Background Systemic fungal infection (SFI) is one of leading causes of morbidity and mortality in very low birth weight (VLBW) preterm infants. Because early diagnosis of SFI is challenging due to nonspecific manifestations, prophylaxis becomes crucial. This study aimed to assess effectiveness of oral nystatin as an antifungal prophylaxis to prevent SFI in VLBW preterm infants. Methods A prospective, open-labelled, randomized controlled trial was performed in a neonatal intensive care unit (NICU) of an academic hospital in Indonesia. Infants with a gestational age < 32 weeks and/or birth weight of < 1500 grams with risk factors of fungal infection were assessed for eligibility and randomized to either an intervention group (nystatin) or control group. The intervention group received 1 ml of oral nystatin three times a day, and the control group received a dose of 1ml of sterile water three times a day. The incidence of fungal colonization and SFI were observed and evaluated during the six-week study period. Overall, mortality rates and nystatin-related adverse drug reactions during the study period were also documented. Results A total of 95 patients were enrolled. The incidence of fungal colonization was lower among infants in nystatin group compared to those in control group (29.79% and 56.25%, respectively; relative risk 0.559; 95% confidence interval 0.357-0.899; p-value=0.009). There were five cases of SFI, all of which were found in the control group (p-value=0.056). There was no difference in overall mortality between the two groups. No adverse drug reactions were noted during the study period. Conclusions Nystatin is effective and safe as an antifungal prophylactic medication in reducing colonization rates in the study population. Whilst the use of nystatin showed a potential protective effect against SFI among VLBW preterm infants, there was no statistical significant difference in SFI rates between groups.

Background: Systemic fungal infection (SFI) is one of leading causes of morbidity and mortality in very low birth weight (VLBW) preterm infants. Because early diagnosis of SFI is challenging due to nonspecific manifestations, prophylaxis becomes crucial. This study aimed to assess effectiveness of oral nystatin as an antifungal prophylaxis to prevent SFI in VLBW preterm infants. Methods: A prospective, open-labelled, randomized controlled trial was performed in a neonatal intensive care unit (NICU) of an academic hospital in Indonesia. Infants with a gestational age ≤ 32 weeks and/or birth weight of ≤ 1500 g with risk factors for fungal infection were assessed for eligibility and randomized to either an intervention group (nystatin) or control group. The intervention group received 1 ml of oral nystatin three times a day, and the control group received a dose of 1 ml of sterile water three times a day. The incidence of fungal colonization and SFI were observed and evaluated during the six-week study period. Overall mortality rates and nystatin-related adverse drug reactions during the study period were also documented. Results: A total of 95 patients were enrolled. The incidence of fungal colonization was lower among infants in nystatin group compared to those in control group (29.8 and 56.3%, respectively; relative risk 0.559; 95% confidence interval 0.357-0.899; p-value = 0.009). There were five cases of SFI, all of which were found in the control group (pvalue = 0.056). There was no difference in overall mortality between the two groups. No adverse drug reactions were noted during the study period. Conclusions: Nystatin is effective and safe as an antifungal prophylactic medication in reducing colonization rates in the study population. Whilst the use of nystatin showed a potential protective effect against SFI among VLBW preterm infants, there was no statistical significant difference in SFI rates between groups. Trial registration: NCT03390374. Registered 4 January 2018-Retrospectively registered.

Background Systemic fungal infection (SFI) is one of leading causes of morbidity and mortality in very low birth weight (VLBW) preterm infants. Because early diagnosis of SFI is challenging due to nonspecific manifestations, prophylaxis becomes crucial. This study aimed to assess effectiveness of oral nystatin as an antifungal prophylaxis to prevent SFI in VLBW preterm infants. Methods A prospective, open-labelled, randomized controlled trial was performed in a neonatal intensive care unit (NICU) of an academic hospital in Indonesia. Infants with a gestational age < 32 weeks and/or birth weight of < 1500 grams with risk factors of fungal infection were assessed for eligibility and randomized to either an intervention group (nystatin) or control group. The intervention group received 1 ml of oral nystatin three times a day, and the control group received a dose of 1ml of sterile water three times a day. The incidence of fungal colonization and SFI were observed and evaluated during the six-week study period. Overall, mortality rates and nystatin-related adverse drug reactions during the study period were also documented. Results A total of 95 patients were enrolled. The incidence of fungal colonization was lower among infants in nystatin group compared to those in control group (29.79% and 56.25%, respectively; relative risk 0.559; 95% confidence interval 0.357-0.899; p-value=0.009). There were five cases of SFI, all of which were found in the control group (p-value=0.056). There was no difference in overall mortality between the two groups. No adverse drug reactions were noted during the study period. Conclusions Nystatin is effective and safe as an antifungal prophylactic medication in reducing colonization rates in the study population. Whilst the use of nystatin showed a potential protective effect against SFI among VLBW preterm infants, there was no statistical significant difference in SFI rates between groups.

Indonesia has ranked third among countries with the highest number of smokers in Asia because the price of cigarettes in those countries is still affordable. The strategy to make the price of cigarettes is not affordable is increasing cigarette excise tax. This instrument is considered the most effective way to control cigarette consumption. The purpose of this study was to find out how the public perceive the increase of the cigarette excise tax to cover the National Health Insurance (NHI) deficit and to identify the factors which affect such perception. This study used mobile phone survey and the sample were 1000 respondents. The list of potential respondent’s mobile phone numbers was selected using the systematic random sampling method with an interval of 100,000 to 200,000. The result showed that 87.9% respondents agree to increase cigarette price so that the children do not start to smoke. The majority of respondents (86.2%) also agree to increase the price of cigarettes to finance the JKN deficit. Perceptions of respondents who agreed to increase the price of cigarettes to prevent smoking initiation in children also tended to accede the increase in cigarette prices for financing the JKN deficit.  Abstrak Indonesia menempati peringkat ketika jumlah perokok tertinggi di Asia karena harga rokok masih terjangkau. Strategi agar harga rokok tidak terjangkau adalah menaikkan cukai rokok. Instrumen tersebut dinilai paling efektif untuk mengendalikan konsumsi rokok. Tujuan penelitian adalah untuk mengetahui bagaimana persepsi masyarakat terhadap kenaikan cukai rokok untuk pembiayaan Jaminan Kesehatan Nasional (JKN) dan mengidentifikasi faktor yang memengaruhi persepsi tersebut. Metode penelitian menggunakan survei melalui telepon dengan sampel 1000 responden. Daftar nomor telepon seluler calon responden dipilih dengan cara systematic random sampling interval 100.000 sampai 200.000. Hasil penelitian menunjukkan bahwa 87,9% setuju harga rokok dinaikkan agar anak-anak tidak mulai merokok. Mayoritas responden (86,2%) juga setuju mengenai kenaikan harga rokok untuk pembiayaan defisit JKN. Persepsi responden yang setuju terhadap kenaikan harga rokok agar mencegah inisisasi merokok pada anak-anak juga cenderung setuju terhadap kenaikan harga rokok untuk pembiayaan defisit JKN.