Community Medicine and Education Journal

Maternal Oxygen Transport Capacity and Nutritional Reserves: Anemia and Mid-Upper Arm Circumference (MUAC) as Independent Predictors of Low Birth Weight in the Indonesian Highlands

I Putu Adigama — 2025-12-16

Low birth weight (LBW) remains a critical determinant of neonatal mortality and long-term metabolic syndrome, particularly in agrarian transition zones. While demographic factors are often studied, the specific impact of maternal oxygen transport capacity (hemoglobin) and somatic nutritional reserves (Mid-Upper Arm Circumference/MUAC) remains under-characterized in highland populations where the paradox of food security versus nutritional insecurity exists. A retrospective case-control study was conducted in the highland region of Bangli, Indonesia, covering all deliveries in 2024. To maximize statistical power within the available clinical population, a total sampling technique was employed for the case group (n=20 mothers delivering infants <2,500g), matched 1:2 with randomly selected controls (n=40 mothers delivering infants ≥2,500g). Data were analyzed using independent t-tests and binary logistic regression. The multivariate model was restricted to biological predictors to maintain statistical stability given the sample size. The prevalence of anemia and Chronic Energy Deficiency (CED) was significantly higher in the case group (p<0.001). Bivariate analysis indicated profound risks associated with anemia (OR=9.00) and CED (OR=6.93). In the adjusted multivariate model, maternal anemia (aOR=11.45; 95% CI: 2.50–52.40) and CED (aOR=9.80; 95% CI: 2.15–44.60) remained dominant, independent predictors. The wide confidence intervals reflect the small sample size inherent to the facility-based dataset. ROC analysis demonstrated that MUAC <23.5 cm offers excellent diagnostic accuracy (AUC=0.845). In conclusion, clinical markers of oxygen transport and nutritional substrate availability are superior predictors of LBW compared to maternal age or parity in this cohort. The findings advocate for a biological-first approach to antenatal risk stratification.

Sustaining Infection Prevention and Control Post-Accreditation: A Systematic Review and Meta-Analysis of Global Longitudinal Outcomes

Adhika Rahman — 2026-03-27

Hospital accreditation is globally recognized as a strategic framework for standardizing healthcare quality. However, the long-term efficacy of accreditation in sustaining Infection Prevention and Control (IPC) practices and reducing Healthcare-Associated Infections (HAIs) remains fiercely debated. Most existing literature relies on cross-sectional data, failing to capture the temporal stability of post-accreditation outcomes. A systematic review and meta-analysis were conducted following PRISMA guidelines. We analyzed longitudinal, interrupted time-series, and pre-and-post research articles evaluating IPC compliance and HAI incidence before, during, and after accreditation cycles. Data extraction focused on sample sizes, means, and standard deviations to calculate the Standardized Mean Difference (SMD) using a DerSimonian-Laird random-effects model. Heterogeneity was assessed via the I-squared statistic. Eight longitudinal studies encompassing varying international healthcare contexts were included. The pooled meta-analysis demonstrated a statistically significant, moderate improvement in IPC outcomes post-accreditation, with an overall SMD of 0.52 (95 percent Confidence Interval: 0.38 to 0.66, p < 0.001). Subgroup analyses revealed that structural IPC compliance measures showed higher effect sizes (SMD = 0.58) compared to direct clinical outcomes like HAI incidence density reductions (SMD = 0.42). Moderate heterogeneity was observed (I-squared = 54 percent). In conclusion, hospital accreditation acts as a significant catalyst for improving IPC metrics over time. The moderate effect size on direct clinical outcomes suggests that accreditation provides a structural foundation that must be coupled with continuous quality improvement and strong institutional leadership to prevent post-survey decay.

Short-Term Clinical Effects of Standardized Syzygium polyanthum (Bay Leaf) Tea Infusion on Serum Uric Acid Modulation in Hyperuricemia: A Pilot Trial in Primary Care

Andi Asda Astiah — 2026-04-06

Hyperuricemia management relies heavily on synthetic xanthine oxidase inhibitors, which possess adverse effect risks. This pilot trial evaluates the short-term clinical effects of a standardized Syzygium polyanthum (Indonesian bay leaf) tea infusion on serum uric acid levels in a primary care setting, standardizing conventional preparation methods. A quasi-experimental, pre- and post-test controlled pilot trial was conducted at a community health center on Sumatra Island, Indonesia. Twenty-four adults with hyperuricemia were purposively assigned (alternating days of presentation) to an intervention group (n=12) or a control group (n=12). The intervention comprised 2.0 grams of standardized S. polyanthum tea infused at 80 degrees Celsius for 1 to 3 minutes, consumed twice daily for seven days. Both groups underwent monitored dietary purine restriction. Serum uric acid was evaluated via capillary analysis. The intervention cohort exhibited a statistically significant reduction in median serum uric acid from 8.1 mg/dL (Interquartile Range [IQR]: 7.4–8.9) to 6.9 mg/dL (IQR: 6.2–7.5) (p=0.034). The control group showed no significant alteration (median 8.0 mg/dL to 7.9 mg/dL; p=0.299). Intervention compliance was 95.4%, with no adverse gastrointestinal events reported. In conclusion, standardized S. polyanthum tea infusion significantly reduces serum uric acid over seven days, presenting a culturally syntonic and safe complementary intervention for primary healthcare frameworks, though extended treatment may be required to reach optimal clinical targets below 6.0 mg/dL.

Adaptive Leadership and Evidence-Based Policy in Hospital Financial Crisis Management During Disruption: A Systematic Review and Meta-Analysis

Katerine Katerine — 2026-04-21

Hospital financial resilience during crises requires adaptive leadership—the capacity to diagnose complex system challenges and mobilise sustained organisational change. Systematic evidence on adaptive leadership effectiveness in hospital crisis management remains fragmented. Objectives: To synthesise quantitative evidence on the effectiveness of adaptive leadership interventions for improving hospital organisational performance during financial and operational disruptions. Systematic review with meta-analysis using the PRISMA 2020 framework. We searched PubMed, ScienceDirect from 2017–2026 for studies examining adaptive leadership or resilience outcomes in hospital settings during financial or operational crises. Two independent reviewers extracted data and assessed risk of bias using Newcastle-Ottawa Scale (NOS). We estimated effect sizes (Hedges g) from 6 of 7 studies with estimated correlation coefficients (inter-rater reliability ICC=0.85), converted via d = 2r/√(1−r²). Random-effects meta-analysis used DerSimonian-Laird estimator. Certainty of evidence assessed via GRADE. Seven studies (k=7) contributed to meta-analysis; 10 to systematic review. Pooled standardised mean difference (SMD) = 0.467 (95% CI: 0.305–0.628, p<0.0001); I²=0% (Q=1.01, p=0.985). Effect remained robust in sensitivity analyses (leave-one-out: 0.445–0.493). Heterogeneity by study design minimal (Review k=3 SMD=0.476; Empirical k=2 SMD=0.438). GRADE assessment: moderate certainty (downgraded for indirectness and effect size estimation). In conclusion, adaptive leadership interventions show small-to-moderate evidence-supported effect on hospital organisational performance during crises. This effect persists across study designs and contexts despite methodological heterogeneity. This meta-analysis provides initial quantitative synthesis to guide hospital policy-makers and clinical leaders in crisis management strategy selection.

Religiosity, Spirituality, and Nonsuicidal Self-Injury Among Adolescents: A Meta-Analysis of Cross-Sectional and Longitudinal Studies

Maya Aulya Saputri — 2026-04-22

Nonsuicidal self-injury (NSSI) represents a growing public health concern among adolescents worldwide, with prevalence rates reaching 44.8% in Asian populations. Spirituality and religiosity have been proposed as protective factors against self-injurious behaviours; however, the quantitative evidence for this association has not been systematically synthesised with rigorous methodological standards. This meta-analysis aimed to evaluate the association between spirituality/religiosity and self-injurious behaviours in adolescents and young adults, and to clarify distinctions between NSSI and suicidal behaviour. A systematic search of multiple databases (PubMed, PsycINFO, CINAHL, Web of Science) was conducted using predefined search terms related to spirituality, religiosity, religion, self-injury, self-harm, NSSI, and adolescent populations. Original research articles reporting quantitative data on the association between spirituality/religiosity and self-injurious behaviours were included. Ten studies met inclusion criteria for qualitative synthesis, of which six provided sufficient quantitative data for meta-analysis. Effect sizes were converted to standardised mean differences (Hedges' g) and pooled using a random-effects model (DerSimonian-Laird). Risk of bias was assessed using an adapted Newcastle-Ottawa Scale. Prediction intervals (PI) were calculated alongside 95% confidence intervals (CI). The pooled standardised mean difference was −0.67 (95% CI: −1.12 to −0.21; 95% PI: −2.18 to 0.85; p = 0.004), indicating a protective effect of spirituality/religiosity against self-harm. Substantial heterogeneity was observed (I² = 96%; τ² = 0.30), reflecting variability in study designs, populations, outcome measures, and religiosity constructs. Sensitivity analyses confirmed directional consistency of findings, though studies differ considerably in effect magnitude. Subgroup analyses identified potential differences by study design (cross-sectional vs. longitudinal) and geographic region, though these require cautious interpretation given limited sample numbers (k = 6). Meta-regression was limited by small sample size and collinearity between study characteristics. In conclusion, spirituality and religiosity demonstrated a protective association with reduced self-injurious behaviours among adolescents and young adults. However, the substantial heterogeneity, predominantly observational evidence base, concentration in Western populations, and inability to distinguish NSSI from suicidal behaviour in all studies necessitate cautious interpretation. These findings support further investigation of spiritual assessment in adolescent mental health, though clinical implications must be tempered by methodological limitations. Well-designed prospective studies examining cultural context, mechanisms of action, and distinctions between NSSI phenotypes are required.

Patient Safety Culture in Community Pharmacies Serving the Indonesian Chronic Disease Referral Programme (BPJS Program Rujuk Balik): A Sequential Exploratory Mixed-Methods Study

Eka Pebi Hartianty — 2026-06-02

Community pharmacies are the most accessible health facility in Indonesia and a central interface of the BPJS Kesehatan Program Rujuk Balik (PRB) for chronic disease pharmaceutical care, yet empirical evidence on patient safety culture in this setting remains sparse. This sequential exploratory mixed-methods study characterised the twelve-dimension patient safety culture profile, quantified the cognition-to-practice gap, and identified actionable system priorities. Three sequential phases were conducted between July 2024 and February 2025: a cross-sectional Community Pharmacy Survey on Patient Safety Culture (CPSOPSC) among 35 pharmacy staff (Cronbach’s α=0.84), an expanded indicator survey of 43 staff, and semi-structured interviews with three pharmacists practising in PRB-contracted pharmacies. Highest positive responses occurred on teamwork (97.1%, 95% CI 95.0–99.2), organisational learning (87.6%, 95% CI 84.0–91.2), physical space (84.8%, 95% CI 80.9–88.7) and staff training (84.3%, 95% CI 80.5–88.1); lowest on documentation of errors (23.8%, 95% CI 19.3–28.3), staffing and workload (52.1%, 95% CI 47.0–57.2) and patient counselling (54.3%, 95% CI 49.2–59.4). Firth-penalised logistic regression with cluster-robust variance (area under the receiver-operating-characteristic curve [AUC]=0.78, 95% CI 0.71–0.85) identified prescription volume (adjusted odds ratio [aOR] 3.12, 95% CI 1.78–5.47, p=0.001) and independent ownership (aOR 2.41, 95% CI 1.32–4.40, p=0.004) as dominant correlates of low-documentation outcome. The expectation–experience indicator gap was 21.2 percentage points (95% CI 17.4–25.0, p<0.001, Cohen’s d=1.42). Eight qualitative themes triangulated with quantitative dimensions confirmed documentation infrastructure, workforce capacity, and counselling time as priority structural levers. Findings support extending BPJS PRB credentialing to include patient-safety indicators, advancing Sustainable Development Goals 3.8, 3.d, 4.4, 10.3 and 17.18.