Minggu, 08 Mei 2011

Mental health beyond the crises


In some parts of the world it is only during or after an emergency that people with mental health disorders get any treatment at all and often the help on offer is not what they need, Dr Mustafa Elmasri tells Fiona Fleck that the international community needs to rethink its emergency mental health relief.

Bulletin of the World Health Organization 2011;89:326–327. doi:10.2471/BLT.11.040511
Dr Mustafa Elmasri
Courtesy of Mustafa Elmasri
Dr Mustafa Elmasri
Dr Mustafa Elmasri is a psychiatrist in Gaza with two decades of experience working in conflicts and war, and their painful aftermath. He earned his Medical Degree from Alexandria University in 1983, Diploma in Psychotherapy from Tel Aviv University in 1996 and Diploma of Psychiatric Practice in 1997 from the universities of London and Egypt’s Ain Shams. He started his career as a doctor in Gaza in 1986 and started working in mental health care in 1992. From 1998–2000, he worked with genocide survivors in Cambodia, 2000–2003 with terrorized civilians in Algeria and 2005–2006 with Darfur refugees in Chad. Since 2008, he has been working with the World Health Organization to integrate mental health services into Gaza’s primary health care.
Q: Much of your work has been in the Middle East and northern Africa, what kind of mental health care is provided in these countries?
A: It differs from country to country, but on the whole there is a lack of psychosocial expertise. Mental health care in many of these countries is based on traditional classical psychiatry but often they have very few psychiatrists. Psychosocial work is done mainly by small local and international nongovernmental organizations (NGOs). There is practically no civil society – although that may be changing now – so much of the mental health care response in emergencies is dependent on external initiatives and funding, which are precarious. This leads to mistakes. For example, in Gaza, people came in on emergency projects after the recent war (2008–9) working directly with local people and undermining the local services. I worked with young local counsellors and saw how their work and ambitions were damaged by these short-term emergency projects.
Q: Is this typical?
A: It happens after each disaster. You have a rush of interested donors, but usually these projects and interventions are short-term and, therefore, counterproductive. Whatever emergency response is needed, it should come from within the existing health system, a structure that will exist after you leave and it should not be in the form of highly sophisticated interventions by foreigners for “poor local people”.
Q: Are the locals also unhappy about this?
A: People in need are usually happy to receive assistance, but in some cases it is not effective and quite inappropriate. For example, in former Yugoslavia in the 1990s, foreign NGO staff were chased out of villages because so many people were coming in. During the recent war in Gaza, far too many international NGOs came in. They recruited staff and trained them for a few days on some aspects of trauma work, sent them around the place going from house to house looking for traumatized people. Of course, families rejected this psychological help when what they really needed was help with basic needs, such as shelter and medical care. Young counsellors working single-handedly with no team support stood helplessly offering what was not in demand. Usually trauma and stress counsellors work in a crisis team and offer services as part of a comprehensive framework. It is not surprising that the NGOs had to bring in another wave of psychologists to work with the counsellors themselves.
Q: What is your approach?
A: I work with the local experts and structures regardless of their knowledge and expertise. The split between emergency and development projects is a business distinction that obscures the fact that every population is in a constant process of change and development. The idea of “emergency relief” is totally distorted in the psychosocial sector because it’s often only after a disaster that people get help when they needed it before. Gaza was under siege before and remains so after the war. But emergency relief was tagged to the war and has dwindled since. Six months of funding was allocated to 200 local NGOs working in the field, but none to the Ministry of Health’s mental health services.
Q: Does cultural background play a role?
A: Every mental health intervention should be adapted to the culture, today this is a given. Even if you are prescribing medication, you must take into consideration cultural beliefs on medicines. The same with psychotherapy. As trainers, we need to adapt our approach to the people we want to help. Some schools of psychotherapy are more appropriate than others. For example, cognitive behavioural therapy is usually suitable for people from Arabic-speaking cultures. It is based on evidence and rational thinking, which are part of the Arab Islamic value-system – when your beliefs are the main basis for your behaviour and when you believe that what you do will have an impact in this life and the after life.
Q: Describe your work and your life in Gaza?
A: We are integrating mental health care into the primary health care structure. The target is the wider population with mainly stress but also other common mental disorders among people who would not normally approach the mental health services. We are working with institutions to produce more mental health specialists who are badly needed in this community. We are also training nurses, psychologists and social workers. We also use other psychotherapy methods, such as cognitive behavioural therapy and other psychosocial interventions, including social work, community intervention and family psycho-education. Life here in Gaza is tough but it is a life at home with family and friends.
Q: Can you give examples of this work?
A: In Gaza, local universities produce BA level graduates of psychology, sociology and medicine with very little if any clinical experience. At present we do not have programmes for clinical psychology. Specialists are overworked and underpaid in the Ministry of Health and many are attracted by the NGO and private sectors, usually working with very narrow and pre-specified target groups within the population. But these projects do not help the many people with mild to moderate mental illness not directly related to war and trauma, and the people with severe mental illness who do not approach or receive effective mental health services. Our approach is to develop the capacity of mental health workers within the existing mental health and primary care services to provide competent and continuous help, regardless of the episodic escalations of war and violence.
Q: It’s against IASC (Inter-Agency Standing Committee) guidelines, why do we continue to see psychotherapists parachuting into emergency situations?
A: I encountered this phenomenon in Cambodia. People seemingly dropped from the sky and tried to communicate directly with the local people, to help them with their mental health problems, but it was useless. Perhaps this was because there were very few local psychologists or doctors, but I found it was better to train social workers in counselling and behavioural techniques of psychotherapy. Another example, we know now that single session debriefing is harmful, but in Gaza after the last war international NGOs sent in psychologists to debrief health and emergency staff in single-group sessions.
Q: What was your experience in Cambodia?
A: There were psychiatrists and psychologists from different parts of the world communicating through interpreters. My interpreter had to change some words because they were culturally inappropriate. International specialists should not provide direct clinical care of local people but should work with and support local care providers. Even if their local colleagues have limited experience, international specialists can train and mentor them, and give them confidence. It’s not a good idea to just drop in from the sky like a prophet, promise a lot of things and leave when the funding runs out. It means broken hearts and unfinished business – and these people have suffered enough already from loss and empty promises. They need long-term working relationships beyond the emergency situation, to help them build on the expertise you transfer.
Q: What about countries with little or no mental health experts?
A: Development is a natural phenomenon that you can assist or hinder, not something you plant or create. I worked with Darfur refugees in Chad. It is one of the poorest countries in the world and had one psychiatrist for the whole population. The challenge was to start mental health and psychosocial services from scratch. So I trained traditional healers, local nurses and medical assistants. People outside were concerned about the atrocities they had witnessed and the horrors they had experienced and there were cases of post traumatic stress disorder (PTSD) and other stress-related mental illness. But my first year involved establishing a clinical service for people with severe mental illness and children with epilepsy, some of whom had never been seen by medical personnel before. It was also essential to work with the host population as they perceived the refugees as receiving better support and care, while sharing their resources (land, wood, animals). So interventions were usually placed within the Chadian health system providing services for both camp refugees and the local population in nearby villages. The clinics became meeting places where the refugees and locals could share the pain and the cure.
Q: How did you do this?
A: Surveying traditional healing systems among refugees from Darfur in Chad, I collaborated with the faqihs (experts on Islamic law) from both the refugee and local Chadian communities, who treated medical and psychological illness. I trained them to identify epilepsy and psychosis, and refer these cases to the clinic. We also shared experiences on how we dealt with stress and mild mental illness, and learned from each other. It may sound odd or funny, but it is neither. Traditional healers were the key partner beyond the patients and their families in gaining an understanding of the psychological experience and access to social support structures. As part of our collaboration, I referred mild cases of stress and somatization disorder to the healers and they also organized group chanting and prayer groups for my patients.
Q: Are the survivors of horrific experiences scarred for life?
A: Not necessarily. Human beings are adaptable. With proper help and support many people can overcome the illness part of the trauma. Memories will remain painful, but people get on with their lives and re-build their world. In Algeria I saw how people returned to their lives, sometimes mentally more robust. We should not try to heal the historical part of trauma, it is a person’s choice whether to forgive and forget or to demand compensation. Our task is to treat the illness and help the person function normally again.

Vaccination: rattling the supply chain


The introduction of new vaccines, combined with a push to expand immunization globally to reach every child, is straining vaccine supply chains to the limit. New thinking on the way vaccines are delivered is needed. Gary Humphreys reports.


Bulletin of the World Health Organization 
2011;89:324–325. doi:10.2471/BLT.11.030511

The first decade of this century was perhaps the most productive in the history of vaccine development, seeing the release of a plethora of new life-saving vaccines for rotavirus diarrhoea, types of meningitis and pneumonia, and for human papillomavirus (HPV) infections that cause cervical cancer. “We are in a very different situation now compared to 10 years ago,” says Dr Osman Mansoor at the United Nations Children’s Fund (UNICEF) in New York. Mansoor, who is UNICEF’s senior health adviser for the Expanded Programme on Immunization and New Vaccines, notes that more vaccines are in the pipeline. In fact more than 80 vaccines are in the late stages of clinical testing, and 30 of them are designed to protect against major diseases including dengue and malaria.
At the same time, the global vaccine market is booming: since 2000, global revenue from the sale of vaccines has almost tripled reaching more than US$ 17 billion by mid-2008. While most of this expansion is accounted for by sales of new and more costly vaccines in industrialized countries, more vaccines are also reaching developing countries due to the efforts of the GAVI Alliance (formerly the Global Alliance for Vaccines and Immunization), a public–private partnership established in 2000 to increase immunization in poor countries.
It is important to have adequate supplies of vaccine for each vaccine session, especially when women and children, such as these in Niger, must travel long distances on foot.
WHO/Umit Kartoglu
It is important to have adequate supplies of vaccine for each vaccine session, especially when women and children, such as these in Niger, must travel long distances on foot.
The World Health Organization (WHO) and UNICEF estimate that just over 80% of the world’s children now have access to immunization, as measured by coverage of the third dose of DTP (diphtheria, tetanus and pertussis) vaccine, while an increasing number also have access to powerful new vaccines. “In the past, countries relied on a package of vaccines against six diseases,” says Project Optimize Coordinator Modibo Dicko, referring to WHO’s Expanded Programme on Immunization, which was launched in 1974. “Now some countries are doubling the number of vaccines they offer.”
As encouraging as all this seems, the scaling up of immunization programmes and the introduction of new vaccines is putting an unprecedented strain on delivery systems that have not changed in decades. James Cheyne, a supply-chain consultant, who started his career in vaccine logistics in Burma (now Myanmar) in 1977, is in a good position to judge those systems since he has had a hand in designing several himself.
Cheyne cites the unnecessary layering of distribution networks as one of his main concerns. “Typically there is a central store that supplies the regional stores, which then feed the provincial stores and district stores that in turn supply the local health centres,” he says, pointing out that while this layering made sense 30 years ago, because the lines of communication were weak, these days low-cost telecommunications technology has changed things. “You don’t need a store for each administrative level anymore because we have cell phones and the person from the health centre can call the central store directly,” Cheyne says.
Making better use of that kind of technology is a core aspect of the work being done by Project Optimize, a collaboration between WHO and PATH (formerly the Program for Appropriate Technology in Health), a nongovernmental organization.
For Michel Zaffran, the director of Project Optimize, information technology is key in combating one of the biggest problems faced by vaccine distribution systems – overstock in supply. On the face of it the idea that immunization programmes are hampered by too much vaccine seems paradoxical. But, in fact, the overstocking of vaccines increases cold storage costs and generates waste (when vaccines are lost, damaged or not used before their expiry date, and when not all vials in a multi-dose vial get used).
“We want to have as little buffer stock as possible, but still we want to have enough vaccine to vaccinate the children,” Zaffran says, arguing that this means putting in place information systems and technologies that give managers a real-time picture of how much stock they have throughout a country and whether the quantities meet the requirements of their immunization strategy.
Health worker in Niger shows bottles with vaccine vial monitors.
WHO/Umit Kartoglu
Health worker in Niger shows bottles with vaccine vial monitors.
According to UNICEF’s Mansoor, an even more pressing problem is when there are shortages of vaccine supplies to meet demand for children who turn up for vaccination sessions.
These problems can be further exacerbated when the volume of vaccine flowing through the system increases, as has been the case since 2000, and vaccines have become bulkier, partly due to manufacturers’ packaging policies. As Zaffran explains, increased price is one of the main drivers of this trend: “In the early days when the vaccine cost around US$ 0.10, WHO encouraged health workers to open a vial for one child even if it meant wasting nine doses. There were wastage rates of 60% or 70%. Now that we are introducing vaccines, which cost several dollars a dose, things have changed.”
According to Dicko, the cost of newer vaccines is between US$ 3.50 and US$ 7.50 per dose (when procured through UNICEF) and sometimes more. Newer vaccines are often in single or two-dose packages. While this helps to reduce wastage, it also means that they require more cold chain space per dose compared with the traditional EPI (Expanded Programme on Immunization) vaccines that come in 10- and 20-dose vials.
Another significant driver of increased bulk is more sophisticated packaging. Until 2009, the only pneumococcal conjugate vaccine (against a range of child infections including pneumonia and meningitis) was only available in a pre-filled syringe that required nearly 20 times as much storage space as in a 10-dose vial. “New vaccines require upwards of five times the amount of physical space in cold storage,” says Dicko, who cites the problems faced by Turkey as an example of the sort of challenges that result. “In 2005 Turkey needed only 2600 m2 of cold storage in order to accommodate its stocks of vaccine. When they introduced the first generation of pneumococcal vaccine in 2008, Turkey’s storage space requirement jumped (four times) to 11 400 m2. They had to rent cold storage space.” Turkey found a solution, but not every country does. For Zaffran it is not too strong to describe the situation faced by many countries as a “crisis”. “Countries are postponing the introduction of these vaccines because they do not have the capacity,” he says. “Some countries are actually delaying the time when the vaccines arrive, even when they have been paid for by others because they do not have the capacity either at the central level or in the country.”
The kind of problem faced by Turkey is also causing people to rethink the use of the cold chain, the temperature controlled supply chain, which has traditionally been used for virtually all vaccine delivery. “Most vaccines are stored at a temperature of between 2 and 8 degrees Celsius,” explains Cheyne, referring to guidance that is described on the vaccine packaging.
“One vaccine has the potential of being kept for six months at 45 degrees, but the requirement is still to keep it at temperatures between 2 and 8. It makes absolutely no sense at all,” he says. Moving some vaccines from the cold chain to a temperature-controlled chain at, say, 25 degrees, would make room for other vaccines or enable countries to cut back on storage costs Cheyne argues. UNICEF’s Mansoor sees another advantage. “For me, the issue is not so much getting vaccines out of the cold chain but getting them beyond the cold chain to reach into areas where there is no refrigeration so that more children can benefit,” he says.
Vaccine supplies packed in cold boxes and strapped to a motorbike for delivery in a rural area in Niger.
WHO/Umit Kartoglu
Vaccine supplies packed in cold boxes and strapped to a motorbike for delivery in a rural area in Niger.
For Mansoor the move makes even more sense given the availability of vaccine vial monitors (VVM), which are now on the label of virtually all vaccines shipped by UNICEF. The labels carry the image of a circle containing a white square. “The white square gets darker with cumulative heat exposure. If the vaccine has been subjected to heat that risks making it subpotent, the VVM shows this when the colour of the inner square is the same or darker than the outer circle,” Mansoor explains. Currently there is no equivalent detection method for freezing, which is much more damaging to some of the newer vaccines than heat in current cold chain arrangements. Like Cheyne, Dicko thinks there are many candidates for removal from the cold chain, citing as examples the vaccines against hepatitis B, Japanese encephalitis, cholera, diphtheria, tetanus and HPV infections. However, he says, this list cannot be drawn up without the consent of the manufacturers and the regulatory authorities. “It cannot be done outside that process,” he says, “but we are building evidence that it can and should be done”.

Sabtu, 07 Mei 2011

Daftar Nama Kecamatan Kelurahan/Desa & Kodepos Di Kota/Kabupaten Cilacap Jawa Tengah (Jateng)

Akhir-akhir ini, gw kesusahan banget nyariin kode pos, khususnya cilacap, n' sekitarnya...
so, gw mo post in deeh, biar ga kelabakkan lagi klo mo nyari2.....



Berikut ini adalah daftar nama-nama Kelurahan / Desa dan Kecamatan beserta nomor kode pos (postcode / zip code) pada Kota/Kabupaten Cilacap, Provinsi Jawa Tengah (Jateng), Republik Indonesia.
Negara : Negara Kesatuan Republik Indonesia (NKRI)
Provinsi : Jawa Tengah (Jateng)
Kota/Kabupaten : Cilacap
1. Kecamatan Adipala
Daftar nama Desa/Kelurahan di Kecamatan Adipala di Kota/Kabupaten Cilacap, Provinsi Jawa Tengah (Jateng) :
- Kelurahan/Desa Adipala (Kodepos : 53271)
- Kelurahan/Desa Adiraja (Kodepos : 53271)
- Kelurahan/Desa Adireja Kulon (Kodepos : 53271)
- Kelurahan/Desa Adireja Wetan (Kodepos : 53271)
- Kelurahan/Desa Bunton (Kodepos : 53271)
- Kelurahan/Desa Doplang (Kodepos : 53271)
- Kelurahan/Desa Glempangpasir (Kodepos : 53271)
- Kelurahan/Desa Gombolharjo (Kodepos : 53271)
- Kelurahan/Desa Kalikudi (Kodepos : 53271)
- Kelurahan/Desa Karanganyar (Kodepos : 53271)
- Kelurahan/Desa Karangbenda (Kodepos : 53271)
- Kelurahan/Desa Karangsari (Kodepos : 53271)
- Kelurahan/Desa Pedasong (Kodepos : 53271)
- Kelurahan/Desa Penggalang (Kodepos : 53271)
- Kelurahan/Desa Welahan Wetan (Kodepos : 53271)
- Kelurahan/Desa Wlahar (Kodepos : 53271)
2. Kecamatan Bantarsari
Daftar nama Desa/Kelurahan di Kecamatan Bantarsari di Kota/Kabupaten Cilacap, Provinsi Jawa Tengah (Jateng) :
- Kelurahan/Desa Bantarsari (Kodepos : 53281)
- Kelurahan/Desa Binangun (Kodepos : 53281)
- Kelurahan/Desa Bulaksari (Kodepos : 53281)
- Kelurahan/Desa Cikedondong (Kodepos : 53281)
- Kelurahan/Desa Citembong (Kodepos : 53281)
- Kelurahan/Desa Kamulyan (Kodepos : 53281)
- Kelurahan/Desa Kedungwadas (Kodepos : 53281)
- Kelurahan/Desa Rawajaya (Kodepos : 53281)
3. Kecamatan Binangun
Daftar nama Desa/Kelurahan di Kecamatan Binangun di Kota/Kabupaten Cilacap, Provinsi Jawa Tengah (Jateng) :
- Kelurahan/Desa Alangamba (Kodepos : 53281)
- Kelurahan/Desa Bangkal (Kodepos : 53281)
- Kelurahan/Desa Binangun (Kodepos : 53281)
- Kelurahan/Desa Jati (Kodepos : 53281)
- Kelurahan/Desa Jepara Kulon (Kodepos : 53281)
- Kelurahan/Desa Jepara Wetan (Kodepos : 53281)
- Kelurahan/Desa Karangnangka (Kodepos : 53281)
- Kelurahan/Desa Kemojing (Kodepos : 53281)
- Kelurahan/Desa Kepudang (Kodepos : 53281)
- Kelurahan/Desa Pagubugan (Kodepos : 53281)
- Kelurahan/Desa Pagubugan Kulon (Kodepos : 53281)
- Kelurahan/Desa Pasuruhan (Kodepos : 53281)
- Kelurahan/Desa Pesawahan (Kodepos : 53281)
- Kelurahan/Desa Sidaurip (Kodepos : 53281)
- Kelurahan/Desa Sidayu (Kodepos : 53281)
- Kelurahan/Desa Widarapayung Kulon (Kodepos : 53281)
- Kelurahan/Desa Widarapayung Wetan (Kodepos : 53281)
4. Kecamatan Cilacap Selatan
Daftar nama Desa/Kelurahan di Kecamatan Cilacap Selatan di Kota/Kabupaten Cilacap, Provinsi Jawa Tengah (Jateng) :
- Kelurahan/Desa Cilacap (Kodepos : 53211)
- Kelurahan/Desa Sidakaya (Kodepos : 53212)
- Kelurahan/Desa Tambakreja (Kodepos : 53213)
- Kelurahan/Desa Tegalkamulyan (Kodepos : 53215)
- Kelurahan/Desa Tegalrejo (Kodepos : 53215)
5. Kecamatan Cilacap Tengah
Daftar nama Desa/Kelurahan di Kecamatan Cilacap Tengah di Kota/Kabupaten Cilacap, Provinsi Jawa Tengah (Jateng) :
- Kelurahan/Desa Lomanis (Kodepos : 53221)
- Kelurahan/Desa Donan (Kodepos : 53222)
- Kelurahan/Desa Sidanegara (Kodepos : 53223)
- Kelurahan/Desa Gunungsimping (Kodepos : 53224)
- Kelurahan/Desa Kutawaru (Kodepos : 53225)
6. Kecamatan Cilacap Utara
Daftar nama Desa/Kelurahan di Kecamatan Cilacap Utara di Kota/Kabupaten Cilacap, Provinsi Jawa Tengah (Jateng) :
- Kelurahan/Desa Gumilir (Kodepos : 53231)
- Kelurahan/Desa Mertasinga (Kodepos : 53232)
- Kelurahan/Desa Tritih Kulon (Kodepos : 53233)
- Kelurahan/Desa Karangtalun (Kodepos : 53234)
- Kelurahan/Desa Kebonmanis (Kodepos : 53235)
7. Kecamatan Cimanggu
Daftar nama Desa/Kelurahan di Kecamatan Cimanggu di Kota/Kabupaten Cilacap, Provinsi Jawa Tengah (Jateng) :
- Kelurahan/Desa Bantarmangu (Kodepos : 53256)
- Kelurahan/Desa Bantarpanjang (Kodepos : 53256)
- Kelurahan/Desa Cibalung (Kodepos : 53256)
- Kelurahan/Desa Cijati (Kodepos : 53256)
- Kelurahan/Desa Cilempuyang (Kodepos : 53256)
- Kelurahan/Desa Cimanggu (Kodepos : 53256)
- Kelurahan/Desa Cisalak (Kodepos : 53256)
- Kelurahan/Desa Karangreja (Kodepos : 53256)
- Kelurahan/Desa Karangsari (Kodepos : 53256)
- Kelurahan/Desa Kutabima (Kodepos : 53256)
- Kelurahan/Desa Mandala (Kodepos : 53256)
- Kelurahan/Desa Negarajati (Kodepos : 53256)
- Kelurahan/Desa Panimbang (Kodepos : 53256)
- Kelurahan/Desa Pesahangan (Kodepos : 53256)
- Kelurahan/Desa Rejodadi (Kodepos : 53256)
8. Kecamatan Cipari
Daftar nama Desa/Kelurahan di Kecamatan Cipari di Kota/Kabupaten Cilacap, Provinsi Jawa Tengah (Jateng) :
- Kelurahan/Desa Caruy (Kodepos : 53262)
- Kelurahan/Desa Cipari (Kodepos : 53262)
- Kelurahan/Desa Cisuru (Kodepos : 53262)
- Kelurahan/Desa Karangreja (Kodepos : 53262)
- Kelurahan/Desa Kutasari (Kodepos : 53262)
- Kelurahan/Desa Mekarsari (Kodepos : 53262)
- Kelurahan/Desa Mulyadadi (Kodepos : 53262)
- Kelurahan/Desa Pegadingan (Kodepos : 53262)
- Kelurahan/Desa Segaralangu (Kodepos : 53262)
- Kelurahan/Desa Serang (Kodepos : 53262)
- Kelurahan/Desa Sidasari (Kodepos : 53262)
9. Kecamatan Dayeuhluhur
Daftar nama Desa/Kelurahan di Kecamatan Dayeuhluhur di Kota/Kabupaten Cilacap, Provinsi Jawa Tengah (Jateng) :
- Kelurahan/Desa Bingkeng (Kodepos : 53266)
- Kelurahan/Desa Bolang (Kodepos : 53266)
- Kelurahan/Desa Cijeruk (Kodepos : 53266)
- Kelurahan/Desa Cilumping (Kodepos : 53266)
- Kelurahan/Desa Ciwalen (Kodepos : 53266)
- Kelurahan/Desa Datar (Kodepos : 53266)
- Kelurahan/Desa Dayeuhluhur (Kodepos : 53266)
- Kelurahan/Desa Hanum (Kodepos : 53266)
- Kelurahan/Desa Kutaagung (Kodepos : 53266)
- Kelurahan/Desa Matenggeng (Kodepos : 53266)
- Kelurahan/Desa Panulisan (Kodepos : 53266)
- Kelurahan/Desa Panulisan Barat (Kodepos : 53266)
- Kelurahan/Desa Panulisan Timur (Kodepos : 53266)
- Kelurahan/Desa Sumpinghayu (Kodepos : 53266)
10. Kecamatan Gandrungmangu
Daftar nama Desa/Kelurahan di Kecamatan Gandrungmangu di Kota/Kabupaten Cilacap, Provinsi Jawa Tengah (Jateng) :
- Kelurahan/Desa Bulusari (Kodepos : 53254)
- Kelurahan/Desa Cinangsi (Kodepos : 53254)
- Kelurahan/Desa Cisumur (Kodepos : 53254)
- Kelurahan/Desa Gandrungmangu (Kodepos : 53254)
- Kelurahan/Desa Gandrungmanis (Kodepos : 53254)
- Kelurahan/Desa Gintungreja (Kodepos : 53254)
- Kelurahan/Desa Karanganyar (Kodepos : 53254)
- Kelurahan/Desa Karanggintung (Kodepos : 53254)
- Kelurahan/Desa Kertajaya (Kodepos : 53254)
- Kelurahan/Desa Layansari (Kodepos : 53254)
- Kelurahan/Desa Muktisari (Kodepos : 53254)
- Kelurahan/Desa Rungkang (Kodepos : 53254)
- Kelurahan/Desa Sidaurip (Kodepos : 53254)
- Kelurahan/Desa Wringinharjo (Kodepos : 53254)
11. Kecamatan Jeruklegi
Daftar nama Desa/Kelurahan di Kecamatan Jeruklegi di Kota/Kabupaten Cilacap, Provinsi Jawa Tengah (Jateng) :
- Kelurahan/Desa Brebeg (Kodepos : 53252)
- Kelurahan/Desa Cilibang (Kodepos : 53252)
- Kelurahan/Desa Citepus (Kodepos : 53252)
- Kelurahan/Desa Jambusari (Kodepos : 53252)
- Kelurahan/Desa Jeruklegi Kulon (Kodepos : 53252)
- Kelurahan/Desa Jeruklegi Wetan (Kodepos : 53252)
- Kelurahan/Desa Karangkemiri (Kodepos : 53252)
- Kelurahan/Desa Mendala (Kodepos : 53252)
- Kelurahan/Desa Prapagan (Kodepos : 53252)
- Kelurahan/Desa Sawangan (Kodepos : 53252)
- Kelurahan/Desa Sumingkir (Kodepos : 53252)
- Kelurahan/Desa Tritih Lor (Kodepos : 53252)
- Kelurahan/Desa Tritih Wetan (Kodepos : 53252)
12. Kecamatan Kampung Laut
Daftar nama Desa/Kelurahan di Kecamatan Kampung Laut di Kota/Kabupaten Cilacap, Provinsi Jawa Tengah (Jateng) :
- Kelurahan/Desa Klaces (Kodepos : 53253)
- Kelurahan/Desa Panikel (Kodepos : 53253)
- Kelurahan/Desa Ujungalang (Kodepos : 53253)
- Kelurahan/Desa Ujunggagak (Kodepos : 53253)
13. Kecamatan Karangpucung
Daftar nama Desa/Kelurahan di Kecamatan Karangpucung di Kota/Kabupaten Cilacap, Provinsi Jawa Tengah (Jateng) :
- Kelurahan/Desa Babakan (Kodepos : 53255)
- Kelurahan/Desa Bengbulang (Kodepos : 53255)
- Kelurahan/Desa Cidadap (Kodepos : 53255)
- Kelurahan/Desa Ciporos (Kodepos : 53255)
- Kelurahan/Desa Ciruyung (Kodepos : 53255)
- Kelurahan/Desa Gunungtelu (Kodepos : 53255)
- Kelurahan/Desa Karangpucung (Kodepos : 53255)
- Kelurahan/Desa Pamulihan (Kodepos : 53255)
- Kelurahan/Desa Pengawaren (Kodepos : 53255)
- Kelurahan/Desa Sidamulya (Kodepos : 53255)
- Kelurahan/Desa Sindangbarang (Kodepos : 53255)
- Kelurahan/Desa Surusunda (Kodepos : 53255)
- Kelurahan/Desa Tayem (Kodepos : 53255)
- Kelurahan/Desa Tayemtimur (Kodepos : 53255)
14. Kecamatan Kawunganten
Daftar nama Desa/Kelurahan di Kecamatan Kawunganten di Kota/Kabupaten Cilacap, Provinsi Jawa Tengah (Jateng) :
- Kelurahan/Desa Babakan (Kodepos : 53253)
- Kelurahan/Desa Bojong (Kodepos : 53253)
- Kelurahan/Desa Bringkeng (Kodepos : 53253)
- Kelurahan/Desa Grugu (Kodepos : 53253)
- Kelurahan/Desa Kalijeruk (Kodepos : 53253)
- Kelurahan/Desa Kawunganten (Kodepos : 53253)
- Kelurahan/Desa Kawunganten Lor (Kodepos : 53253)
- Kelurahan/Desa Kubangkangkung (Kodepos : 53253)
- Kelurahan/Desa Mentasan (Kodepos : 53253)
- Kelurahan/Desa Sarwadadi (Kodepos : 53253)
- Kelurahan/Desa Sidaurip (Kodepos : 53253)
- Kelurahan/Desa Ujungmanik (Kodepos : 53253)
15. Kecamatan Kedungreja
Daftar nama Desa/Kelurahan di Kecamatan Kedungreja di Kota/Kabupaten Cilacap, Provinsi Jawa Tengah (Jateng) :
- Kelurahan/Desa Bangunreja (Kodepos : 53263)
- Kelurahan/Desa Bojongsari (Kodepos : 53263)
- Kelurahan/Desa Bumireja (Kodepos : 53263)
- Kelurahan/Desa Ciklapa (Kodepos : 53263)
- Kelurahan/Desa Jatisari (Kodepos : 53263)
- Kelurahan/Desa Kaliwungu (Kodepos : 53263)
- Kelurahan/Desa Kedungreja (Kodepos : 53263)
- Kelurahan/Desa Rejamulya (Kodepos : 53263)
- Kelurahan/Desa Sidanegara (Kodepos : 53263)
- Kelurahan/Desa Tambakreja (Kodepos : 53263)
- Kelurahan/Desa Tambaksari (Kodepos : 53263)
16. Kecamatan Kesugihan
Daftar nama Desa/Kelurahan di Kecamatan Kesugihan di Kota/Kabupaten Cilacap, Provinsi Jawa Tengah (Jateng) :
- Kelurahan/Desa Bulupayung (Kodepos : 53274)
- Kelurahan/Desa Ciwuni (Kodepos : 53274)
- Kelurahan/Desa Dondong (Kodepos : 53274)
- Kelurahan/Desa Jangrana (Kodepos : 53274)
- Kelurahan/Desa Kalisabuk (Kodepos : 53274)
- Kelurahan/Desa Karangjengkol (Kodepos : 53274)
- Kelurahan/Desa Karangkandri (Kodepos : 53274)
- Kelurahan/Desa Keleng (Kodepos : 53274)
- Kelurahan/Desa Kesugihan (Kodepos : 53274)
- Kelurahan/Desa Kesugihan Kidul (Kodepos : 53274)
- Kelurahan/Desa Kuripan (Kodepos : 53274)
- Kelurahan/Desa Kuripan Kidul (Kodepos : 53274)
- Kelurahan/Desa Menganti (Kodepos : 53274)
- Kelurahan/Desa Pesanggrahan (Kodepos : 53274)
- Kelurahan/Desa Planjan (Kodepos : 53274)
- Kelurahan/Desa Slarang (Kodepos : 53274)
17. Kecamatan Kroya
Daftar nama Desa/Kelurahan di Kecamatan Kroya di Kota/Kabupaten Cilacap, Provinsi Jawa Tengah (Jateng) :
- Kelurahan/Desa Ayamalas (Kodepos : 53282)
- Kelurahan/Desa Bajing (Kodepos : 53282)
- Kelurahan/Desa Bajing Kulon (Kodepos : 53282)
- Kelurahan/Desa Buntu (Kodepos : 53282)
- Kelurahan/Desa Gentasari (Kodepos : 53282)
- Kelurahan/Desa Karangmangu (Kodepos : 53282)
- Kelurahan/Desa Karangturi (Kodepos : 53282)
- Kelurahan/Desa Kedawung (Kodepos : 53282)
- Kelurahan/Desa Kroya (Kodepos : 53282)
- Kelurahan/Desa Mergawati (Kodepos : 53282)
- Kelurahan/Desa Mujur (Kodepos : 53282)
- Kelurahan/Desa Mujur Lor (Kodepos : 53282)
- Kelurahan/Desa Pekuncen (Kodepos : 53282)
- Kelurahan/Desa Pesanggrahan (Kodepos : 53282)
- Kelurahan/Desa Pucung Kidul (Kodepos : 53282)
- Kelurahan/Desa Pucung Lor (Kodepos : 53282)
- Kelurahan/Desa Sikampuh (Kodepos : 53282)
18. Kecamatan Majenang
Daftar nama Desa/Kelurahan di Kecamatan Majenang di Kota/Kabupaten Cilacap, Provinsi Jawa Tengah (Jateng) :
- Kelurahan/Desa Bener (Kodepos : 53257)
- Kelurahan/Desa Boja (Kodepos : 53257)
- Kelurahan/Desa Cibeunying (Kodepos : 53257)
- Kelurahan/Desa Cilopadang (Kodepos : 53257)
- Kelurahan/Desa Jenang (Kodepos : 53257)
- Kelurahan/Desa Mulyadadi (Kodepos : 53257)
- Kelurahan/Desa Mulyasari (Kodepos : 53257)
- Kelurahan/Desa Padangjaya (Kodepos : 53257)
- Kelurahan/Desa Padangsari (Kodepos : 53257)
- Kelurahan/Desa Pahonjean (Kodepos : 53257)
- Kelurahan/Desa Pengadegan (Kodepos : 53257)
- Kelurahan/Desa Sadabumi (Kodepos : 53257)
- Kelurahan/Desa Sadahayu (Kodepos : 53257)
- Kelurahan/Desa Salebu (Kodepos : 53257)
- Kelurahan/Desa Sepatnunggal (Kodepos : 53257)
- Kelurahan/Desa Sindangsari (Kodepos : 53257)
- Kelurahan/Desa Ujungbarang (Kodepos : 53257)
19. Kecamatan Maos
Daftar nama Desa/Kelurahan di Kecamatan Maos di Kota/Kabupaten Cilacap, Provinsi Jawa Tengah (Jateng) :
- Kelurahan/Desa Glempang (Kodepos : 53272)
- Kelurahan/Desa Kalijaran (Kodepos : 53272)
- Kelurahan/Desa Karangkemiri (Kodepos : 53272)
- Kelurahan/Desa Karangreja (Kodepos : 53272)
- Kelurahan/Desa Karangrena (Kodepos : 53272)
- Kelurahan/Desa Klapagada (Kodepos : 53272)
- Kelurahan/Desa Maos Kidul (Kodepos : 53272)
- Kelurahan/Desa Maos Lor (Kodepos : 53272)
- Kelurahan/Desa Mernek (Kodepos : 53272)
- Kelurahan/Desa Penisihan (Kodepos : 53272)
20. Kecamatan Nusawungu
Daftar nama Desa/Kelurahan di Kecamatan Nusawungu di Kota/Kabupaten Cilacap, Provinsi Jawa Tengah (Jateng) :
- Kelurahan/Desa Banjareja (Kodepos : 53283)
- Kelurahan/Desa Banjarsari (Kodepos : 53283)
- Kelurahan/Desa Banjarwaru (Kodepos : 53283)
- Kelurahan/Desa Danasri (Kodepos : 53283)
- Kelurahan/Desa Danasri Kidul (Kodepos : 53283)
- Kelurahan/Desa Danasri Lor (Kodepos : 53283)
- Kelurahan/Desa Jetis (Kodepos : 53283)
- Kelurahan/Desa Karangpakis (Kodepos : 53283)
- Kelurahan/Desa Karangputat (Kodepos : 53283)
- Kelurahan/Desa Karangsembung (Kodepos : 53283)
- Kelurahan/Desa Karangtawang (Kodepos : 53283)
- Kelurahan/Desa Kedungbenda (Kodepos : 53283)
- Kelurahan/Desa Klumprit (Kodepos : 53283)
- Kelurahan/Desa Nusawangkal (Kodepos : 53283)
- Kelurahan/Desa Nusawungu (Kodepos : 53283)
- Kelurahan/Desa Purwadadi (Kodepos : 53283)
- Kelurahan/Desa Sikanco (Kodepos : 53283)
21. Kecamatan Patimuan
Daftar nama Desa/Kelurahan di Kecamatan Patimuan di Kota/Kabupaten Cilacap, Provinsi Jawa Tengah (Jateng) :
- Kelurahan/Desa Bulupayung (Kodepos : 53264)
- Kelurahan/Desa Cimrutu (Kodepos : 53264)
- Kelurahan/Desa Cinyawang (Kodepos : 53264)
- Kelurahan/Desa Patimuan (Kodepos : 53264)
- Kelurahan/Desa Purwodadi (Kodepos : 53264)
- Kelurahan/Desa Rawaapu (Kodepos : 53264)
- Kelurahan/Desa Sidamukti (Kodepos : 53264)
22. Kecamatan Sampang
Daftar nama Desa/Kelurahan di Kecamatan Sampang di Kota/Kabupaten Cilacap, Provinsi Jawa Tengah (Jateng) :
- Kelurahan/Desa Brani (Kodepos : 53273)
- Kelurahan/Desa Karangasem (Kodepos : 53273)
- Kelurahan/Desa Karangjati (Kodepos : 53273)
- Kelurahan/Desa Karangtengah (Kodepos : 53273)
- Kelurahan/Desa Ketanggung (Kodepos : 53273)
- Kelurahan/Desa Nusajati (Kodepos : 53273)
- Kelurahan/Desa Paberasan (Kodepos : 53273)
- Kelurahan/Desa Paketingan (Kodepos : 53273)
- Kelurahan/Desa Sampang (Kodepos : 53273)
- Kelurahan/Desa Sidasari (Kodepos : 53273)
23. Kecamatan Sidareja
Daftar nama Desa/Kelurahan di Kecamatan Sidareja di Kota/Kabupaten Cilacap, Provinsi Jawa Tengah (Jateng) :
- Kelurahan/Desa Gunungreja (Kodepos : 53261)
- Kelurahan/Desa Karanggedang (Kodepos : 53261)
- Kelurahan/Desa Kunci (Kodepos : 53261)
- Kelurahan/Desa Margasari (Kodepos : 53261)
- Kelurahan/Desa Penyarang (Kodepos : 53261)
- Kelurahan/Desa Sidamulya (Kodepos : 53261)
- Kelurahan/Desa Sidareja (Kodepos : 53261)
- Kelurahan/Desa Sudagaran (Kodepos : 53261)
- Kelurahan/Desa Tegalsari (Kodepos : 53261)
- Kelurahan/Desa Tinggarjaya (Kodepos : 53261)
24. Kecamatan Wanareja
Daftar nama Desa/Kelurahan di Kecamatan Wanareja di Kota/Kabupaten Cilacap, Provinsi Jawa Tengah (Jateng) :
- Kelurahan/Desa Cigintung (Kodepos : 53222)
- Kelurahan/Desa Limbangan (Kodepos : 53232)
- Kelurahan/Desa Adimulya (Kodepos : 53265)
- Kelurahan/Desa Bantar (Kodepos : 53265)
- Kelurahan/Desa Cilongkrang (Kodepos : 53265)
- Kelurahan/Desa Jambu (Kodepos : 53265)
- Kelurahan/Desa Madura (Kodepos : 53265)
- Kelurahan/Desa Madusari (Kodepos : 53265)
- Kelurahan/Desa Majingklak (Kodepos : 53265)
- Kelurahan/Desa Malabar (Kodepos : 53265)
- Kelurahan/Desa Palugon (Kodepos : 53265)
- Kelurahan/Desa Purwasari (Kodepos : 53265)
- Kelurahan/Desa Sidamulya (Kodepos : 53265)
- Kelurahan/Desa Tambaksari (Kodepos : 53265)
- Kelurahan/Desa Tarisi (Kodepos : 53265)
- Kelurahan/Desa Wanareja (Kodepos : 53265)

Lower BP number revealed in new AHA guideline – are you at risk for hypertension?

Hypertension is one of the leading  non-communicable diseases  (NCDs) besides diabetes and  obesity . Numerous efforts have been made to r...