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One of the well-known functional drinks using tea is kombucha tea. Kombucha tea is a traditional drink fermented from a solution of tea and sugar using a kombucha microbial starter called SCOBY (Symbiotic Culture of Bactery and Yeast), which contains bacteria and yeast (acetobacter xylinum, several types of yeast, such as Saccharomyces cerevisiae) which is fermented for 14 days in room temperature. Other ingredients that can be used as innovations in making kombucha tea are poor green apples and red beets. Malang green apples have a sweet and refreshing taste, but the health benefits of apples are also unquestionable. In addition to the poor green apple, an ingredient that can be used as an innovation in adding flavor and color to kombucha is red beet. Red beet or better known as beetroot is a tuber plant that belongs to the Amaranthaceae-Chenopodiaceae family, this makes beetroot a family with radish and other root vegetables. This study aims to determine the preference level of 15 panelists through organoleptic test. The assessment indicators in this study are sweetness, acidity, bitternes, aroma and colour. Based on the results of organoleptic tests on kombucha tea by adding Malang green apples and red beets, that of the five assessment indicators of kombucha tea namely sweetness, acidity, bitterness, aroma, and color obtained results that really liked kombucha tea by adding Malang green apples and red beets.

Foreign body inhalation is a life threatening emergency condition that commonly occur in children. A foreign body (FB) can be lodged in either the upper or lower airway or cause either a partial or complete airway obstruction. Complete obstruction of upper airway is a potentially life-threatening situation that causes severe respiratory distress and suffocation. Lower airway FB typically manifests with sudden-onset coughing and choking, followed by wheezing and dyspnea. We are presenting a case report of 3years old female child with a foreign body in the right bronchus intermediacy over one year. Patient was managed by performing thoracotomy after failed rigid bronchoscopy. This case is importance as to reduce the frequency of prescribing without throughout investigations.

The presence of rice milling entrepreneurs in the lowland rice production process has a strong influence so that rice farmers depend on entrepreneurs and it is difficult to get out of the patron-client relationship that has been built by the two. Entrepreneurs are present as "saviors" of the farmers in the context of socio-economic problems where farmers lack capital in the process of producing lowland rice and to meet urgent daily needs. The purpose of this study is to describe the patron-client relationship that occurs in the production process of lowland rice farming using descriptive qualitative research methods. As a research strategy, a case study was used on rice milling entrepreneurs and lowland rice farmers in Mopuya Utara II Village, Dumoga Utara District, Bolaang Mongondow Regency, North Sulawesi Province. The results of this study indicated that the dependence of farmers on rice mill entrepreneurs was built through a long friendship process and a sense of reluctance in which the entrepreneurs were considered "saviors" because they provided social security to farmers even though in reality entrepreneurs got bigger profits.

Thyroid carcinoma is uncommon in our geographical setting. When it occurs the leading histological type is papillary thyroid carcinoma followed by follicular thyroid carcinoma which are differentiated thyroid carcinomas. Differentiated thyroid carcinomas usually have a good prognosis as compared to undifferentiated thyroid carcinomas. Follicular Thyroid Carcinoma usually presents with a solitary thyroid nodule with or without cervical lymphadenopathy. We present a 57 year old female with history of anterior neck swelling for 5 years and inability to walk using the left lower limb for 2 years. Total thyroidectomy and modified neck dissection was done. Histopathology results revealed follicular thyroid carcinoma. Patient was received radiochemotherapy treatment post-surgery. Follicular thyroid carcinoma may present with a symptomatic distant metastatic bony lesion as presented. It is important for clinicians to be aware this and carry out confirmatory relative investigations., Highlights • Thyroid carcinoma is uncommon in our settings with the leading variant being papillary thyroid carcinoma. • Differentiated thyroid carcinomas have a good prognosis compared to undifferentiated thyroid carcinomas. • Metastatic involvement of iliac wing by follicular thyroid cancer remains to be a rare occurrence. • Papillary thyroid cancer may metastasize to the lungs and bones. • The pelvis is the second most common metastatic region for papillary thyroid cancer by the spine.

In Tanzania, 27.1% of all women of reproductive age are currently using modern contraception and 16.8% have an unmet need for family planning. We therefore examined factors associated with family planning uptake after giving birth in two regions of Tanzania. The survey, which collected information beyond that collected in the Tanzania Demographic Health Survey, used a two-stage, stratified-cluster sampling design, conducted in April 2016 in Mara and Kagera regions in Tanzania. A total of 1184 women aged 15–49 years, who had given birth less than two years prior to the survey were included. Logistic regression mixed effect modelling was used to examine factors associated with family planning uptake. A total of 393 (33.2%) women used family planning methods and 929 (79%) required prior approval from their partners. Participation of men in utilization of maternal health care was low, where 680 (57.8%) women responded that their partners accompanied them to at least one antenatal care (ANC) counselling visit and 120 (10%) responded that their partners participated in family planning counselling. Women who did not want to disclose whether they had discussed family planning with their partners, strikingly had the highest percentage of using family planning methods after birth. Factors independently associated with family planning uptake included: having discussed family planning with the partner (aOR 3.22, 95% CI 1.99–5.21), having been counselled on family planning during antenatal care (aOR 2.68, 95% CI 1.78–4.05), having discussed family planning with a community health worker (CHW) (aOR 4.59, 95% CI 2.53–8.33) and with a facility health care worker (aOR 1.93, 95% CI 1.29–2.90), having primary or higher educational level (aOR 1.66, 95% CI 1.01–2.273), and being in union (aOR 1.86, 95% CI 1.02–3.42). Educational interaction with community and facility health workers, as well as having a supportive partner as facilitator increased uptake of family planning. This needs to be prioritized in regions with similar socio-cultural norms in Tanzania and beyond.

Hirschsprung's disease (HD) is one of the most common causes of pediatric bowel obstruction in low- and middle-income countries (LMICs). This paper describes the unique aspects of presentation, diagnosis, management and post-operative care and outcomes of HD in LMICs. In LMICs, patients with HD are much more likely to present in a delayed fashion with subsequent increased morbidity and mortality including higher rates of chronic obstruction, malnutrition with failure to thrive, complete obstruction and perforation. There are multifactorial causes for delay, with opportunities to improve initial timely diagnosis and referral, support families to address socioeconomic and cultural barriers, and improve workforce and infrastructure resources to provide definitive care. In LMICs, the diagnosis is often made based on clinical presentation and radiographic findings as pathological services may be limited. Initial diversion with multi-stage procedure, instead of a single-stage pull-through, predominates. This is also a result of multifactorial causes, including initial presentation to general surgeons at first-level hospitals instead of pediatric surgeons, delayed presentation with sick, malnourished children with significantly distended bowel, and a lack of fresh-frozen pathological services to guide the extent of resection. Post-operatively, HD patients in LMICs experience higher complication and mortality rates - likely stemming from sicker baseline presentations and more limited resources. Significant recent advances in care have occurred for patients with HD in LMICs, while opportunities to continue to improve care remain.

Background Worldwide, infantile hypertrophic pyloric stenosis has an incidence of 3 in 1000 livebirths, with an unknown etiology. Even when babies present with characteristic symptoms, it is often misdiagnosed leading to late referral for appropriate surgical care. The purpose of this study was to document our experience in management of pyloric stenosis within our setting. Results A total of 33 patient records were reviewed. All the patients presented with non-bilious vomiting. The ratio of males to females was 4.5:1. Of these patients, 76% had electrolyte imbalance with low chloride count in the majority of patients. All the patients underwent an open Ramstedt pyloromyotomy, and 91% had a good outcome. Conclusion Management of IHPS has very good outcomes in our setting. Earlier referral of patients leads to improved outcomes.

The growth of tourism sectors in Bali offers prospected bussinws opportunities to Garuda Indoninesia aircraft provides air transportation services from/to their homeland. As Australian tourist market is the biggest market in Bali, this study aims to explore the services performance, level of important factors of service performance of Garuda Indonesia at direct flight Australia –Bali route. Total 56 respondents contribute in this study which departed from several airport in Perth, Sydney, Tullamarine (Melbourne), Canberra, Adelaide, and Brisbane to Bali. Important-Performance Analysis used as approch in this study based on the recommendation of previous study by Martilla and James (1977). Service attributes measured in this study adopted from Garuda Indonesia service attributes which consist of 1) On Time Performance, 2) Website Service ( www.garuda-indonesia.com ), 3) Call Centre Service, 4) Sales Office Service, 5) Ticketing service at Airport, 6) Customer Service Desk, 7) Check-in service, 8) Arrival Assistance & Transfer Desk, 9) Executive Lounge Garuda, 10) Boarding Management, 11) In Flight Sales, 12) Cabin Crew Service, 13) Cabin Condition (Ambience & Cleanliness), 14) Seat Comfort, 15) Lavatory Cleanlines & Function), 16) Food & Beverage (Quality & Quantity), 17) In Flight Entertainment (Audio Video & Reading Material), 18) Cabin Amenity (Blanket, Towel, Pillow, Toilet Kit), 19) Baggage Service, 20) Complaint Handling, 21) Loyalty Program (for Frequent Flyer Program), 22) Overall Staff Greeting & Announcement. Research finding shows that there were 11 service attibutes catagorized as very important attributes, 11 others attributes catagorized as less important attributes, 19 service attributes performance met passengers expectation, and 3 attributes under passengers expectation. This study recommends Garuda Indonesia Management to retain service attribute’s performance which classified as in Quadran B, and ignores service attributes performance which classified as in Quadran D because of over valued by passengers. Keywords: service performance, level of important factors, Garuda Indonesia, Australian tourists. ABSTRAK Pesatnya perkembangan sektor kepariwisataan Bali telah memberi peluang bisnis pada PT. Garuda Indonesia untuk menyediakan pelayanan transportasi kepada wisatawan dari dan ke negara mereka. Tujuan dari penelitian ini adalah untuk mengetahui kinerja pelayanan dan tingkat kepentingan atribut kinerja pelayanan PT. Garuda Indonesia pada rute penerbangan Australia-Bali. Responden penelitian ini berangkat melalui Perth, Sydney, Tullamarine International Airport (Melbourne), Canberra, Darwin, Adelaide, Brisbane. Jumlah responden pada penelitian ini adalah 56 orang wisatawan Australia. Penelitian ini dianalisis menggunakan analisis Tingkat Kepentingan dan Kinerja/Kepuasan Pelanggan atau Important-Performance Analysis yang mengadopsi teori Martilla dan James (1977). Atribut penelitian ini menggunakan atribut pelayanan PT. Garuda Indonesia yang terdiri atas 1) On Time Performance , 2) Website Service ( www.garuda-indonesia.com ), 3) Call Centre Service , 4) Sales Office Service , 5) Ticketing service at Airport , 6) Customer Service Desk , 7) Check-in service , 8) Arrival Assistance & Transfer Desk , 9) Executive Lounge Garuda, 10) Boarding Management , 11) In Flight Sales , 12) Cabin Crew Service , 13) Cabin Condition ( Ambience & Cleanliness ), 14) Seat Comfort , 15) Lavatory Cleanlines & Function ), 16) Food & Beverage ( Quality & Quantity ), 17) In Flight Entertainment ( Audio Video & Reading Material ), 18) Cabin Amenity ( Blanket, Towel, Pillow, Toilet Kit ), 19) Baggage Service , 20) Complaint Handling , 21) Loyalty Program ( for Frequent Flyer Program ), 22) Overall Staff Greeting & Announcement . Hasil penelitian menyimpulkan bahwa, terdapat sebelas (11) atribut tergolong tingkat kepentingan tinggi, sebelas (11) atribut tergolong tingkat kepentingan rendah, sembilan belas (19) atribut yang kinerjanya sudah memenuhi harapan wisatawan Australia dan tiga (3) atribut yang kinerjanya belum memenuhi harapan wisatawan Australia. Penelitian ini merekomendasikan bahwa, atribut penentu kepuasan penumpang yang terdapat pada Kuadran B harus tetap dipertahankan kualitasnya, sedangkan untuk atribut yang berada pada Kuadran C, direkomendasikan kepada pihak manajemen Garuda Indonesia agar dapat ditempatkan pada prioritas rendah, sedangkan faktor-faktor pada Kuadran D dapat diabaikan karena kinerjanya memang sudah berlebihan. Kata kunci: kinerja pelayanan, tingkat kepentingan kinerja, Garuda Indonesia, wisatawan Australia.

Background: Surgical site infections are dreaded by many as they impose a greater economic costs, morbidity and mortality that in developing countries place a burden on an already burdened healthcare system

Background An intestinal stoma, though a life-saving procedure on the care of many gastrointestinal conditions, carries significant number of complications. This study describes the common indications, complications, and management of stomas and identifies the factors that are associated with these complications in a tertiary care hospital in Tanzania. Methods A cross-sectional study of patients with intestinal stomas was conducted at Bugando Medical Centre (BMC) between July 2016 and June 2017. Ethical approval to conduct the study was obtained from relevant authority before the commencement of the study. Results A total of 167 patients (M: F = 1.2:1) were enrolled in the study. The mean age at diagnosis was 0.6 ± 1.4 years for children and mean age for adults was 36.7 ± 15.8 years. Anorectal malformation (110, 89.4%) was the most common indication for intestinal stoma formation in children, while bowel perforation (14, 31.8%) was the main indications in adults. The sigmoid colon (137, 82.0%) was the most common anatomical site for stoma formation followed by the ileum (18, 10.8%). Stoma prolapse (18, 41.9%) was the most frequent complication of a stoma, whereas, surgical site infection (9, 34.6%) was the most frequent complication after stoma closure. Thirty five (26.7.%) of the children developed stomal complications, while only 8 (22.2%) of the adults developed complications. The level of training of operating surgeon and timing of surgery were the main predictors of stoma-related complications (p

Negative experiences of care may act as a deterrent to current and/or future utilization of facility-based health services. To examine the situation in Tanzania, we conducted a sub-analysis of a cross-sectional household survey conducted in April 2016 in the Mara and Kagera regions of Tanzania. The sample included 732 women aged 15&ndash, 49 years who had given birth in a health facility during the previous two years. Log binomial regression models were used to investigate the association between women&rsquo, s experiences of care during childbirth and the receipt of early postnatal checks before discharge. Overall, 73.1% of women reported disrespect and abuse, 60.1% were offered a birth companion, 29.1% had a choice of birth position, and 85.5% rated facility cleanliness as good. About half of mothers (46.3%) and newborns (51.4%) received early postnatal checks before discharge. Early postnatal checks for both mothers and newborns were associated with no disrespect and abuse (RR: 1.23 and 1.14, respectively) and facility cleanliness (RR: 1.29 and 1.54, respectively). Early postnatal checks for mothers were also associated with choice of birth position (RR: 1.18). The results suggest that a missed opportunity in providing an early postnatal check is an indication of poor quality of the continuum of care for mothers and newborns. Improved quality of care at one stage can predict better care in subsequent stages.

Background: HIV infection has been reported to be prevalent in patients with surgical acute abdomen. This study aimed to establish HIV seroprevalence among patients with surgical acute abdomen and to identify factors affecting clinical outcomes among these patients at a tertiary care hospital in Tanzania Methods: This was a prospective cross-sectional study of patients with surgical acute abdomen admitted to three selected hospitals in Mwanza between February 2016 and July 2016.Results: Out of the 106 patients (M: F = 1.5:1) included in the study, 15 (14.2%) were HIV positive. Of these, nine were males and 6 were females. Surgical site infection was the most common postoperative compilation and was found to be significantly higher in HIV positive patients with CD 4+ count below 200 cells/μl (p 65 years), pre-existing medical illness, delayed presentation (>48 hours), HIV positivity, high American Society of Anesthetists class, surgical site infections (p< 0.001).Conclusion: This study has shown that HIV infection is prevalent among patients with surgical acute abdomen in our setting. Factors influencing the clinical outcome of these patients need to be addressed, in order to deliver optimal patient care and improve their treatment outcome.

Background: Anorectal malformations (ARM) are common congenital abnormalities in most parts of the world and its management remains a challenge to surgeons practicing in resource-limited setting such as Tanzania. This study aimed to determine the patterns and outcome of surgical management of ARM at a Tanzanian tertiary care hospital. Methods and Patients: This was a cross sectional study (with a follow up component) of patients with ARMs admitted to Bugando Medical Centre between May 2014 and April 2017.Results: A total of 109 patients (M: F ratio= 1:1.4) were studied. The median age at diagnosis was 50 days. The majority of patients, 78(71.6%) were less than a year old. Most of patients, 91(83.5%) had major clinical type of ARMs. Associated congenital anomalies were recorded in 18 (16.5%) patients. The majority of patients, 64(58.7%) reported to hospital late in acute intestinal obstruction. Most of patients in this study, 107(98.2%) were initially managed by a preliminary colostomy before definitive treatment. Out of 109 patients with ARMs, only 39 (33.0%) underwent definitive operations. Of the 107 patients who had preliminary colostomy, only 28(26.2%) had their colostomies closed at the end of study period. The overall complication and mortality rates were 47.7% and 16.0% respectively. Delayed presentation (> 48 hours), associated congenital anomalies, prolonged duration of operation (> 3 hours) and surgical site infections were the main predictors of mortality (p < 0.001). The follow up of patients in this study was generally good as only 3(8.3%) patients were lost to follow up. Good results using Kelly’s scoring system were obtained in 83.3% of surviving patients.Conclusion: Anorectal malformations are common in our setting. The major type of ARMs is commoner than the minor type. The outcome of surgery is good when the patients present early at birth. Therefore there is need for increasing community awareness and among all healthcare workers who handle neonates to effect early presentation and therefore prompt management.

Objective To compare maternal outcome of multiple versus singleton pregnancies at a tertiary hospital in Tanzania. Methods A case control study was designed using maternally linked data from Kilimanjaro Christian Medical Centre (KCMC) medical birth registry for the period of 2000–2010. A total of 822 multiple gestations (cases) were matched with 822 singletons (controls) with respect to maternal age at delivery and parity. The odds ratio (ORs) with 95% confidence intervals (CIs) for adverse maternal outcome between singleton and multiple gestations were computed in a multivariable logistic regression model. Results Of the 33 997 births, there were 822 (2.1%) multiples. Compared with singletons, women with multiple gestations had increased risk for preeclampsia ( OR 2.6; 95% CI : 1.7–3.9), preterm labour ( OR 5.6; 95% CI : 4.2–7.4), antepartum haemorrhage ( OR 1.6; 95% CI : 1.1–2.3), anaemia ( OR 2.0; 95% CI : 1.6–2.6) and caesarean section ( OR 1.5; 95% CI : 1.4–1.7). In addition, there were six maternal deaths among women with multiple gestations, of which all were attributed to postpartum haemorrhage. This accounted for a case fatality rate of 15.8%. Conclusions Multiple gestations are associated with adverse maternal outcomes. Close follow-up and timely interventions may help to prevent poor outcomes related to multiple gestations. These findings suggest the needs for clinicians to counsel women with multiple gestations during prenatal care regarding the potential risks.

Background Infantile hypertrophic pyloric stenosis (IHPS) is the most common cause of gastric outlet obstruction in infants. There is paucity of published data regarding this condition in our setting. This study describes the clinical presentation, mode of treatment and outcome of treatment of this disease and identifies factors responsible for poor outcome of these patients. Methods This was a descriptive retrospective study of infants with HPS admitted to Bugando Medical Centre and subsequently underwent surgery between February 2009 and January 2014. Results A total of 102 patients (M:F = 4.7:1) were studied. The median age at presentation was 5 weeks. The median duration of illness was 4 weeks. Fifty-four (52.9 %) patients occur in first-born children. Associated anomalies were reported in 7 (6.9 %) patients. Non-bilious vomiting was the most frequent symptom and it was described in all (100 %) patients. A palpable mass was found in 23.5 % of infants. The diagnosis of IHPS was made clinically in 86 (84.3 %) and by ultrasound in 16 (15.7 %) patients. The treatment was Ramstedt’s pyloromyotomy in all cases. There were 6 (5.9 %) intra-operative mucosal perforations which were repaired successively. Postoperative complication was 11.8 %. The median length of hospital stay was 12 days and it was significantly associated with prolonged pre-operative hospitalization (p = 0.001). The mortality rate was 4.9 %. Age below 2 weeks, late presentation (≥14 days), severe dehydration on admission, hypokalaemia on admission and surgical site infection were the main predictors of mortality (p

Public awareness of the importance of adopting a healthy lifestyle continues to increase. One indicator can be seen is an increase in the consumption of organic food. Likewise, the high interest of the global community in organic food is expected to impact on the restaurant business in Bali, especially in Ubud Tourist Area. At this time there are some marketing difficulties facing the restaurant business that sells food made from organic. The purpose of research is exploring the strengths, weaknesses, opportunities, and threats organic restaurant in Ubud Tourist Area - Bali. It is also to investigate the marketing strategy to increase tourists visiting an organic restaurant in Region Ubud - Bali.Methods of data collection using observation, interviews, questionnaires, and documentation, and then analyzed using SWOT analysis. The results of this study are the internal condition of organic restaurants in Ubud Tourist Area is excellent for tourists and managers of restaurants, as well as external environmental conditions in Ubud. Based on a combination of analysis and IE Matrix Matrix position, the right strategy is applied industry Organic restaurant in Ubud Tourist Area is a strategy of market penetration, product development, and market development is limited.