTION: Plastic surgeons can help to eliminate stunting by surgically treating children born with congenital craniofacial anomalies such as tongue-tie, or ankyloglossia. Releasing ankyloglossia can help to support breastfeeding and the later development of orofacial anatomy and physiology. Failure to do so can lead to growth and development difficulties in children. We report a heartbreaking case of a stunted 8 year-old female with underdiagnosed and untreated ankyloglossia. PRESENTATION OF CASE: The patient was consulted with a short stature, speech disorder, and swallowing disorder. History taking and physical examination led to a diagnosis of type 4 (posterior) ankyloglossia. The Hazelbaker Assessment Tool for Lingual Frenulum Function mandated a frenotomy. Under general anesthesia, frenotomy was performed surgically, and significant tongue mobility was gained. DISCUSSION: This case alerted both surgeon and pediatrician that collaboration is a must to intervene in such a specific congenital anomalies. Posterior (type 4) ankyloglossia may cause difficulties in tongue mobility which can lead to difficulties in breastfeeding and swallowing, speech disorders, and malocclusion. Posterior ankyloglossia is not only the most severe form of ankyloglossia, but also the most difficult to diagnose. CONCLUSION: In the absence of social and environmental factors, posterior (type 4) ankyloglossia was the single most responsible factor in this growth and development delay in the girl. Timely diagnosis and treatment could have prevented such a stunted condition.

The effect of a single-strain probiotic administration in the treatment of thermal burns patients.

BACKGROUND AND OBJECTIVES: Between 2007 and 2011, the mortality rate for burns patients at Dr. Soetomo General Hospital, Surabaya, Indonesia was 14.1% and 60% were suspected to be sepsis-related. Immunosuppression, gut barrier disruption, and intestinal hypomotility cause bacterial and bacterial product translocation. Probiotics improve the intestinal microbiome and eventually reduce bacterial translocation, and an increased secretory immunoglobulin A (SIgA) secretion post-administration of a multi-species probiotic has been observed. We aimed to determine whether a single-strain probiotic administration could show strengthened intestinal immunity, through an increase in SIgA levels, as with multi-strain probiotics. MATERIALS AND METHODS: Sixteen burns patients from our hospital Burns Centre were randomized into three treatment groups, and the patients were administered either a placebo, a Lactobacillus reuteri protectis probiotic, or a Bifidobacterium infantis 35624 probiotic for 14 consecutive days. The SIgA levels were analyzed using ELISA pre- and post-treatment. RESULTS: The post-treatment SIgAlevelsin the placebo, Lactobacillusreuteri protectis probiotic, and Bifidobacterium infantis 35624 probiotic groups were 222.56±74.22 mg/dL, 223.92±68.89 mg/dL, and 332.38±64.27 mg/dL, respectively. Decreased SIgA levels were observed in the placebo (7.19±15.87) and in the Lactobacillus reuteri protectis probiotic (1.9920±14.76) groups, whereas an increase was seen in the SIgA level in the Bifidobacterium infantis 35624 probiotic group (58.26±77.41). CONCLUSION: The Bifidobacterium infantis 35624 single-strain probiotic is generally superior to Lactobacillus reuteri protectis in altering intestinal immunity; however, this finding was not statistically significant. A multi-strain probiotic supplement is recommended for burns patients.

The effect of a single-strain probiotic administration in the treatment of thermal burns patients.

BACKGROUND AND OBJECTIVES: Between 2007 and 2011, the mortality rate for burns patients at Dr. Soetomo General Hospital, Surabaya, Indonesia was 14.1% and 60% were suspected to be sepsis-related. Immunosuppression, gut barrier disruption, and intestinal hypomotility cause bacterial and bacterial product translocation. Probiotics improve the intestinal microbiome and eventually reduce bacterial translocation, and an increased secretory immunoglobulin A (SIgA) secretion post-administration of a multi-species probiotic has been observed. We aimed to determine whether a single-strain probiotic administration could show strengthened intestinal immunity, through an increase in SIgA levels, as with multi-strain probiotics. MATERIALS AND METHODS: Sixteen burns patients from our hospital Burns Centre were randomized into three treatment groups, and the patients were administered either a placebo, a Lactobacillus reuteri protectis probiotic, or a Bifidobacterium infantis 35624 probiotic for 14 consecutive days. The SIgA levels were analyzed using ELISA pre- and post-treatment. RESULTS: The post-treatment SIgA levels in the placebo, Lactobacillus reuteri protectis probiotic, and Bifidobacterium infantis 35624 probiotic groups were 222.56±74.22 mg/dL, 223.92±68.89 mg/dL, and 332.38±64.27 mg/dL, respectively. Decreased SIgA levels were observed in the placebo (7.19±15.87) and in the Lactobacillus reuteri protectis probiotic (1.9920±14.76) groups, whereas an increase was seen in the SIgA level in the Bifidobacterium infantis 35624 probiotic group (58.26±77.41). CONCLUSION: The Bifidobacterium infantis 35624 single-strain probiotic is generally superior to Lactobacillus reuteri protectis in altering intestinal immunity; however, this finding was not statistically significant. A multi-strain probiotic supplement is recommended for burns patients.