The 7Th AIC-ICMR on Health and Life Sciences

PROCEEDING

The 7th AIC-ICMR on Health and Life Sciences

The Annual International Conference 2017 Syiah Kuala University

“Advancing Knowledge, Research, and Technology for Humanity”

ISSN: 2089-208X

Banda Aceh, Aceh, Indonesia October 18-20, 2017

Misri Yanty Lubis1,2*, Lamek Marpaung2, Muhammad Pandapotan Nasution3 And Partomuan Simanjuntak4,5

1Department of Agrotechnology, Faculty of Agriculture, Graha Nusantara University, Tor Simarsayang, Padangsidimpuan 22712, Indonesia. 2Department of Chemistry, Faculty of Mathematic and Natural Science, Sumatera Utara University, Padang Bulan, Medan 20155, Indonesia. 3Department of Pharmacology, Faculty of Pharmacy, Sumatera Utara University, Padang Bulan, Medan 20155, Indonesia. 4Department of Pharmacology, Faculty of Pharmacy, Pancasila University, Srengseng Sawah, Jagakarsa, Jakarta 12630, Indonesia. 5Research Centre for Biotechnology, Indonesian Institute of Science, Jln. Raya Bogor Km 46, Cibinong 16911, Indonesia.

Abstract This research studied about antioxidant activity various extracts of jiringa (Archidendron jiringa) Jack. I. C. Nielsen) pods by using DPPH method. The IC50 of extracts obtained from linear regression equation on chart concentration vs % inhibition. Pods of jiringa dried at room temperature 1 x 24 h and then macerated with methanol. Filtrat were evaporated with rotary evapoarator to obtained methanol extract. Further, methanol extract dissolved with water and partitioned with ethyl acetate for several times, and then evaporated to obtained ethyl acetate extract. Ethyl acetate extract partitioned with methanol and n-hexane to obtained n-hexane extract and total phenolic. All extracts tested antioxidan activity by using DPPH method and consitution of phenolic compound by using FeCl3. The IC50 values for all extracts in order to evaluate antioxidant activity were calculated from linear regression equation on chart consentration vs % inhibition. Test phenolic compounds with FeCl3 showed positive test for methanol extract, ethyl acetate extract and total phenolic. In the other hand, n- hexane extract showed negative test. The IC50 values of methanol extract, ethyl acetate extract, n- hexane extract and total phenolic were 30.5134; 20.3220; 139.3794 and 11.7987 µg/ml, respectively. Extract pods of jiringa with variaty solvent showed high antioxidant activity, except n-hexane extract. The high antioxidant activity cause of phenolic compounds constitution. Pods of jiringa extracts have high antioxidant activity because it contains phenolic compounds that can be used as a source of a new natural antioxidant.

Keywords: antioxidant, jiringa, phenolic, DPPH

INTRODUCTION

Jiringa (Archidndron jiringa (Jack) I. C. Nielsen) is a leguminous tree that widely distributed in Indonesia, Malaysia and Thailand (Lim 2012). It‘s used as a vegetable (young shoots), food flavouring agent (seeds) (Ashuwini et al. 2012), medicine (leaves and seeds), source of dye for silk (pods) and timber for craft work and firewood (Charungchitrak et al. 2011). The plant usually stands up to 25 meters in height with a smooth, grey coloured bark.

Proceedings of the 7th AIC-ICMR on Health and Life Sciences

The beans measure up to 3.5 centimeters in diameter and 2.0 centimeters in thickness. Jiringa‘s beans are typically taken together with rice as a side dish either as raw vegetable, roasted, fried or boiled (Muslim and Abdul 2010; Ruzilawati et al. 2012). Jiringa is one of traditional medicine herbs. Seeds have been reported as a source of natural antioxidant (Mohammad 2006) that could destroy excess free radicals and prevent oxidative damage (Fonseca 2017). Seeds are used to treat hypertension and diabetic disease. The old leaves burnt to obtain ashes were used against itching (Mohammad 2006). Jiringa‘s pods is organic waste. If the pods of jiringa is cut with a knife containing iron, it will appear a black bluish or black purple colour. This indicates the presence of phenolic compounds in the pods of jiringa (Khoddami 2013). Phenolic compounds of plant can inhibit oxidation in the human body becouse of it‘s antioxidant potential (Amarowicz and Shahidi 2017). This time, There has been interesting to find natural sources of antioxidant in plants, because of their potential health associated with several degenerative and aging related diseases such as cancer and cardio vascular diseases (Badhani et al. 2015; Baydar et al. 2007; Tomas et al. 2012; Andreata et al. 2009). Synthetic antioxidants may have toxic, carcinogenic and negative effects to humans body. Ascorbic acid is one of the sources of natural antioxidants (Baydar et al. 2007; Tomas et al. 2012; Andreata et al. 2009). We use it as a standard in this reserach. The aim of this research is to investigate the antioxidant activity of various extract jiringa‘s pods and relatied with content of phenolic compounds. Solvent extraction is commenly applied to isolate bioactive compounds from plants (Pai et al. 2017; Pinela et al. 2016; Mokrani and Madani 2016; Krishnan 2016; Xu 2016). Ethanolic extract pods of jiringa showed contrentation phenolics and potent antioxidant activity (Nahdzatul et al. 2012). The antioxidant activity studies of extracts jiringa‘s pods in some of these solvents (methanol, n- hexane and ethyl acetat) have not yet been reported.

Figure 1 Jiringa‘s pods

Plant Material Jiringa‘s pods (Archidendron jiringa (Jack) I. C. Nielsen) were collected from Namorambe village, Deli Serdang, North Sumatra, Indonesia. The plant material was identified at the Herbarium Bogoriensis of The Research Centre for Biology, Indonesian Institute of Sciences (LIPI), Cibinong, Indonesia.

Extraction Jiringa‘s pods (Archidendron jiringa (Jack) I. C. Nielsen) were dried and powdered (4,160 g) at room temperature. Further, macerated with methanol (16 liters) for several times. The resultant extracts were concentrated to dryness in a rotary evaporator. Methanol extract (140 g) was dissolved with water for several times. After filtration, the aqueous solution was partitioned with ethyl acetate solvent. Soluble portion of ethyl acetate solvent after concentrated with rotary evaporator was collected (37.88 g). Ethyl acetate extract was partitioned further with mixture of n-hexane-methanol to get extracts. The methanol extracts was considered as total phenolic (13.87 g) and n-hexane extract was obtaned 2.08 g. We use

FeCl3 to test phenolic compounds.

DPPH Method Antioxidant of methanol extract, ethyl acetate extract, n-hexane and total phenolic were based on reactions with DPPH (1,1-diphenyl-2-picrylhydrazyl) respectively and were compare to standard ascorbic acid. Radical has a deep violet colour do to its unpaired electron and radical scavenging can be followed spectrophotometrically by the loss of absorbance at 515 nm as the pale yellow non-radical form is produced (Musa et al. 2016). DPPH solution 0.4 mM was made from 7.9 mg DPPH (Molecular weight is 394.32) which was dissolved with methanol pro analysis up to 50 ml. Placed in a dark bottle. The blank soluble was prepared from 0.4 mM DPPH of 1 ml into 5 ml tested reaction tube, then added methanol pro analysis until the mark and homogenized. The tube was covered with aluminum foil. The extract was weighed as 5 mg and then dissolved into 10 ml methanol pro analysis (500 µg/ml). This solution is called as the mother liquor. The mother liquor 50, 100, 150, 200 and 250 µl were piped into 5 ml reaction tube to obtain concentrations of 5, 10, 15, 20 and 25 µg/ml. In each tube was added 1 ml of DPPH solution 1 mM and added with

Proceedings of the 7th AIC-ICMR on Health and Life Sciences methanol pro analysis up to 5 ml then homogenized. The tube was covered with aluminum foil. Ascorbic acid solution was prepared same with solution test.

dry jiringa‘s pods (4,160 g)

- Macerated with methanol

(16 liters) 1 x 24 h - Concentrated with rotary evaporator

Methanol extract Antioxidant (140 g) activity test

- Dissolved with water for several

times (16 liters) - Partitioned with ethyl acetate for

several times

Water fraction Ethyl acetate fraction

- Concentrated with

rotary evaporator

Ethyl acetae extract Antioxidant (37.88 g) activity test

- Dissolved with methanol - Partitioned with n-

hexane for several times

n-hexane Ethyl acetate fraction fraction

- Concentrated with - Concentrated with rotary evaporator rotary evaporator

Total Phenolic Antioxidant n-hexane extract Antioxidant (13.87 g) activity test (2.08 g) activity test

Figure 2 Flow diagram to obtained extracts and antioxidant activity test

RESULTS AND DISCUSSION

Result of plant identification Result of plant identification at the Herbarium Bogoriensis of The Research Centre for Biology, Indonesian Institute of Sciences (LIPI), Cibinong, Indonesia was Archidendron jiringa (Jack) I. C. Nielsen.

Result of Phenolic Compound Test Phenolic compound test result indicated the present of phenolic compound in methanol extract, ethyl acetate extract and phenolic total (table 2). Extract was added FeCl3 showed black bluish colour (Tiwari et al. 2011).

Table 1 Rendement of jiringa‘s pods extracts Extract Weight (g) Rendement (%)a Methanol 140 3.37 Waterb - - Ethyl Asetate 37.88 27.06 n-hexane 2.08 5.49 Phenolic Total 13.87 36.62 aRendement calculated with equation below:

Proceedings of the 7th AIC-ICMR on Health and Life Sciences

bNot calculated because this fraction too much water and dificult to evaporated. Phenolic compounds test with this fraction by using FeCl3 showed negative test in table 2.

Table 2 Result of phenolic compound test by using FeCl3 Extract Resulta Methanol + Water - Ethyl Asetate + n-hexane - Phenolic Total + a(+) showed the present of phenolic compounds and (-) showed none phenolic compounds.

Result of Antioxidant Activity Test

Test phenolic compounds with FeCl3 showed positive test for methanol extract, ethyl acetate extract and total phenolic. In the other hand, n-hexane extract showed negative test.

The IC50 values of methanol extract, ethyl acetate extract, n-hexane extract and total phenolic were 30.5134, 20.3220, 139.3794, 11.7987 µg/ml, respectively.

The IC50 of extracts calculated from linear regression equation at chart (Figure 3-7). From absorbance of blank and sample, we calculated % inhibition by using equation 1 below:

̅ (1)

IC50 is concentration of sample or standard that can inhibit 50% of DPPH. The lowest IC50 means has the highest antioxidant activity. The phenolic total has highest antioxidant activity and the lower is n-hexane extract. According to standard, the value of

IC50 < 50 µg/ml, it is very strong antioxidant, 50 µg/ml < IC50 < 100 µg/ml is strong antioxidant, 101 µg/ml < IC50 < 150 µg/ml is medium antioxidant and IC50 > 150 µg/ml is weak antioxidant (Fidrianny 2014).

Proceedings of the 7th AIC-ICMR on Health and Life Sciences

50 y = 0,9874x + 19,871 45 45,88 40 37,98 35 34,88 30 28,97 25 25,7 20 Series1 15 Linear (Series1) % inhibition% 10 5 0 0 5 10 15 20 25 concentration

Figure 3 Chart Concentration vs % Inhibition Methanol extract

60 y = 0,9689x + 30,31 57,32 50

47,99 42,71 40 37,987 38,21 30 Series1 20

% inhibition% Linear (Series1) 10

0 0 5 10 15 20 25 concentration

Figure 4 Chart Concentration vs % Inhibition Ethyl Aceteat extract

12 y = 0,3434x + 2,1371 10 9,76 8,97 9,239 8 6 5,35 Series1 4 3,12

2 Linear (Series1) % inhibition% 0 0 5 10 15 20 25 concentration

Figure 5 Chart Concentration vs % Inhibition n-hexane extract

60 56,99 57,32 59,12 50 47,98 40 42,33 30 Series1 20 y = 0,8584x + 39,872 Linear (Series1) % inhibition% 10 0 0 5 10 15 20 25 concentration

Figure 6 Chart Concentration vs % Inhibition total phenolic

120 y = 2,0747x + 45,214 100 96,34

83,987 80 79,4 70,97 60 Series1 50,98

%Inhibition 40 Linear (Series1)

0 0 5 10 15 20 25 Concentration

Figure 7 Chart Concentration vs % Inhibition Ascorbic acid as a standard

CONCLUSION

Extract pods of jiringa with variaty solvent showed high antioxidant activity, except n-hexane extract. The high antioxidant activity cause of phenolic compounds constitution. Pods of jiringa extracts have high antioxidant activity because it contains phenolic compounds that can be used as a source of a new natural antioxidant.

Proceedings of the 7th AIC-ICMR on Health and Life Sciences

ACKNOWLEDGEMENTS

We thank to Herbarium Bogoriensis of The Research Centre for Biology, Indonesian Institute of Sciences (LIPI), Cibinong, Indonesia for the botanical identification of jiranga‘s plant that used in this research.

REFERENCES

Amarowicz R and Shahidi F. 2017. Antioxidant activity of broad bean seed extract and its phenolic composition. Journal of functional foods 38:656-62. Andreata RHPA. 2009. New species of Smilax and a key to all species from Minas Gerais, Brazil. Systematic Botany 34:28–31. Ashuwini S, Alias A, Karim RB. 2012. Pithecellobium jiringa legume flour for potential food applications: Studies on their physico-chemical and functional properties. Food Chem 130:528-35. Baydar NG, Ozkanb G, Yasar S. 2007. Evaluation of the antiradical and antioxidant potential of grape extracts. Food Control 18:1131–36. Bharti B, Neha S, Rita K. 2015. Gallic acid: a versatile antioxidant with promising therapeutic and industrial applications. Royal Sociaty of Chemistry 5:27540-557. Charungchitrak S, Petsom A, Sangvanich P, Karnchanatat A. 2011. Antifungal and Antibacterial Activities of Lectin from the Seeds of Archidendron jiringa Nielsen. Food Chemistry. 126:1025-32. Fonseca JC, Barbosa MA, Silva ICA, Duarte A, Castro, Santos L. 2017. Antioxidant and allelopathic activities of Smilax brasiliensis Sprengel (Smilacaceae). South African Journal of Botany 111:336–40. Khoddami A, Meredith A, Wilkes, Thomas. 2013. Techniques for Analysis of Plant Phenolic Compounds. Journal molecule 18:2328-75. Krishnan RY, Chandran MN, Vadivel V, Pajan KS. 2016. Insights on the influence of microwave irradiation on the extraction of flavonoids from Terminalia chebula. Sep Purif Technol. 170:224–33.

Lim, T, K. 2012. Edible Medicinal and Non-Medicinal Plants, volume 2, fruits, Springer Dordrecht Heidelberg London New York. p. 544-8. Mohammad ACY, Nik NNA, Wahyu B, Setianto, Omar AK. 2006. Supercritical Carbon Dioxide Extraction of Constituents of Pithecellobium Jiringa Seeds and Their Identification Using Time of Flight Gas Spectrometry. Proceedings of the 1st International Conference on Natural Resources Engineering & Technology. Putrajaya, Malaysia. p. 616-25.

Pinela J, Prieto MA, Carvalho AM, Barreiro MF, Oliveira MBPP, Barros L. 2016. Microwave-assisted extraction of phenolic acids and flavonoids and production of antioxidant ingredients from tomato: a nutraceutical oriented optimization study. Sep Purif Technol 164:114–24 . Ruzilawati AB, Imran A, Shaida FS. 2012. Effect of Pithecellobium jiringa as antimicrobial agent. Bangladesh J Pharmacol 7:131-4. Tiwari P, Bimlesh K, Mandeep K, Gurpreet K, Harleen K. 2011. Phytochemical screening and Extraction: A Review. Internationale Pharmaceutica Sciencia 1:98-106. Tomas BFA and Andres LC. 2012. Polyphenols and health: current state and progress. Journal of Agricultural and Food Chemistry 60:8773–75.

Xu WJ, Zhai JW, Cui Q, Liu JZ, Luo M, Fu YJ. 2016. Ultra turrax based ultrasound assisted extraction of five organic acids from honeysuckle (Lonicera japonica Thunb.). Sep Purif Technol 166:73–82.

Proceedings of the 7th AIC-ICMR on Health and Life Sciences

Specific Interventions During the First 1000 Days of Life Program and Toddlers‘ Nutritional Status

Nur Ramadhan1,2*, Teuku Tahlil1 and Kartini Hasballah1 1Magister of Nursing, Nursing Faculty of Syiah Kuala University, Banda Aceh, 23111 2Loka Litbang Biomedis Aceh *Corresponding author email address: [email protected]

Abstract The First 1000 Days of Life is a golden period for a child to grow and develop optimally. During this period, the nutritional needs are increasing and meeting these needs will positively influence their short-term and long-term health outcomes. So that, interventions must be started from prenatal care to 2 years of age. However, various problems about meeting the specific nutritional needs remain a considerable challenge during that period. Therefore, the number of young children suffering from stunting is still high. This cross-sectional study aims to identify the relationship between specific interventions during 1000 days and nutritional status among children under five years old at one of Health Community Centres in Aceh. The number of respondents in this study was 185 people from 8 villages in which is the service area of the health centre. The measurement of nutritional status of children under the age of five was carried out based on the height/ age (TB/U) index, and specific interventions during the time span were assessed by interview. The result of this study showed that 34,1% of respondents were young children suffering stunting and 96.2% of babies were born in normal weight. There was a correlation between specific interventions and stunting in toddlers. These interventions include supplementation of iron during pregnancy (p = 0,002 (OR: 2,6,95% CI: 1,4- 1,9)), initiation of breastfeeding (p = 0,000 (OR: 3,3,95% CI: 1,7-6,3)), exclusive breastfeeding (p = 0.019 (OR: 2.0, 95% CI: 1,1-3,8)), and appropriate feeding practice of supplementary feeding (p = 0.012 (OR: 2,2,95% CI: 1,1-4,2)). The results of multivariate test indicated that initiation of early breastfeeding is the most dominant factor on nutritional status in toddler (p = 0,000 (OR: 3,3, 95% CI: 1,7-6,5)). The need for capacity enhancement of the first 1000 days should be addressed, not only for pregnant and lactating mothers, but also prospective mothers and families to shape the health quality of future generation.

Keywords: First 1000 Days, Nutritional Status, Specific Intervention, toddler

INTRODUCTION

Stunting is one of global nutritional challenges, especially in poor and developing countries. It is growth faltering due to the manifestation of insufficiency nutrition during pregnancy until 24 months or two years of age (Bloem et al., 2013; Paulo et al., 2000). In 2012, it was estimated 162 millions of children under five years old were stunted worldwide. If this trend continues, projection indicates that 127 million children will be stunted in 2025. In Asia, 56% of the children are stunted, meanwhile in Africa it reaches 36%. The prevalence of stunting in Indonesia (37,2 %) is higher than in Myanmar (35 %), Vietnam (23%) and Thailand (16%) (Pusdatin Kemenkes RI, 2016).

The 7th Annual International Conference (AIC) Syiah Kuala University and The 6th International Conference on Multidisciplinary Research (ICMR) in conjunction with the International Conference on Electrical Engineering and Informatics (ICELTICs) 2017, October 18-20, 2017, Banda Aceh, Indonesia The first 1.000 days of life program is an accelerating nutrional improvements since infants are still in the womb, 280 days (9 months and 10 days), exclusive breastfeeding during 180 days, breastfeeding & nutritious complementary foods during( 6 months) and 550 days ( 180 months) (Wahana Visi Indonesia, 2013). Period 0 – 24 months are very crucial moments to determine the quality of life, so that it is called as golden period. This period is very sensitive because the effects created on the child‘s life will be permanent and cannot be changed. Therefore adequate nutrition is very necessary at this age (Mucha, 2007). Stunting is a problem because it is related to the increased risk of illness and death, suboptimal brain development that can cause motor delays, and delayed mental development (Kusharisupeni, 2002; Unicef, 2013). Resports (Victora et al., 2008; Crookston et al., 2010; Hoddinott et al., 2013; Unicef, 2013;) suggest that stunting is associated with poor educational achievement, shorter height, lack of motor ability at school age, low productivity, obese, uncontaminated disease vulnerability, increased risk of degenerative disease and decrease incomes when become an adult People do not aware yet that stunting is an issue because children with stunting look like others with normal activities, not like wasted children that must be dealt with soon. People also do not realize that maternal nutrition during pregnancy contributes to birth outcomes later (Unicef, 2013). Reducing stunting becomes one of main indicators of the first 1000 days of life program success. It consists of specific interventions for pregnant women, lactating mothers, and children until the age of two and sensitive interventions for society involving related sectors (Kemenko Kesra RI, 2012). Sepcific intervention includes pregnancy examination, iron supplementation for pregnant women, IMD & new babyborn health examination, exclusive breastfeeding, immunization, complementary foods, vitamin A supplementation and growth monitoring in baby and child (Zulkarnain, 2016). A research in Bhutan found that mother who did not do adequate antenatal examination and complementary foods during 6 months was at risk for stunting 1.31,1.51,and 2.73 times higher (Aguayo, Badgaiyan, & Paintal, 2015). Stunting can be prevented through sustainable care and treatment. A research in Brazil found that the prevelance of stunting in children under five years could be reduced by implementing 4 priority actions : 1) improvements of maternal and child health services and nutrition; 2)a rise in education and information for teenage girl and female; 3) expansion of water and sanitation system; 4) improvements in the purchasing power of families (Monteiro et al., 2010). Other research in Peru involving stunted children aged 6-18 months proved that a correct intervention can increase the height of chidlren with stunting. At 4, 5-6 years old,

100

Proceedings of the 7th AIC-ICMR on Health and Life Sciences they can have the same intelligence as other children with no stunting when babies (Crookston et al., 2010). In Indonesia, results of the basic health research in 2013 show that the prevalence of stunting (37,2%) was higher than in 2010 (35,6%) and 2007 (36,8%) (Balitbangkes, 2014b). About 8,9 millions or one out of three children in Indonesia do not grow maximally (WHO, 2010). The prevelance of stunting in Aceh is higher than national prevelance – 41,5% (Balitbangkes, 2014a). Besides, 3 out of 5 specific programs – initiation breastfeeding, exclusive breastfeeding, breastfeeding until the age of two years old, vitamin A supplementation for children under 5 years old, iron supplementory for pregnant women are still low (Global Nutrition Report, 2015). Aceh health profile in 2015 showed that exclusive breasfeeding practice in Aceh was 53% (national target 80 %), Fe tablet supplementation for preganant women was 77% (national target 95 %) and there were 366 cases of children with malnutrition/undernutrition (Dinkes Aceh, 2015). Banda Aceh health profile in 2015 suggested that postnatal care and neonatal visits was above 90%, scope of baby health service was 78% and immunization coverage was 80 %, exclusive breasfeeding practice was only 55,1%, and there were still some casef of children with malnutrition and undernutrition (Dinas Kesehatan Kota Banda Aceh, 2015). In 2015, there were 27.645 children under five years old in Kota Banda Aceh, and the biggest number could be found at Baiturahman Community Health Center (PUSKESMAS) coverage area. The community health center implemented various activities of the first 1000 days of life program especially specific intervention program. It leads to further analysis if the activities in the first 1000 days of life program especially specific intervention in pregnant women, breastfeeding mother and baby are implemented properly. This study aims to indentify the relationship between specific intervention activities during the first 1000 days of life program and nutritional status amongst children under the age of five years old in Aceh.

MATERIALS AND METHODS

This study was conducted by applying a cross-sectional approach. The study population consisted of all mothers whose children aged 25-60 months at one Community Health Center service area in Aceh, Indonesia. Samples collection was conducted by applying purposive sampling method. The criteria of samples included mothers whose children aged 25-60 month and agreed to be interviewed.

101

RESULTS AND DISCUSSION

Respondents characteristics

Characteristics of the study paricipants can be seen in Table 1. As can been seen in the Table 1, most of the childrens‘ mothers were between 20-34 years old - the ideal age for preganancy, with the youngest was 20 years old. Pregnancy at young age is at risk for premature birth, BBLR, bleeding during delivery that can cause death of mothers and infants (Pusdatin Kemenkes RI, 2015). Pregnancy at the age of less than 20 years old is not normal biologically. The emotion of the mothers at this age are not stable yet and their mental are still immature. As the result, they do not really aware of fullfilling the nutritional needs during pregnancy. Meanwhille, at age of >34 years old, mothers have performance decline and lower endurance. They are also vulnerable for various diseases (Sistiarini, 2008). Age is one of crucial factors that can affect individual‘s behavior. Age contributes to the process of creating someone‘s ability. When someone gets older, they will get more abilities (Sediaoetama, 2006).

Table 1 - Distribution of Respondents characteristics (monther and children under the age of five) (n=185) Variable f %

Age of mother 1 5 a. < 20 years old 121 65,4 b. 20-34 years old 63 34,1 c. ≥ 35 years old

102

Proceedings of the 7th AIC-ICMR on Health and Life Sciences

Educational background of mother 3 1,6 a. Elementary school graduation 10 5,4 b. Junior High School graduation 120 64,9 c. Senior High School graduation 52 28,1 d. Diploma 3/ bachelor/master/doctoral degree

Occupation of mother 117 63,2 a. Housewife 34 18,4 b. Civil Servant/ POLRI/ TNI/ BUMN 10 5,4 c. Trader 24 13,0 d. Private employees

Age of the child 91 49,2 a. 25-36 months 59 31,9 b. 37-48 months 35 18,9 c. 49–60 months

Sex of the child 95 51,4 a. Male 90 48,6 b. Female

Birth weight 5 2,7 a. BBLR (<2500 gr) 178 96,2 b. Normal (2500-4000 gr) 2 1,1 c. BBLL (>4000 gr)

Nutritutional status ( height/weight age indicators TB/ U)

of children under the age of five

a. Normal 122 65,9 b. Stunting 63 34,1

Table 1 also shows that most of respondents educational background in this study are senior high school. It has been reported that someone with higher educational background will get easier in absorbing information and implementing them in their daily life compared to those with lower educational background (Azwar, 2002). Mother educational background also has an impact on their understanding level in healthcare, hygiene, and awareness againts children and family (Madanijah, 2003). As regards with mothers‘ occupation, Table 1 shows that most of mothers in this research do not work or play their role as a housewife. That does not mean they are not good because mother who is busy working has limited time with their family, so that they do not give enough attention on their children health and growth. It will give an impact on inadequate nutritional fulfillment that can lead to malnutrion and not optimal growth (Mulyani, 1990) Children under the age of five observed in this study aged 25-60 months old with an assumption they have already passed the first 1000 days of life. Based on the sex or gender of

103

The relationship between Specific Intervention during the first 1000 days of life and nutritional indicators of weight height and age TB/U

The relationship between specific intervention during the first 1000 days of life and nutritional indicators of weight/height and age are shown in table 2.

Table 2 - The relationship between specific intervention programs and nutritional status of Height and Age TB/U (n=185) TB/U (height,weight,age) OR Variables Non stunting Stunting p-value (95%CI) f (%) f (%) Iron supplementation  Proper 81 (75) 27 (25) 0,002 2,634  Improper 41 (53,2) 36 (46,8) 1,411-4,919 Antenatal care  Proper 117 (67,2) 57 (32,8) 0,150 2,463  Improper 5 (45,5) 6 (54,5) 0,721-8,413 Early initiation of breasfeeding  Yes 89 (76,1) 28 (23,9) 0,000 3,371  No 33 (48,5) 35 (51,5) 1,782-6,378 Exclusive Breasfeeding  Yes 78 (72,9) 29 (27,1) 0,019 2,078  No 44 (56,4) 34 (43,6) 1,120-3,856 Complementary breasfeeding food  Proper 90 (72) 35 (28) 0,012 2,250  Improper 43 (53,3) 28 (46,7) 1,186-4,267 Immunization  Completed 112 (68,3) 52 (31,7) 0,060 2,369  Incompleted 10 (7,6) 11 (52,4) 0,947-5,929 It can be seen in table 2 that some sepecific intervention programs during the first 1000 days of life have relationship between nutrional status of TB/U (height, weight, age)

104

Proceedings of the 7th AIC-ICMR on Health and Life Sciences

(p-value = <0,05). Results of multivariate analysis with multiple logistic regression can be seen in table 3.

Table. 3 - Final Result of Multiple logistic Regression Analysis on Children under the Age of Five Nutritional Status Variable with indicator TB/ U (n=185)

95% C.I.for

B S.E. Wald df Sig. Exp(B) EXP(B) Lower Upper Step Iron 0,971 0,332 8,541 1 .003 2,642 1,377 5,067 1a Supplementation IMD 1,218 0.335 13,245 1 .000 3,379 1,754 6,510 Constant -3,785 0,731 ,000 ,023

Iron supplementation and practice of early initiation of breastfeeding can effect nutritional status of TB/ U (height, weight, age) silmutanously – iron supplementation (p- value = 0, 003) and IMD (p-value = 0, 000). The most dominant variable that effect nutritional status of TB/ U (height, weight, age) is the practice of early initiation of breastfeeding (OR = 3,37). Stunting reduction program becomes one of main indicators that make the first 1000 days of life program successfull. Stunted children are not caused by genetic factors, but because of malnutrition and repeated diseases due to unhealthy environment. If infant receives adequate nutrition during pregnancy, they will have normal weight and height birth (Zulkarnain, 2016). Stunting is growth faltering as the accumulation of inadequate nutrition during pregnancy until the age of 24 months. It becomes worse with inappropriate of catch up growth (Bloem et al., 2013; Hoffman, Sawaya, Verreschi, Tucker, & Roberts, 2000; Kusharisupeni, 2002) Preveious research suggests teenager with growth-retardation experienced higher anxiety, depression symptom, and low self-esteem than teenager with normal growth. Stunted children before the age of two years had worse emotion and behaviour at their last teenaged (Walker, Chang, Powell, Simonoff, & Grantham-McGregor, 2007). Stunting contributes to bad quality of human resources that will give an impact on a nation potential development (Unicef, 2013) One of specific intervention programs during the first 1000 days of life is nutritional fullfillment for mothers during pregnancy. Mothers have to consume adequate food nutrition, supplementation of iron or Fe, and their health needs to be monitored. They have to take at

105

The 7th Annual International Conference (AIC) Syiah Kuala University and The 6th International Conference on Multidisciplinary Research (ICMR) in conjunction with the International Conference on Electrical Engineering and Informatics (ICELTICs) 2017, October 18-20, 2017, Banda Aceh, Indonesia least 90 tablets of iron during pregnancy. The result of this study in table 2 shows that there is a relationship between iron supplementation and the case of stunted chidlren (p-value = 0,002) with OR 2,6. A previous prospective cohort study in Nepal showed that relative risk (RR) stunting cases is 14% lower on children whose mothers took iron and folic acid during pregnancy and 23% RR stunting cases can be reduced if mothers took 90 tablets of iron and folic acid during pregnancy <6 months (Nisar, Dibley, & Aguayo, 2016). Antenatal care is not related to stunting in this study. It is not in line with the research conducted by (Najahah, Adhi, & Pinatih, 2013) that found mothers who did not do standard antenatal care is at risk giving birth to children 2,4 times higher than mothers who did standard one. During pregnancy, mothers have to do antenatal care to monitor the growth and development of the fetus and it can be delivered healthily. Government must provide facilities and hold comprehensive healthcare so that every child can obtain optimal health since they were still in the womb.Therefore, mothers have to get at least four times antenatal care, once at first trimester, once at second trimester and twice at third trimester. The healthcare obtained during antenatal care is 5T cares which are weight scaling, blood pressure test, TT immunization, fundus height measurement, and Fe tablet supplementation (Kemenkes RI, 2010). This study found that there is a correlation between early initiation of breastfeeding practice (IMD) and stunting (p-value = 0,000). Also, the logistic regression test shows that IMD (early initiation breastfeeding) is the most related factor to stunting. Mothers who practice early initiation of breastfeeding are at risk 3,3 times lower to have non stunted children. A previous research (Muchina, 2010) found that there is a significant relationship between initiation breastfeeding practice delayment and stunting (OR = 2.00). It is also in line with the research conducted by Yunus that mentioned children who got early initiation breasfeeding are at risk 2,3 times lower for stunting. It is different from a research conducted by (Nadiyah, Briawan, & Martianto, 2014) that found early initiation breastfeeding practice is not related to stunting. Another research also found that there is no significant differences between prevelance of stunting based on early initiation of breastfeeding (Teshome, Kogi- Makau, Getahun, & Taye, 2009). First breast milk produced on the first day of birth contains of colostrum. It contains protein and immunoglobulin with the highest concentration. The immunoglobulin in colostrum is immunoglobulin A (IgA) that protects the surface of of infant‘s gastrointestinal tract from patogen bacteria and virus (Roesli, 2008) Table 2 shows that there is a relationship between the provision of Exclusive breastfeeding with stunting cases (p-values <0,005). This is in line with the research

106

Proceedings of the 7th AIC-ICMR on Health and Life Sciences conducted by Damayanti, Muniroh, & Farapti in 2016 that found children under the age of five who did not get exclusive breastfeeding are at risk 16,5 times higher with stunting than those who got exclusive breastfeeding. Children with non exclusive breastfeeding have higher risk for stunting (OR = 6,54) (Lestari, Margawati, & Rahfiludin, 2014). Other research revealed that the provision of exclusive breastfeeding can increase the height growth of children (Kamudoni, Maleta, Shi, & Holmboe-Ottesen, 2015). A research conducted in Bangladesh (Khatoon, Mollah, Choudhury, Islam, & Rahman, 2011) concluded that there is a positive relationship between the provision of exclusive breastfeeding and height growth on children. It has been reported (Haschke & Detzel, 2013) that there is a growth difference between children with exclusive breastfeeding and non exclusive breastfeeding. Mother‘s breast milk can prevent malnutrition or stunting on children aged 0-24 months. Exclusive breastfeeding can prevent stunting or growth failure. Lactofferin in breast milk binds up the iron to inhibit bacterial growth. Besides, pereksidase enzim in breast milk can destroy bacterial growth. Mother‘s breast milk produces TGF β protein (Transforming Growth Factor Beta) that will balance the pro inflamation and anti inflamation so that the intestine can work properly. It also contains growth factors (IGF-1, EGF, TGF α) that can increase babie‘s digestive tract adaptation on gastrointestinal tract development, cell maturity, and form bactrial colonies (Verduci et al., 2014) Children under five years old who do not receive exclusive breasfeeding will be riskier at stunted-growth because it can cause infectious diseases like diarrhea. It is usually experienced more by children under the age of six months that receive foods besides mother‘s breast milk. Infectious diseases may lead to appetite decline, decreased absorption of nutrients and increased of catabolism so that nutrition cannot be completed for growth (Damayanti, Muniroh, & Farapti, 2016; Lestari et al., 2014). There is a correlation between complementary feeding practice and stunting in this study (p <0,05). A previous research in South Ethiopia found that there is a significant relationship (p <0,005) between the provision of complementary feeding during the first 6 months and stunting cases (Tessema, Belachew, & Ersino, 2013). Other researchers (Najahah et al., 2013) suggest children under five years old who received inadequate complementary feeding are risky 7,4 times higher at stunting than those who received adequate complementary feeding. Complementary feeding is nutrients given to children aged 6-24 months to meet their nutritional needs when breast milk is no longer enough. Improving the quality and quantity of complementary foods for healthy children aged 6 – 24 months is necessary (Permadi, Hanim,

107

CONCLUSIONS

There was a correlation between specific interventions and stunting in children under five years old. These interventions include supplementation of iron during pregnancy, initiation of breastfeeding, exclusive breastfeeding and appropriate feeding practice of supplementary feeding. There is evidence that the initiation of early breastfeeding is the most dominant factor on nutritional status in children under five years old.

ACKNOWLEDGEMENTS

Authors would like to extend best gratitude to all participated respondents, head of Dinas Kesehatan Kota Banda Aceh, head of Puskesmas and head of KIA Puskesmas Baiturrahman Kota Banda Aceh. Futhermore, author would like to extend our gratitude to Mr. Fahmi Ichwansyah, S.Kp., MPH, Ph.D that is Kepala Loka Litbang Biomedis Aceh to his support during the conduct of this study.

108

Proceedings of the 7th AIC-ICMR on Health and Life Sciences

REFERENCES

Aguayo, V. M., Badgaiyan, N., & Paintal, K. (2015). Determinants of Child Stunting in The Royal Kingdom Of Bhutan : An In-Depth Analysis of Nationally Representative Data. Maternal and Child Nutrition, 11, 333–345. http://doi.org/10.1111/mcn.12168 Aridiyah, F. O., Rohmawati, N., & Ririanty, M. (2015). Faktor-faktor yang Mempengaruhi Kejadian Stunting pada Anak Balita di Wilayah Pedesaan dan Perkotaan. E-Jurnal Pustaka Kesehatan, 3(1), 163–170. Azwar, S. (2002). Sikap Manusia: Teori dan Pengukurannya. Jakarta (ID): Pustaka Pelajar. Jakarta: Pustaka Pelajar. Balitbangkes. (2014a). Laporan Riset Kesehatan Dasar Aceh 2013. Jakarta. Balitbangkes. (2014b). Riset Kesehatan Dasar 2013. Departemen Kesehatan Republik Indonesia. Jakarta. Bloem, M. W., Pee, S. De, Hop, L. T., Khan, N. C., Laillou, A., Moench-pfanner, R., … Asia, S. (2013). Key strategies to Further Reduce Stunting in Southeast Asia : Lessons from the ASEAN Countries Workshop. Food and Nutrition Bulletin, 34(2), 8–16. Crookston, B. T., Penny, M. E., Alder, S. C., Dickerson, T. T., Merrill, R. M., Stanford, J. B., … Dearden, K. A. (2010). Children who recover from early stunting and children who are not stunted demonstrate similar levels of cognition. J Nutrition, 140(11), 1996– 2001. http://doi.org/10.3945/jn.109.118927 Damayanti, R. A., Muniroh, L., & Farapti. (2016). Perbedaan Tingkat Kecukupan Zat Gizi dan Riwayat Pemberian Asi Eksklusif pada Balita Stunting dan Non Stunting. Media Gizi Indonesia, 11(1), 61–69. Dinas Kesehatan Kota Banda Aceh. (2015). Profil Kesehatan Kota Banda Aceh. Banda Aceh. Dinkes Aceh. (2015). Profil Kesehatan Provinsi Aceh 2014. Banda Aceh. Global Nutrition Report. (2015). Actions and Accountability to Accelerate The World‟s Progress on Nutrition. Washington DC. Haschke, F., & Detzel, P. (2013). Feeding Patterns during the First 2 Years, 62(suppl 3), 16– 25. http://doi.org/10.1159/000351575 Hoddinott, J., Behrman, J. R., Maluccio, J. A., Melgar, P., Quisumbing, A. R., Ramirez-Zea, M., … Martorell, R. (2013). Adult consequences of growth failure in early childhood. American Journal of Clinical Nutrition, 98(5), 1170–1178. http://doi.org/10.3945/ajcn.113.064584 Hoffman, D. J., Sawaya, A. L., Verreschi, I., Tucker, K. L., & Roberts, S. B. (2000). Why are nutritionally stunted children at increased risk of obesity ? Studies of metabolic rate and fat oxidation in sha ... Studies of metabolic rate and fat oxidation in shantytown children. Am J Clin Nutr, 72, 702–707. Jesmin, A., Yamamoto, S. S., Malik, A. A., & Haque, M. A. (2011). Prevalence and Determinants of Chronic Malnutrition among Preschool Children: A Cross-sectional Study in Dhaka City, Bangladesh. Journal of Health Population and Nutrition, 29(5),

109

The 7th Annual International Conference (AIC) Syiah Kuala University and The 6th International Conference on Multidisciplinary Research (ICMR) in conjunction with the International Conference on Electrical Engineering and Informatics (ICELTICs) 2017, October 18-20, 2017, Banda Aceh, Indonesia 494–499. Kamudoni, P., Maleta, K., Shi, Z., & Holmboe-Ottesen, G. (2015). Exclusive breastfeeding duration during the first 6 months of life is positively associated with length-for-age among infants 6–12 months old, in Mangochi district, Malawi. European Journal of Clinical Nutrition, 69(1), 96–101. http://doi.org/10.1038/ejcn.2014.148 Kemenkes RI. (2010). Pedoman Pelayanan Antenatal Terpadu. Jakarta: Kementerian Kesehatan RI. Kemenko Kesra RI. (2012). Pedoman Perencanaan Program Gerakan Nasional Percepatan Perbaikan Gizi Dalam Rangka Seribu Hari Pertama Kehidupan. Jakarta. Khatoon, T., Mollah, M. A. H., Choudhury, A. M., Islam, M. M., & Rahman, K. M. (2011). Association between infant- and child-feeding index and nutritional status: Results from a cross-sectional study among children attending an Urban Hospital in Bangladesh. Journal of Health, Population and Nutrition, 29(4), 349–356. http://doi.org/10.3329/jhpn.v29i4.8450 Kusharisupeni. (2002). Peran Status Kelahiran Terhadap Stunting Pada Bayi. Jurnal Kedokteran Trisakti, 23(3), 73–80. Retrieved from http://www.univmed.org/wp- content/uploads/2011/02/Kusharisupeni.pdf. Lestari, W., Margawati, A., & Rahfiludin, M. Z. (2014). Faktor Risiko Stunting pada Anak Umur 6-24 bulan di Kecamatan Penanggalan Kota Subulussalam Provinsi Aceh. Jurnal Gizi Indonesia, 3(1), 37–45. http://doi.org/10.14710/JGI.3.1.126-134 Madanijah, S. (2003). Model Pendidikan GI-PSI-Sehat Bagi Ibu serta Dampaknya terhadap Perilaku Ibu, Lingkungan Pembelajaran, Konsumsi Pangan, dan Status Gizi Anak Usia Dini. Institut Pertanian Bogor. Monteiro, C. A., Benicio, M. H. D., Conde, W. L., Konno, S., Lovadino, A. L., Barros, A. J. D., & Victora, C. G. (2010). Narrowing socioeconomic inequality in child stunting: the Brazilian experience, 1974-2007. Bulletin of the World Health Organization, 88(4), 305–311. http://doi.org/10.2471/BLT.09.069195 Mucha, N. (2007). Implementing Nutrition-Sensitive Development: Reaching Consensus. Bread for the World Institute, (November), 1–8. Muchina, E. (2010). Relationship Between Breastfeeding Practices And Nutritional Status Of Children Aged 0-24 Months In Nairobi, Kenya. African Journal of Food Agriculture Nutrition and Development, 10(4), 2358–2378. Mulyani. (1990). Penelitian Gizi dan Kesehatan. Bogor: Pusat penelitian dan Pengembangan Gizi dan Makanan. Nadiyah, Briawan, D., & Martianto, D. (2014). Faktor Risiko Stunting Pada Anak Usia 0 — 23 Bulan Di Provinsi Bali , Jawa Barat , Dan Nusa Tenggara Timur. Jurnal Gizi Dan Pangan, 9(2), 125–132. Najahah, I., Adhi, K. T., & Pinatih, G. N. I. (2013). Faktor risiko balita stunting usia 12-36 bulan di Puskesmas Dasan Agung , Mataram , Provinsi Nusa Tenggara Barat. Public Health And Preventive Medicine Archive, 1(2), 134–141.

110

Proceedings of the 7th AIC-ICMR on Health and Life Sciences

Nisar, Y. Bin, Dibley, M. J., & Aguayo, V. M. (2016). Iron-Folic Acid Supplementation During Pregnancy Reduces the Risk of Stunting in Children Less Than 2 Years of Age : A Retrospective Cohort Study from Nepal. http://doi.org/10.3390/nu8020067 Paulo, S., Hoffman, D. J., Sawaya, A. L., Verreschi, I., Tucker, K. L., & Roberts, S. B. (2000). Why are nutritionally stunted children at increased risk of obesity ? Studies of metabolic rate and fat oxidation in shantytown children, 702–707. Permadi, M. R., Hanim, D., Kusnandar, & Indarto, D. (2016). Risiko Inisiasi Menyusu Dini Dan Praktek Asi Eksklusif Terhadap Kejadian Stunting Pada Anak 6-24 Bulan. Penelitian Gizi Dan Makanan, 63(1), 9–14. Pusdatin Kemenkes RI. (2016). Situasi Balita Pendek. Jakarta: Pusat Data dan Informasi Kementerian Kesehatan RI. Ramli, Agho, K. E., Inder, K. J., Bowe, S. J., Jacobs, J., & Dibley, M. J. (2009). Prevalence and risk factors for stunting and severe stunting among under-fives in North Maluku province of Indonesia. BMC Pediatrics, 9(1), 64. http://doi.org/10.1186/1471-2431-9- 64 Roesli, U. (2008). Inisiasi Menyusui Dini. Jakarta: Pustaka Bunda. Satyawati. (2012). MPASI-Makanan Pendamping ASI Dapur Ibu. Jakarta: Dian Rakyat. Sediaoetama. (2006). Ilmu Gizi untuk Mahasiswa dan Profesi (II). Jakarta: Dian Rakyat. Sistiarini, C. (2008). Faktor Maternal dan Kualitas Pelayanan Antenatal yang Berisiko Terhadap Kejadian Berat Badan Lahir Rendah ( BBLR ) Studi Pada Ibu Yang Periksa Hamil Ke Tenaga Kesehatan dan Melahirkan di RSUD Banyumas. Universitas Diponegoro. Teshome, B., Kogi-Makau, W., Getahun, Z., & Taye, G. (2009). Magnitude and determinants of stunting in children underfive years of age in food surplus region of Ethiopia: The case of West Gojam Zone. Ethiopian Journal of Health Development, 23(2), 98–106. http://doi.org/10.4314/ejhd.v23i2.53223 Tessema, M., Belachew, T., & Ersino, G. (2013). Feeding patterns and stunting during early childhood in rural communities of Sidama, South Ethiopia. The Pan African Medical Journal, 14, 75. http://doi.org/10.11604/pamj.2013.14.75.1630 Unicef. (2013). Improving child nutrition: The achievable imperative for global progress. Division of Communication, UNICEF. http://doi.org/978-92-806-4686-3 Verduci, E., Banderali, G., Barberi, S., Radaelli, G., Lops, A., Betti, F., … Giovannini, M. (2014). Epigenetic effects of human breast milk. Nutrients, 6(4), 1711–1724. http://doi.org/10.3390/nu6041711 Victora, C. G., Adair, L., Fall, C., Hallal, P. C., Martorell, R., Richter, L., & Sachdev, H. S. (2008). Maternal and Child Undernutrition: Consequences for Adult Health and Human Capital. The Lancet, 371(9609), 340–357. http://doi.org/10.1016/S0140- 6736(07)61692-4 Vitolo, M. R., Gama, C. M., Bortolini, G. A., Campagnolo, P. D. B., & Drachler, M. D. L. (2008). Some risk factors associated with overweight , stunting and wasting among

111

112

Proceedings of the 7th AIC-ICMR on Health and Life Sciences

The Antibiogram of Escherichia Coli Isolated from Wound Specimens in dr. Zainoel Abidin General Hospital Banda Aceh

Wilda Mahdani Department of Microbiology, Faculty of Medicine, University of Syiah Kuala, Darussalam, Banda Aceh 23111, Indonesia; Clinical Microbiology Laboratory, Dr. Zainoel Abidin General Hospital, Banda Aceh 23126, Indonesia;

Abstract Wound infection is an unexpected condition in patient's management. This condition can lead to delayed healing, worsening conditions and increasing mortality. One of the nosocomial infection agents, Escherichia coli, has many virulence factors that allow it to be a significant pathogen in wound. The objective of the study was to determine the antimicrobial sensitivity pattern of Escherichia coli isolated from wound specimens in Dr. Zainoel Abidin General Hospital Banda Aceh. A total of 744 wound samples were received over a period of one year from July 2016 to June 2017. The number of 553 samples indicated bacterial growth. Identification and Antimicrobial Susceptibility Test including Extended Spectrum Beta Lactamases (ESBL) detection were performed based on the Clinical Laboratory Standard Institute (CLSI) guidelines. E. coli accounted for 88 (15.9%) isolates. ESBL production was detected in 62 (70.4%) of E. coli isolates. These E. coli isolates exhibited high susceptibility to meropenem, amikacin and tigecycline. While the third generation cephalosporins appeared to be less effective. This study shows that there was high number of E. coli producing ESBL isolated from wound specimens. Hospitals should implement comprehensive antimicrobial stewardship policies in order to control the incidence of infections and antibiotic resistance.

Keywords: Escherichia coli, Wound specimen, Antimicrobial resistance, Antimicrobial stewardship.

INTRODUCTION

Wounds occur due to the loss of skin integrity. The local environment becomes moist, warm, and nutritious so that it becomes conducive to microbial colonization and proliferation. The diversity of microorganisms in any wound is affected by the type of wound, depth, location, and quality of tissue perfusion, antimicrobial administration and host immune response. An infected wound will fail to be recovered, patients suffer from increased trauma, increased medical costs, and wound management practices will demand more resources (Bowler, et.al., 2001). The commensal E. coli is the predominant nonpathogenic flora of the human gut. The other pathogenic E. coli strains are able to cause illness outside the gut even in a very healthy humans (Nataro & Kaper, 1998). The E.coli strain that causes extra intestinal infections is

113

MATERIALS AND METHODS

Wound specimens were collected in the ward then sent to the Dr. Zainoel Abidin General Hospital microbiology laboratory. The kind of specimens may consist of pus, aspirate, swab or tissue biopsy. Direct Gram Staining performed for all types of wound specimens. Identification and Antimicrobials Susceptibility Testing were performed using Vitek 2 Semiautomatic Method System (bioMérieux, France) confirmed by CLSI guidelines. The isolates data were then systematically recorded. Data E. coli from these specimens was taken from microbiology laboratory record between July 2016 and June 2017.

RESULTS AND DISCUSSION

Out of the 744 samples that examined, 553 samples indicated the presence of microbial growth. Which are mostly bacteria and scantily yeasts. The rest showed no growth.

Table 1. The microbes that recovered from wound specimens. Recovery Sample amount Percentage No growth 191 25.7 Bacteria 547 73.5 Yeast 6 0.8 Total 744 100

The top ten isolates from wound specimens between July 2016 and June 2017 in Dr. Zainoel Abidin General Hospital Banda Aceh were Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, Proteus mirabilis, Enterobacter cloacae, Enterococcus faecalis, yeast and Enterobacter aerogenes. E. coli ranks as the second of all isolates most frequently recovered from these wound specimens.

114

Proceedings of the 7th AIC-ICMR on Health and Life Sciences

Table 2. The top ten isolates from wound specimens in Dr. Zainoel Abidin General Hospital. No. Microorganism Amount Percentage

1 Staphylococcus aureus 110 19.9 2 Escherichia coli 88 15.9 3 Klebsiella pneumoniae 75 13.6 4 Pseudomonas aeruginosa 53 9.6 5 Acinetobacter baumannii 47 8.5 6 Proteus mirabilis 34 6.1 7 Enterobacter cloacae 16 2.9 8 Enterococcus faecalis 9 1.6 9 Yeast 6 1.1 10 Enterobacter aerogenes 3 0.5

E. coli is the second most common isolate after S.aureus. Brady, et.al. (2008) reported that S. aureus is the leading cause of wound infection, this is mediated by biofilm formation in wounds. Gram-positive cocci are commonly present in acute wounds. The facultative Gram negative rods are common after several weeks. The most commonly isolated gram negative bacteria include Proteus, E. Coli, and Klebsiella. As the wound condition worsens, the infection travels to a deeper structure then the infection tends to be polymicrobial (Kaftandzieva, et.al., 2012). While immunosuppression is likely to play a role in disease outcomes as well as virulence may also have an impact on wound pathogenesis (Sunder, et.al., 2012). The interesting finding is that as many as 62 (70.4%) E. coli isolates were Extended Spectrum Beta Lactamases (ESBL) producers. ESBL is an enzyme produced by bacteria that can damage the betalactam ring in beta-lactam antibiotics. This causes resistance to Penicillins, third generation cephalosporins and monobactam. This enzyme can not inhibit cephamycins and carbapenems (Bonnet, 2004). ESBL is a serious threat. It is a resistance mechanism that can thwart treatment with commonly used antibiotics in the hospitals. Microbiological examination is essential for detection of antimicrobial resistance (Shaikh, et.al., 2015).

115

0 E. coli Non-ESBL E. coli ESBL

Figure 1. The Non-ESBL and ESBL Escherichia coli isolates.

The susceptibility pattern of these E. coli isolates showed in figure 2. All (100%) of isolates are still sensitive to Amikacin and Tigecycline. Meropenem is still sensitive at 98%. Followed by Piperacillin-Tazobactam and Gentamycin respectively 76% and 66%. The susceptibility of isolates to penicillin, third generation cephalosporins and fluoroquinilones is very low. In this case, these antibiotics are not recommended for empiric therapy.

120 100 80 60 40 20 0

Figure 2. The susceptibility pattern of E. coli isolated from wound specimens.

116

Proceedings of the 7th AIC-ICMR on Health and Life Sciences

The epidemiological knowledge of local antibiotic resistance is essential for the selection of empirical therapies. Selection of antibiotics should consider local epidemiology and patient characteristics. Discussion with clinical microbiologists may facilitate the decision-making process (Tamma & Cosgrove, 2011). Selection of appropriate antibiotics should also be carried out by considering the causative etiology, site of infection, dose and duration of treatment (Rajalakshmi & Amsaveni, 2012).

CONCLUSIONS

Wound is a common thing experienced by human being. Unfortunately, some wound might become infected. Management of infected wounds include dead tissue debridement, immune response maximization, adequate nutrition, appropriate dressing, reduced pressure and the use of topical and systemic antimicrobial agents (Bowler, et al., 2001). This microbiological study has shown that S. aureus is the most common bacteria found in infected wounds. E coli ranks as the second most frequent. E. coli isolated from wound specimens in Dr. Zainoel Abidin General Hospital are mostly ESBL producers. ESBL producers are the part of multidrug resistant organisms. Overuse and misuse of antibiotics will greatly harm the patient, the health care system, and the community. The inappropriate use of antimicrobial agents contributes to the rising cost of health services, the emergence of multidrug resistant organisms, and adverse drug side effects. Antimicrobial stewardship programs provide a standard, evidence-based approach to encouraging the prudent use of antimicrobial agents (Tamma & Cosgrove, 2011).

ACKNOWLEDGEMENTS

Special thanks to Dr. dr. Zinatul Hayati, M.Kes, Sp.MK(K), Ridhia Putri, S.Si and all of microbiology laboratory staff of Dr. Zainoel Abidin Hospital for their help. Hopefully, this article will be useful in the management of wound infection.

REFERENCES

Bonnet, R. (2004). Growing group of extended-spectrum beta-lactamases:the CTX-M enzymes. Antimicrobial Agents Chemotherapy, 48(1): 1–14. Bowler, P.G., Duerden, B.I., and Armstrong, D.G., Wound microbiology and associated approaches to wound management. Clinical Microbiology Review, 14(2):244.

117

118