Seroconversion among children with HBsAg-positive mothers in Indonesia and factors affecting the anti-HBs titers

Background and aim

Around 2% of newborns are at risk of hepatitis B virus (HBV) infection from their mothers. To prevent this, infants born to HBsAg-positive mothers are given hepatitis B immune globulin (HBIG) and hepatitis B (HB) vaccine as immunoprophylaxis. This study aims to investigate the efficacy of immunoprophylaxis in infants born to HBsAg-positive mothers and the contributing factors.

Methods

The study was conducted on a group of 87 children, ranging from nine months to under 36 months, born to HBsAg-positive mothers and received immunoprophylaxis within 24 h after birth followed by a national immunization schedule at the Community Health Center (CHC) in three administrative cities of DKI Jakarta. We measured the levels of HBsAg and anti-HBs, and utilized ordinal logistic regression models to identify factors that influence the anti-HBs titers after vaccination.

Results

Out of 87 children, only one child had positive HBsAg results. The data showed that 88.5% of the children had seroprotection with anti-HBs levels ≥10 mIU/mL. Additionally, 48.3% of the children had a high protective response with anti-HBs levels ≥100 mIU/mL, while 11.5% had a non-protective response. Children under one year of age, with a family history of HBV carriers, and who received five doses of the HB vaccine exhibited higher levels of anti-HBs titer category with adjusted OR 3.9 (95%CI: 1.3-11.6), 5.3 (95%CI: 1.1-27.4), and 8.3 (95%CI: 2-34.8), respectively.

Conclusion

The administration of HBIG and HB vaccine successfully prevented vertical transmission, resulting in a high seroprotection rate.

Understanding the pubertal, psychosocial, and cognitive developmental trajectories of stunted and non-stunted adolescents: protocol of a multi-site Indonesian cohort study

Background

The prevalence of stunting among Indonesian children aged 5-12 years decreased from 30.7% in 2013 to 23.6% in 2018 but has remained among the highest rates worldwide. Furthermore, Indonesian children were shorter than the standard reported by the World Health Organization and experienced obesity. The Indonesian government has created many programs to reduce stunting in children under the age of 5 years. An early preventive strategy is necessary because stunting can manifest within the initial 1,000 days of life, including during pregnancy. Therefore, a newer perspective, such as that achieved by addressing stunting in adolescents, has been deemed useful, given that adolescents are in their pubertal stage and are undergoing lifestyle changes. This cohort study was designed to measure these factors comprehensively in stunted and non-stunted children as they pass through adolescence.

Methods

For the prospective cohort, 560 individuals will be recruited from DKI Jakarta, DI Yogyakarta, and East Java. The participants will be categorized into stunted and non-stunted groups, then undergo annual examinations in which key objectives, such as weight, height, and body mass index ,will be assessed for the growth profile; waist circumference, middle-upper arm circumference, hand-grip strength, body fat percentage, and food intake will be evaluated in a nutritional assessment; psychosocial and mental issues will be evaluated according to behavioral problems, symptoms of depression, quality of life, sleep patterns, anxiety disorders, and parenting style through the use of specific questionnaires; and pubertal stage will be assessed using a self-report questionnaire. Some cross-sectional data, such as cognitive performance, hair zinc levels, vitamin D levels, bone mineral density, and bone age, will also be included. All the outcomes will be analyzed in accordance with the variable types.

Discussion

This study provides a thorough dataset of Indonesian adolescents encompassing several elements, such as growth, nutrition, psychosocial wellbeing, mental health, and pubertal development, for both stunted and non-stunted individuals. The data acquired from this study can be used to formulate policies to prevent stunting through targeted interventions for adolescents. Finally, a better understanding of adolescent health could lead to improved strategies to decrease the number of stunted individuals in the next Indonesian generation.

Validity and reliability test of the Indonesian version of the PedHALshort questionnaire

INTRODUCTION

The PedHAL questionnaire is employed in measuring the activities of haemophilia children. The PedHALshort was developed in 2022 to determine the most relevant item for the assessment. Haemo-QoL questionnaire assesses the quality of life of haemophilia children.

AIM

Determine the validity and reliability of the PedHALshort Indonesia language version compared to the Haemo-QoL in the Indonesian population.

METHODS

A cross-sectional study was conducted in Jakarta, Indonesia. The subjects were children (4-16 years old) with moderate or severe haemophilia A or B with repeated joint bleeding. The daily activity was assessed using the PedHALshorts and Haemo-QoL. The validity and reliability were tested. The validity was determined with Pearson correlation test, construct validity was assessed using convergent and discriminant validity. The Spearman correlation was used to determine which domains of Haemo-QoL correlated with PedHALshort. The reliability was analyzed using test-retest reliability. Cronbach's α was used to determined internal consistency.

RESULTS

Fifty children were included in the study (78% haemophilia A, 70% severe group). All domains were valid (r > .284). The convergent validity test showed PedHALshort had a moderate negative correlation with physical health and sports school domain of Haemo-QoL (r = -.479, p < .001). The discriminant validity test showed the PedHALshort demonstrated a moderate negative correlation with physical health (r = -.585), view (r = -.590), sport school domain (r = -.430) in severe haemophilia subjects. The internal consistency of the PedHALshort questionnaire was high (Cronbach's α of .85 (.74-.92)).

CONCLUSION

The PedHALshort is valid and reliable, hence, it can be used to measure the functional physical activity of children with haemophilia.

Immunogenicity Assessment of the SARS-CoV-2 Protein Subunit Recombinant Vaccine (CoV2-IB 0322) in a Substudy of a Phase 3 Trial in Indonesia

BACKGROUND

COVID-19 is one of the most devastating pandemics of the 21st century. Vaccination is one of the most effective prevention methods in combating COVID-19, and one type of vaccine being developed was the protein subunit recombinant vaccine. We evaluated the efficacy of the CoV2-IB 0322 vaccine in Depok, Indonesia.

METHODS

This study aimed to assess the humoral and cellular immune response of the CoV2-IB 0322 vaccine compared to an active control vaccine (COVOVAX™ Vaccine). A total of 120 subjects were enrolled and randomized into two groups, with 60 subjects in each group. Participants received either two doses of the CoV2-IB 0322 vaccine or two doses of the control vaccine with a 28-day interval between doses. Safety assessments were conducted through onsite monitoring and participant-reported adverse events. Immunogenicity was evaluated by measuring IgG anti-RBD SARS-CoV-2 and IgG-neutralizing antibodies. Cellular immunity was assessed by specific T-cell responses. Whole blood samples were collected at baseline, 14 days, 6 months, and 12 months after the second dose for cellular immunity evaluation.

RESULTS

Both vaccines showed high seropositive rates, with neutralizing antibody and IgG titers peaking 14 days after the second dose and declining by 12 months. The seroconversion rate of anti-S IgG was 100% in both groups, but the rate of neutralizing antibody seroconversion was lower in the CoV2-IB 0322 vaccine group at 14 days after the second dose (p = 0.004). The CoV2-IB 0322 vaccine showed higher IgG GMT levels 6 and 12 months after the second dose (p < 0.001 and p = 0.01). T-cell responses, evaluated by IFN-γ, IL-2, and IL-4 production by CD4+ and CD8+ T-cells, showed similar results without significant differences between both groups, except for %IL-2/CD4+ cells 6 months after the second dose (p = 0.038).

CONCLUSION

Both vaccines showed comparable B- and T-cell immunological response that diminish over time.

Immunization Simulation Using Actual-Size Infant Manikins for Medical Students in Indonesia: A Quasi-Experimental Study

INTRODUCTION

Manikins are tools used in simulation training for medical students to develop important skills, one of which is immunization. However, conventional manikins often do not resemble the actual size of an infant's arm or leg. This study aimed to determine the impact of using actual-size manikins on students' knowledge and practical skills, evaluate their confidence in immunization practice, and assess students' responses and feedback regarding the practice using actual-size manikins.

METHODS

This was a quasi-experimental study involving medical students at the Faculty of Medicine, Universitas Indonesia, from October 2020 to April 2021. Students in the intervention group used newly developed actual-size infant arm and leg manikins, while the control group used conventional manikins. All students underwent the objective structured clinical examination (OSCE) and the scores were compared between the 2 groups. Within the intervention group, data on pretest and posttest scores, feedback questionnaires, and self-confidence assessments were also obtained and analyzed.

RESULTS

A total of 205 students were included. Statistically significant difference was found in the OSCE scores between the intervention and control groups (P < 0.01). Students in the intervention group (n = 108) showed significant improvement in knowledge scores after the workshop (P < 0.01). Most students (81.7%) expressed confidence in administering vaccines to live patients after practicing with manikins. In addition, 98.2% of students (n = 107) acknowledged the benefits of practicing with actual-size manikins in accurately determining the injection sites.

CONCLUSIONS

Simulation with the actual-size manikins significantly improved students' knowledge and practical immunization skills, leading to increased confidence and competence in their immunization skills.

A phase II clinical trial of a Vi-DT typhoid conjugate vaccine in healthy Indonesian adolescents and adults: one-month evaluation of safety and immunogenicity

BACKGROUND

Typhoid fever is commonly found until today, especially in developing countries. It has fatal complications and measures must be taken to reduce the incidence of typhoid. Vaccinations are a key factor in prevention. This is a phase II randomized observer-blind clinical trial on a novel Vi-DT conjugate vaccine on 200 subjects 12 to 40 years of age.

METHODS

Subjects were screened for eligibility after which a blood sample was taken and one dose of vaccine was administered. Investigational vaccine used was Vi-DT and control was Vi-PS. Twenty-eight days after vaccination, subjects visited for providing blood sample to assess immunogenicity and were asked about local and systemic adverse reactions that occurred in the first 28 days.

RESULTS

Subjects had minor adverse reactions. Pain was the most common local reaction. Muscle pain was the most common systemic reaction. There were no serious adverse events up to 28 days post vaccination. Seroconversion rates were 100% in the Vi-DT group and 95.96% in the Vi-PS group. Post vaccination GMTs were increased in both groups but it was significantly higher in the Vi-DT group (p < 0.001).

CONCLUSIONS

Vi-DT typhoid conjugate vaccine is safe and immunogenic in healthy Indonesian subjects 12 to 40 years.

TRIAL REGISTRATION

Approved by ClinicalTrials.gov.

CLINICAL TRIAL REGISTRATION NUMBER

NCT03460405. Registered on 09/03/2018. URL: https://clinicaltrials.gov/ct2/show/NCT03460405 .

Mental Health Awareness and Promotion during the First 1000 Days of Life: An Expert Consensus

The first 1000 days of life constitute a critical phase that will determine the optimum growth and development of a child. An important factor in this phase of life is the perinatal mental health of mothers and children. Mental health awareness is an important public health issue with significant impacts on mothers, spouses, and families, as well as the long-term emotional and cognitive development of children as well. However, the awareness and promotion of mental health within the realms of reproductive health, maternal health, and infant health, i.e., the first 1000 days of life, do not receive high prioritization in Indonesia. Nonetheless, Indonesia, with its existing primary healthcare system, has the potential to raise awareness of and promote the importance of perinatal mental health for its citizens. This experts' consensus proposes several strategies to maximize the usefulness of primary healthcare facilities in Indonesia, including Community Health Centers and Integrated Healthcare Posts, to support perinatal mental health awareness and promotion during the first 1000 days of life. The success of this program, in return, will improve the health status of women and children in Indonesia.

Safety profile of inactivated COVID-19 in healthy adults aged ≥ 18 years: A passive surveillance in Indonesia

Coronavirus Disease 2019 (COVID-19) vaccination in Indonesia has shown effectiveness in reducing the morbidity and mortality of Covid-19. The study aims to evaluate the incidence rate and severity of Adverse Events Following Immunization (AEFI) of inactivated SARS-CoV-2 vaccine during the first quarter of 2021 until the second quarter of 2022 in Indonesia. More than two hundred million Sinovac/CoronaVac were given from January 13th, 2021, until June 30th, 2022. Data for this study were collected manually and electronically from the national vaccine safety website managed by the National Committee (NC) of AEFI Indonesia and the Ministry of Health Indonesia. The total number of injections observed in the study was 264,311,992 doses consisting of 142,449,795 (first dose), 121,613,324 (second dose), and 248,873 (booster dose). Of the injections given, 301 subjects with Serious AEFIs (SAE) and 10.261 subjects with non-serious AEFIs (AE) reported, with a majority of SAE and AEs found in the first dose. Most of the SAEs were classified as coincidental events by the NC AEFI (IR 0.8/1 million doses on first dose injection; 0.31 on second dose injection). ISRR (immunization stress-related response) is in the second rank of SAEs reported (0.59 IR/1 million doses on the first dose; 0.14 on the second dose). The incidence rate of SAEs and AEs, both in the variable of age, sex, and symptoms per 1 million dose injections in Indonesia, was very rare according to WHO guidelines. Most SAEs were classified as coincidences or unrelated to the vaccine. The result showed that the Sinovac/CoronaVac in Indonesia is safe.

The efficacy and safety of first-line anti-seizure medications as substitution therapy for children with drug-resistant epilepsy: a randomized controlled trial protocol

Although many anti-seizure medications (ASMs) are available, treatment failure, known as drug-resistant epilepsy (DRE), still occurs in around 30% of children with epilepsy. Second-line ASMs are usually used as substitution therapy in DRE to control seizures, although international consensus is not available yet. Previous studies focus on comparing the ASMs, whether as add-on or substitution therapy, mainly conducted in newly diagnosed epilepsy. However, the study that investigated first-line ASMs as substitution therapy compared to second-line ones, particularly among DRE children, is still lacking. A randomized controlled trial (RCT) enrolling 102 participants, aged 1-18, at three referral hospitals in Indonesia will be conducted, dividing them into intervention and control groups. The intervention group will be treated with first-line ASMs as the substitution therapy, while the other in the control group will get second-line ASMs. The primary outcome measure is the proportion difference of responders between groups who get first-line and second-line ASMs in 14 weeks of intervention. Clinical trial registration: ClinicalTrials.gov, identifier NCT05697614.

Safety profile of inactivated COVID-19 vaccine in indonesian adults

Background

Vaccines are urgently needed to handle the morbidity and mortality of the COVID-19 pandemic in Indonesia. The inactivated vaccine is widely used in Indonesia's national immunization program due to its eligibility of stock, easier to transport, and considered to be more established than newer platforms. In this study, we aimed to evaluate the safety profile of the inactivated vaccine and analyze the safety profile between adults and the elderly.

Methods

A prospective analytical study was conducted to evaluate the safety profile of inactivated COVID-19 vaccine among healthy adults aged ≥ 18 years from September 2nd to December 28th, 2021, at ten primary health centers from 5 districts in Jakarta, Indonesia. The participants were instructed to record the symptoms after inactivated COVID-19 vaccine injection in the diary card for 28 days. Chi-square tests were carried out to analyze the relationship between the adverse event following immunization (AEFI) in adults and elderly groups.

Results

Four of 1113 participants were not included in this study due to the lack of follow-up. Out of 1109 participants, there were 1044 adults (18-59 years) and 65 elderly (>59 years). There were no serious AEFI cases reported. Most AEFI cases were mild to moderate and resolved after several days of injection. Local pain, myalgia and fatigue were the most frequent adverse events reported. We found that there was no correlation between the adults and elderly age group with the incidence of AEFI (p = 0.924) for local reactions (p = 0.181) and most of the systemic reactions (p = 0.629). However, there is an increased risk of fever in the elderly group compared to the adult group (OR 4.046, 95 % CI 1.794-9.124, p = 0.003) following immunization.

Conclusions

Our study demonstrated that the inactivated COVID-19 vaccine is safe, considering that all symptoms experienced were mild to moderate and resolved entirely.

A Qualitative Exploration of Parenting Adolescents in Indonesia

OBJECTIVE

To explore how parents of Indonesian adolescents conceptualize adolescence and to identify the challenges faced in parenting adolescents, focusing on parents from different sociodemographic backgrounds.

METHOD

Focus group discussions (FGD) were undertaken with parents of adolescents aged 10-18 years old from different sociodemographic backgrounds (urban high socioeconomic; urban low socioeconomic; rural low socioeconomic) using a semi-structured interview guide. Content and thematic analysis were assisted by Nvivo version 12.6.0.

RESULTS

Forty-three parents participated in four FGD. All parents recognized that adolescence was a distinct developmental stage, reflected in changing behaviors, escalation of peer influences and sexual development. Parents from poor, rural backgrounds had relatively limited understanding of the emerging capabilities of adolescents and had a narrow repertoire of responses to challenging behaviors, with heavy reliance on religious rules and punishment. Parents from higher socioeconomic backgrounds displayed a wider range of warmer, more engaging approaches that they reported using to shape their children's behaviors.

CONCLUSION FOR PRACTICE

These findings highlight opportunities to enhance parenting skills, which appear most warranted in parents of adolescents from disadvantaged backgrounds. Embedding basic adolescent parenting information within community programs appears indicated, and enhancing religious leaders' understanding of different approaches to parenting could be helpful in more religious communities.

Health effects of alkaline, oxygenated, and demineralized water compared to mineral water among healthy population: a systematic review

OBJECTIVES

There are many water types available on the market. They are widely known in public with health claims. The questions are, are those claims are scientifically proven or those are just testimonies from the consumers or overclaimed by the producers. This study aims to systematically review evidences on the health effects of alkaline, oxygenated, and demineralized water in comparison with mineral water among healthy population.

CONTENTS

Data were obtained from databases PubMed, Cochrane, Scopus, EBSCO, dan Science Direct since January 2000 until July 2022. There were 10 eligible articles, consisted of two articles on alkaline, four articles on oxygenated, and four articles on demineralized water, that furtherly being analyzed.

SUMMARY

Compared to consumption of mineral water, consumption of alkaline and oxygenated water did not show any significant difference on gut microbiota, urine pH, blood parameter, or fitness parameter. While, consumption of demineralized water in the long term resulted in lower quality of certain nutrient intake.

OUTLOOK

Recent evidences do not prove any additional health effects of alkaline, oxygenated, or demineralized water compared to mineral water. In contrast, demineralized water consumption in the long run was proven to lead to adverse effect.

Evaluating the Efficacy of a Social Media-Based Intervention (Warna-Warni Waktu) to Improve Body Image Among Young Indonesian Women: Parallel Randomized Controlled Trial (Preprint)

BACKGROUND

Body dissatisfaction is a global issue, particularly among adolescent girls and young women. Effective body image interventions exist but face barriers to scaling up, particularly in lower- and middle-income countries, such as Indonesia, where a need exists.

OBJECTIVE

We aimed to evaluate the acceptability and efficacy of Warna-Warni Waktu, a social media-based, fictional 6-episode video series with self-guided web-based activities for improving body image among young Indonesian adolescent girls and young women. We hypothesized that Warna-Warni Waktu would increase trait body satisfaction and mood and decrease internalization of appearance ideals and skin shade dissatisfaction relative to the waitlist control condition. We also anticipated improvements in state body satisfaction and mood immediately following each video.

METHODS

We conducted a web-based, 2-arm randomized controlled trial among 2000 adolescent girls and young women, aged 15 to 19 years, recruited via telephone by an Indonesian research agency. Block randomization (1:1 allocation) was performed. Participants and researchers were not concealed from the randomized arm. Participants completed self-report assessments of trait body satisfaction (primary outcome) and the internalization of appearance ideals, mood, and skin shade dissatisfaction at baseline (before randomization), time 2 (1 day after the intervention [T2]), and time 3 (1 month after the intervention [T3]). Participants also completed state body satisfaction and mood measures immediately before and after each video. Data were evaluated using linear mixed models with an intent-to-treat analysis. Intervention adherence was tracked. Acceptability data were collected.

RESULTS

There were 1847 participants. Relative to the control condition (n=923), the intervention group (n=924) showed reduced internalization of appearance ideals at T2 (F_1,1758=40.56, P<.001, partial η²=0.022) and T3 (F_1,1782=54.03, P<.001, partial η²=0.03) and reduced skin shade dissatisfaction at T2 (F_1,1744=8.05, P=.005, partial η²=0.005). Trait body satisfaction improvements occurred in the intervention group at T3 (F_{1, 1781}=9.02, P=.005, partial η²=0.005), which was completely mediated by the internalization change scores between baseline and T2 (indirect effect: β=.03, 95% CI 0.017-0.041; direct effect: β=.03, P=.13), consistent with the Tripartite Influence Model of body dissatisfaction. Trait mood showed no significant effects. Dependent sample t tests (2-tailed) found each video improved state body satisfaction and mood. Cumulative analyses found significant and progressive improvements in pre- and poststate body satisfaction and mood. Intervention adherence was good; participants watched an average of 5.2 (SD 1.66) videos. Acceptability scores were high for understandability, enjoyment, age appropriateness, usefulness, and likelihood to recommend.

CONCLUSIONS

Warna-Warni Waktu is an effective eHealth intervention to reduce body dissatisfaction among Indonesian adolescent girls and young women. Although the effects were small, Warna-Warni Waktu is a scalable, cost-effective alternative to more intense interventions. Initially, dissemination through paid social media advertising will reach thousands of young Indonesian women.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05383807, https://clinicaltrials.gov/ct2/show/NCT05383807 ; ISRCTN Registry ISRCTN35483207, https://www.isrctn.com/ISRCTN35483207.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/33596.

Iron status and developmental delay among children aged 24–36 months

Background Optimal child development is needed for adequate learning. Children, particularly toddlers, require iron for brain development, and consequently, overall development. Objective To analyze for an association between iron status and developmental status in children aged 24–36 months. Methods This explorative cross-sectional study was held in Kampung Melayu, Jakarta. Subjects were recruited using a total population sampling method. Data were collected through interview with parents, anthropometric examinations, and blood tests. Developmental status was determined using the Ages and Stages Questionnaire-3 (ASQ-3) and iron status was based on ferritin, high sensitivity C-reactive protein (hs-CRP), and hemoglobin levels. Data analyses included Chi-square/Fisher’s exact, Mann-Whitney, and logistic regression tests. Results Of 80 subjects, 17.5% had developmental delay and 41.3% had deficient iron status. There was no significant association between iron status and developmental status in bivariate analysis, but the logistic regression analysis revealed that iron status (OR=6.9; 95%CI 1.328 to 35.633; P=0.022) and nutritional status (OR=11.75; 95%CI 1.551 to 88.979; P=0.017) contributed to developmental delay. Conclusion Better iron status and nutritional status are associated with better child development of children aged 24–36 months. So efforts are needed to maintain iron status as well as nutritional status.

Iron status and developmental delay among children aged 24–36 months

Background Optimal child development is needed for adequate learning. Children, particularly toddlers, require iron for brain development, and consequently, overall development. Objective To analyze for an association between iron status and developmental status in children aged 24–36 months. Methods This explorative cross-sectional study was held in Kampung Melayu, Jakarta. Subjects were recruited using a total population sampling method. Data were collected through interview with parents, anthropometric examinations, and blood tests. Developmental status was determined using the Ages and Stages Questionnaire-3 (ASQ-3) and iron status was based on ferritin, high sensitivity C-reactive protein (hs-CRP), and hemoglobin levels. Data analyses included Chi-square/Fisher’s exact, Mann-Whitney, and logistic regression tests. Results Of 80 subjects, 17.5% had developmental delay and 41.3% had deficient iron status. There was no significant association between iron status and developmental status in bivariate analysis, but the logistic regression analysis revealed that iron status (OR=6.9; 95%CI 1.328 to 35.633; P=0.022) and nutritional status (OR=11.75; 95%CI 1.551 to 88.979; P=0.017) contributed to developmental delay. Conclusion Better iron status and nutritional status are associated with better child development of children aged 24–36 months. So efforts are needed to maintain iron status as well as nutritional status.

Assessment of water consumption during Ramadan intermittent fasting: Result from Indonesian cross-sectional study

During Ramadan fasting, people are likely to consume water and beverages lower than recommended intake due to the limited time. However, it is necessary to achieve the recommended daily water intake to maintain the hydration status, as well as productivity during fasting. Unfortunately, there is a lack of data on drinking patterns during Ramadan. This study aims to investigate water and beverage intake and drinking patterns to help achieve water requirements during Ramadan among Indonesian adults. This is a cross-sectional study conducted during the Ramadan period from April to May 2021 (Ramadan 1442 Hijri). We used a self-administered questionnaire on drinking habits during Ramadan and utilized a 7-day fluid record (Liq.In 7) to assess water and beverage intake among participants who were managed through online procedure. There were 380 participants from five universities across Indonesia who completed the questionnaire accordingly and then analyzed it. The result shows that total water and beverage intake during Ramadan among participants was below the recommendation [1,670 (1,326–2,034) ml/day]. Among the type of beverages, water is the highest level of consumption [1,262 (983–1,666) ml/day] then followed by sugar-sweetened beverages [200 (91–350) ml/day]. We found a significant difference in water and beverages consumption between time of iftar [474 (375–590) ml/day], nighttime [574 (414–810) ml/day], and suhoor [560 (423–711) ml/day]. From this study, we found that during Ramadan the most common drinking pattern is 2-4-2, but a drinking pattern of 4-2-2 glasses (sequence of four glasses at iftar, two glasses at nighttime, two glasses at suhoor) had a significantly higher chance to adhere with the recommendation of fluid intake compared to other patterns. Therefore, based on this research on water and beverage intake, it is necessary and important to make improvements among Indonesian adults during Ramadan, and the drinking pattern of 4-2-2 glasses may help to achieve the recommended daily water consumption.

Pengaruh Pemberian Vitamin E terhadap Kadar Oksidan pada Leukemia Limfoblastik Akut Fase Induksi

Latar belakang. Penderita leukemia limfoblastik akut (LLA) akan mengalami perubahan status oksidan dan antioksidan sejak awal diagnosis dan selama kemoterapi. Vitamin E merupakan antikarsinogenik dan berperan mencegah kerusakan oksidatif pada struktur sel dan jaringan lewat reaksi pemecahan radikal bebas. Tujuan. Mengetahui pengaruh vitamin E terhadap kadar oksidan, kadar enzim transaminase, dan insiden demam neutropenia pada LLA saat awal dan selesai kemoterapi fase induksi. Metode. Uji klinis acak tersamar ganda yang membandingkan kelompok vitamin E dengan kelompok plasebo pada penderita LLA saat awal dan selesai kemoterapi fase induksi pada bulan Juni-November 2019 di poliklinik Hematologi Onkologi Departemen Ilmu Kesehatan Anak FKUI RSCM Kiara. Hasil. Terdapat peningkatan kadar median MDA saat awal fase induksi dan terjadi penurunan MDA secara bermakna saat selesai fase induksi pada kelompok plasebo. Terdapat peningkatan median enzim transaminase (AST dan ALT) saat awal fase induksi dan terjadi penurunan delta median AST secara bermakna saat selesai fase induksi pada kelompok plasebo. Insiden demam neutropenia (per episode) ditemukan hampir sama pada kelompok vitamin E dan kelompok plasebo. Kesimpulan. Vitamin E tidak terbukti secara bermakna memperbaiki kadar MDA, enzim transaminase, dan insiden demam neutropenia pada penderita LLA fase induksi.

Water and Beverages Intake Among Workers Amid the COVID-19 Pandemic in Indonesia

As the COVID-19 pandemic hit worldwide in the early 2020, people were urged to alter their behavior to prevent disease spread, thus, led to change water intake. This study aimed to analyze water and beverage intake among health workers and general workers during COVID-19 pandemic in Indonesia. This study was a comparative descriptive study where the participants were 20–45-year-old health workers and general workers in Indonesia. Data collected included demographic, water and beverage intake, physical activity, nutrient intake, and body weight and height. All data collection was obtained online using self-reported questionnaire. Water intake data was collected for 7 days consecutively using a 7-day fluid record. There were 246 participants comprised of 102 (41.5%) general workers and 144 (58.5%) health workers who were analyzed in this study. All participants showed barely adequate intake of daily total fluid 1,882 (1,473–2,433) ml/day. Total fluid intake among general workers was 1,759 (1,447–2,396) ml/day, whereas in health workers it was slightly higher 1,939 (1,516–2,446) ml/day (p-value = 0.378). Among health workers who were highly exposed to patients with COVID-19 showed the highest percentage in drinking water adequately (20 participants, 60.6%) compared to health workers who worked under moderate (29 participants, 48.3%) and low (24 participants, 47.2%) level of exposure to patients with COVID-19. In conclusion, workers need to improve their daily fluid intake. This study also showed better behavior of water consumption among health workers compared to general workers despite of their strict personal protection equipment during working hour.

Social-emotional development in early life: what happens and how to optimize it

The Physical, metabolic, emotional, cognitive, and social development all begin to develop during early years of childhood.. Social and emotional competencies are increasingly recognized as critical for children's success, in school and in later phases of life into adulthood. According to new research, changes in the gastrointestinal tract's development during the early postnatal period can affect brain development and vice versa., collectively called the gut-brain axis. The gut microbiota has an impact on a variety of mental processes and phenomena, as well as being involved in the pathophysiology of a variety of mental and neurological diseases.. Insights in this area can be targeted through dietary treatments to improve cognitive outcomes in newborns by optimizing the link between the gastrointestinal system and the brain. Further, having a healthy and happy human life could be ensured by acquiring adequate and balance microbiota

A Novel, Scalable Social Media-Based Intervention ("Warna-Warni Waktu") to Reduce Body Dissatisfaction Among Young Indonesian Women: Protocol for a Parallel Randomized Controlled Trial

Background

Despite the prevalence of body dissatisfaction among young Indonesian women and its consequential negative impacts, there are currently no evidence-based, culturally appropriate interventions to tackle this issue. Therefore, there is a need to develop scalable, cost-effective, and accessible interventions to improve body image among this population.

Objective

This paper describes the study protocol of a parallel randomized controlled trial to evaluate the effectiveness of Warna-Warni Waktu, a social media–based intervention that aims to reduce state and trait body dissatisfaction and improve mood among young Indonesian women aged 15-19 years.

Methods

The trial will take place online. Approximately 1800 young women from 10 cities in Indonesia, evenly split across the ages of 15-19 years, will be recruited via a local research agency’s established research panel. Participants will be randomly allocated to the intervention condition or a waitlist control condition. The intervention consists of six 5-minute videos, with each video supplemented with up to five brief interactive activities. The videos (and associated activities) will be delivered at a rate of one per day across 6 days. All participants will complete three self-report assessments: at baseline (Day 1), 1 day following the intervention (Day 9), and 1 month following the intervention (Day 36). The primary outcome will be change in trait body dissatisfaction. Secondary outcomes include change in internalization of appearance ideals, trait mood, and skin shade satisfaction. Intervention effectiveness on these outcomes will be analyzed using linear mixed models by a statistician blinded to the randomized condition. Intervention participants will also complete state measures of body satisfaction and mood before and after watching each video to assess the immediate impact of each video. This secondary analysis of state measures will be conducted at the within-group level.

Results

Recruitment began in October 2021, with baseline assessments underway shortly thereafter. The results of the study will be submitted for publication in 2022.

Conclusions

This is the first study to evaluate an eHealth intervention aimed at reducing body dissatisfaction among young Indonesian women. If effective, the intervention will be disseminated to over half a million young women in Indonesia via Facebook, Instagram, and YouTube.

Trial Registration

ClinicalTrials.gov NCT05023213; https://clinicaltrials.gov/ct2/show/NCT05023213

International Registered Report Identifier (IRRID)

PRR1-10.2196/33596

Growth and Development in Preterm Infants: What is The Long-Term Risk?

ABSTRACT Background: Indonesia comes in the fifth for the greatest number of preterm births. Preterm infants may inflict various complication as the result of underdeveloped immunity, affecting their growth and development in the long run until they reach adult phase. Such complications could be prevented through adequate nutrition fulfillment. Purpose: This article aimed to elaborate the characteristics of growth and development of premature babies, long term effect on the development and the impact of immunity and gut health of preterm infants in supporting their growth and development. Methods: References cited in this article were obtained from the latest primary literature within the last 10 years. Discussion: The rate and ability of infants to perform catch-up growth depends on the birth weight and gestation age, at which the lower birth weight and lower gestational age had slower rate. Brain structures that of preterm infants differ compared to the term, and these changes give rise to various clinical outcomes, including long term emotional, behavioral changes, cognitive and executive functioning. Immature immune system in preterm infants reduces the protective ability by innate and adaptive immunity in overcoming pathogens compared to term infants, including gut microbiota prematurity which affects nutrition absorption and growth and development catch up ability. Appropriate and adequate nutrition supplementation has shown beneficial effects in promoting the growth of normal gut flora, which allow better absorption of nutrition and therefore enhancing growth rate and supporting the development of preterm infants. Conclusions: Optimal growth and development of preterm infants are supported by sufficient nutrition supplementation to support the growth of gut microbiota, facilitating the catch-up growth and development of premature infants and immune system maturity.

The Role of Iron for Supporting Children’s Growth and Development

According to the World Health Organization (WHO), Iron Deficiency (ID) affects around 2 billion people worldwide. Early childhood ID has been associated with permanent cognitive deficits associated with CNS structural, metabolic impairment, growth retardation, impaired immune response, psychological abnormalities, and behavioral delays. This literature review will focus on the important role of iron in child growth and development. Iron is necessary for various cellular processes in the growing brain especially when it comes to memory and learning. Children with early ID show cognitive deficits that persist; however, prompt iron treatment soothes the problem. A chronic ID group reported substantially lower scores of vocabularies, ambient sound perception, and motor measurements in a recent study relative to infants with normal nutritional iron status at 6 months and 14-18 months. Children's iron requirement differentiates based on individual age. The daily iron requirement for one- to three-year-old children is 7 mg. Some risk factors of infants and toddlers in developing ID are insufficient food intake, poor bioavailability, reduced absorption, increase demand, increase losses, cow’s milk enteropathy hookworm infection, and maternal gestation. Iron plays an important role in promoting children's growth and development. Physical health and nutrition are important in the first two years of life. Children who are unable to achieve iron adequacy will possibly show permanent cognitive deficit and impaired motor growth. Thus, iron supplementation may only be successful in early prescription after diagnosing iron deficiency.

Faktor yang Memengaruhi Penurunan Cakupan Imunisasi pada Masa Pandemi Covid-19 di Jakarta

Latar belakang. Pandemi Covid-19 sangat memengaruhi pelayanan imunisasi di seluruh dunia. Tenaga kesehatan dialihkan untuk pelayanan Covid-19 dan orangtua merasa takut membawa anaknya untuk imunisasi ke fasilitas kesehatan sehingga menurunkan cakupan imunisasi. Penurunan cakupan imunisasi akan meningkatkan kejadian penyakit yang dapat dicegah dengan imunisasi (PD3I). Jakarta sebagai ibukota negara adalah kota dengan populasi terbesar dan juga kasus Covid-19 terbanyak di Indonesia.Tujuan. Mengetahui faktor-faktor yang memengaruhi penurunan cakupan imunisasi di Jakarta dari sudut pandang orangtua dan tenaga kesehatan.Metode. Penelitian potong lintang menggunakan kuesioner disebarkan kepada tenaga kesehatan (dokter spesialis anak, dokter umum, perawat, bidan, kader) dan orangtua di Jakarta pada bulan Agustus hingga September 2020. Hasil di evaluasi menggunakan SPSS.Hasil. Sebanyak 125 tenaga kesehatan dan 145 orangtua mengikuti penelitian ini. Tenaga kesehatan menghadapi masalah seperti adanya peraturan pemerintah untuk menghentikan sementara pelayanan imunisasi, kurangnya alat pelindung diri (APD), tenaga kesehatan terinfeksi Covid-19 dan tenaga imunisasi dialihkan untuk pelayanan Covid-19. Masalah pada orangtua antara lain keraguan untuk membawa anaknya imunisasi karena takut tertular Covid-19 dari tenaga kesehatan ataupun pasien lain, Posyandu ditutup, adanya peraturan PSBB dan masalah transportasi.Kesimpulan. Penurunan cakupan imunisasi pada masa pandemi Covid-19 disebabkan oleh multi faktor yang harus diminimalisasi untuk mengurangi kejadian PD3I.

Iron Intake and Its Correlation to Ferritin and Hemoglobin Level among Children Aged 24–36 Months in Jakarta in 2020

Introduction: Iron is essential for child’s development and growth. Children’s iron requirements are secured from daily food intake that might be affected by Covid-19 pandemic. This study aims to determine iron intake and its relationship with ferritin and hemoglobin levels as indicators of iron status among children in Jakarta.Method: This cross-sectional study was conducted in Kampung Melayu, Jakarta from September to October 2020. Seventy seven healthy children aged 24–36 months were taken using total population sampling method. Interviews were conducted to obtain characteristics data and iron intake using a semi-quantitative-food frequency questionnaire (SQ-FFQ). Blood tests are performed to check the levels of ferritin (controlled by hs-CRP value), and hemoglobin.Pearson’s/Spearman’s correlation test was performed using SPSS version 20.0. Result: Median of iron intake was 9.6 (1.5–40,7) mg/day, in which 33.8% of subjects was below the Indonesian Recommended Dietary Allowance (RDA) recommendation. The median ferritin value was 18.1 (1.4–91.1) 𝜇g/L and the hemoglobin was 11.8 (6.6–15.2) g/dL, in which 40.3% and 27.3% subjects with iron insufficient-deficient and anemia, respectively. There were  positive correlations between iron intake and ferritin (r = 0.328, p = 0.002) and iron intake and hemoglobin (r = 0.308, p = 0.003). A strong positive correlation was found between ferritin and hemoglobin (r = 0.769, p < 0.001).Conclusion: Iron intake of children aged 24–36 months had a weak positive correlation with ferritin and hemoglobin level. Keywords: children 24–36 months, ferritin, hemoglobin, iron intake, Jakarta

Profil Asupan Minum pada Anak Prasekolah di Daerah Urban dan Rural di Indonesia dan Faktor-faktor yang Memengaruhinya

Latar belakang. Asupan minum yang kurang akan berdampak terhadap performa fisik dan kognitif serta dapat menimbulkan manifestasi klinis, seperti pusing, lesu, dan gangguan konsentrasi. Anak memiliki proporsi cairan tubuh yang lebih tinggi dibandingkan dewasa. Hingga saat ini belum ada data mengenai kecukupan asupan minum anak prasekolah di Indonesia.Tujuan. Mengetahui kecukupan asupan minum anak prasekolah di daerah urban dan rural di Indonesia.Metode. Penelitian dengan desain potong lintang dilakukan pada bulan Januari-Maret 2016 di Jakarta dan Maluku pada anak usia 36-72 bulan. Perhitungan jumlah cairan dilakukan dengan mencatat jumlah yang diminum dalam 7 Day-Fluid Diary Record. Asupan minum total ditentukan berdasarkan jumlah yang dikonsumsi dari semua kategori dan sesuai dengan angka kecukupan gizi (AKG) 2019.Hasil. Sebanyak 585 anak mengikuti penelitian ini dengan median asupan minum adalah 1133,1 (85-2991,4) mL/hari dan jenis asupan paling tinggi adalah air putih. Subjek yang tinggal di daerah urban mempunyai faktor risiko lebih rendah untuk mengalami asupan minum yang kurang (RR=0,580; 95%IK: 0,418-0,807; p=0,001). Demikian pula semakin muda usia subjek, maka semakin kecil kemungkinan untuk mengalami kejadian asupan minum yang kurang (RR =0,497; 95%IK: 0,356-0,694; p=0,000).Kesimpulan. Rerata asupan minum anak usia prasekolah di Indonesia sedikit lebih rendah dari anjuran AKG. Anak prasekolah berusia ≥54 bulan dan anak yang tinggal di area rural lebih berisiko mengalami kekurangan asupan minum.

Overweight and obesity in 16–18 years old teenagers in South Jakarta and the relationship with academic performance

Objective: In different parts of the world, Indonesia included, overweight and obese people are seen to have worse performance compared to their healthy counterparts. Although there were research that had been done to observe the relationship between overweight, obesity, and academic performance, the results obtained were still divided into significantly and non-significantly related.Methods: A cross-sectional study was done to 373 students from two different schools in South Jakarta on December 2017–January 2018. Data was obtained by measuring height and weight of the participant to get his/her nutritional status and the average of participant’s odd semester Continual Assessment and Semestral Assessment of Academic Year 2017/2018 to see if the result was higher or equal to the passing grade.Results: Data analysis with chi square test shows that there was no significant relationship between overweight, obesity, and academic performance (p = 0.452 for Indonesian Language and p = 0.476 for Mathematics) although overweight and obese students tend to have better performance in some exam.Conclusion: The events that lead to overweight, obesity, and one’s academic performance are all multifactorial that the relationship between the two is difficult to be determined.

Excessive body weight and its relationship to body image in teenagers aged 16–18 years old in South Jakarta

Objective. Overweight is one of the health problems that often occur in children and adolescents throughout the world, both in developed and developing countries. Study results in USA showed yearly increase of overweight prevalence in children aged 2–19 years old. In addition, based on the results by the National Health and Nutrition Examination Survey 2009–2010 in United States, the highest percentage of overweight and obesity by age group was found at 12–19 years old (33.6%). Basic Health Research/Riskesdas’s data in 2013 showed the prevalence of overweight in adolescents aged 16–18 years old in Indonesia reached the highest value of 11.5%. Moreover, most teenagers see their body images as a match between self’s and others’ ideal perception. Teenagers with positive body image tend to be more confident and also easier to get along with other people, especially their peers. In this study, researcher aimed to investigate the relationship between teenagers who have excess body weight with body image, whether it had positive or negative impact.Methods: This was a cross-sectional study. Data collection was done from December 2017 to January 2018. Data collected were anthropometric measurements (weight and height) and the King College London Body Image Questionnaire's filled by participants. From 400 subjects who filled the questionnaires, a total of 350 participants matched the inclusion criteria and were analyzed. Chi square test was done as data analysis.Results: Chi-square analysis for excess body weight status in relation to body image scores showed no relationship (p=1,000).Conclusions: There was no significant relationship between excessive body weight and body image. 

Correlation of overweight nutritional status and sleep quality in 16–18 years old teenagers in South Jakarta

Background and Objectives: Overweight nutritional status in adolescents becomes a health problem that continues to require attention. Not only because of its rapidly increasing prevalence, but also its various adverse effects on adolescent health, especially on the quality of sleep. Sleep quality decrease in adolescents can impact their daily performance, especially in learning. This study aimed to investigate the relationship of overweight nutritional status with sleep quality in adolescents aged 16–18 years old in South Jakarta.Method: This cross-sectional design study was done in two public senior high schools in the South Jakarta. A total of 186 students from classes of 2015, 2016, and 2017 with age between 16-18 years old underwent weight and height measurements, determination of BMI and nutritional status using the CDC BMI-for-age chart, as well as filling the Cleveland Adolescent Sleepiness Questionnaire to assess the quality of sleep.Results: The prevalence of overweight was found by 20.43% (14.52% categorized as overweight, 5.91% categorized as obese) with a median value of the questionnaire 40.00 (23.00 to 58.00). Mann-Whitney test found that the p value for the mean difference of the questionnaire's total score to excess weight is 0.783.Conclusion: There was no correlation between the quality of sleep to excess weight in adolescents aged 16–18 years old in South Jakarta.

A novel Vi-diphtheria toxoid typhoid conjugate vaccine is safe and can induce immunogenicity in healthy Indonesian children 2-11 years: a phase II preliminary report

BACKGROUND

Typhoid fever caused by Salmonella enteric serovar Typhi (S. Typhi) is a common cause of morbidity in the world. In 2017, 14.3 million cases of Typhoid and paratyphoid fever occurred globally. School age children between 3 to 19 years old are the most affected. Poor sanitation and multi drug resistance have increased the need for vaccines to reduce the global burden of disease. Based on previous trials, typhoid conjugate vaccines have longer- lasting protection, higher efficacy, require fewer doses and are suitable from infancy that allows them to be incorporated into the routine immunization program. Our previous phase I trial proved that a novel Vi-DT typhoid conjugate vaccine is safe and immunogenic in subjects 2-5 and 18-40 years. Our phase II trial consisted of subjects 6 months to 40 years. Our previously published paper on subjects 6 to < 24 months proved that this vaccine is safe and immunogenic for this age group. Therefore, with this paper we aimed to evaluate the safety and immunogenicity in children 2-11 years.

METHODS

A randomized, observer-blind, superiority design of Vi-DT Typhoid conjugate vaccine compared to Vi-polysaccharide vaccine (Vi-PS) phase II study was conducted from October 2018 to December 2018 where 200 subjects aged 2-11 years were recruited. A blood sample prior to vaccination was taken, followed by administration of a single dose of either test vaccine (Vi-DT) or control vaccine (Vi-PS) and then a second blood sample was collected 28 days post vaccination. Adverse reactions were assessed and antibody increment was evaluated at 28 days post vaccination through collected serum sample.

RESULTS

Pain was the most common local reaction. Fever and muscle pain were the most common systemic reactions. Both Vi-DT and Vi-PS groups had roughly the same number of adverse reactions. At 28 days post vaccination, 100% of subjects in the Vi-DT group and 93% of subjects in the Vi-PS group produced antibody increment ≥4 times. The Vi-DT group produced a higher GMT as compared to Vi-PS.

CONCLUSION

Vi-DT vaccine is safe and immunogenic in children 2-11 years old.

TRIAL REGISTRATION

Trial registration number: NCT03460405 .

Gambaran Masalah Psikososial pada Remaja dengan Thalassemia Mayor dan Diabetes Mellitus Tipe-1

Latar belakang. Thalassemia dan diabetes mellitus tipe-1 (DM tipe-1) merupakan penyakit kronik yang banyak didapatkan pada anak dan remaja di Indonesia. Adanya penyakit kronik pada remaja dapat berisiko meningkatkan terjadinya masalah psikososial 2-6 kali dibandingkan populasi sehat. Masalah psikososial pada remaja sulit dikenali sehingga perlu dilakukan evaluasi secara rutin. The strengths and difficulties questionnaire (SDQ) adalah instrumen yang praktis dan mudah digunakan untuk mendeteksi masalah tersebut. Tujuan. Mengetahui besaran masalah psikososial pada remaja dengan penyakit kronik di RS. Cipto Mangunkusumo, Jakarta. Metode. Desain potong lintang pada 140 remaja (100 thalassemia mayor dan 40 DM tipe-1), usia 10-18 tahun. Subyek diminta untuk mengisi kuesioner SDQ (laporan mandiri). Hasil. Prevalensi total skor abnormal pada remaja thalassemia mayor adalah 8%, dan DM tipe-1 adalah 15%. Tidak ada skor abnormal pada aspek perilaku pro-sosial kedua penyakit, dan aspek hubungan dengan teman sebaya DM tipe-1. Tidak didapatkan perbedaan bermakna antara diagnosis penyakit, jenis kelamin, dan tingkat pendidikan subyek pasien DM terhadap luaran hasil SDQ. Kesimpulan. Masalah psikososial lebih banyak didapatkan pada remaja DM tipe-1 dibandingkan thalassemia mayor.

Understanding mental health and its determinants from the perspective of adolescents: A qualitative study across diverse social settings in Indonesia

Poor mental health is a leading contributor to the burden of disease experienced by adolescents, including in resource constrained settings. However, little is known about how adolescents in these countries conceptualise mental health and its determinants which is essential to informing effective responses. This study aimed to explore how adolescents in Indonesia (a populous and rapidly developing country) conceptualise mental health and what they identify as important determinants. Eight focus group discussions (FGDs) were conducted with 86 Indonesian adolescents (aged 16-18 years), sampled from schools and community settings from Jakarta and South Sulawesi. FGDs were recorded, transcribed, translated and thematically analysed. Mental health was recognised as a significant concern by adolescents in Indonesia. Good mental health was conceptualised as emotional wellbeing and happiness. By contrast, poor mental health was predominantly described in terms of substantial mental illness manifesting as behavioural and physical disturbance. Further, poor mental health only happened to 'other' people, with stigmatising views prevalent. Absent from the discussions were common symptoms of poor mental health (stress, loneliness, poor sleep) and common mental disorders (e.g. depression, anxiety) or a conceptualisation that reflected poor mental health to be a normal human experience. Discussions around determinants of poor mental health suggested that family connections (particularly with parents), school pressures, and adverse exposures on social media were important drivers of poor mental health, with religion also surfacing as an important determinant. In highlighting mental health as an important issue for Indonesian adolescents, this study provides a foundation for targeted responses.

Six-month follow up of a randomized clinical trial-phase I study in Indonesian adults and children: Safety and immunogenicity of Salmonella typhi polysaccharide-diphtheria toxoid (Vi-DT) conjugate vaccine

Introduction

There is a high global incidence of typhoid fever, with an annual mortality rate of 200,000 deaths. Typhoid fever also affects younger children, particularly in resource-limited settings in endemic countries. Typhoid vaccination is an important prevention tool against typhoid fever. However, the available polysaccharide typhoid vaccines are not recommended for children under 2 years of age. A new typhoid conjugate Vi-diphtheria toxoid (Vi-DT) vaccine has been developed for infant immunization. We aimed to define the safety and immunogenicity of the Vi-DT vaccine among adults and children in Indonesia.

Methods

An observational, blinded, comparative, randomized, phase I safety study in two age de-escalating cohorts was conducted in East Jakarta, Indonesia, from April 2017 to February 2018. We enrolled 100 healthy subjects in 2 age groups: adults and children (18–40 and 2–5 years old). These groups were randomized into study groups (Vi-DT vaccine), and comparator groups (Vi-polysaccharide (Vi-PS) vaccine and another additional vaccine) which was administered in 4 weeks apart. Subjects were followed up to six months.

Result

One hundred healthy adults and children subjects completed the study. The Vi-DT and Vi-PS vaccines showed no difference in terms of intensity of any immediate local and systemic events within 30 minutes post-vaccination. Overall, pain was the most common local reaction, and muscle pain was the most common systemic reaction in the first 72 hours. No serious adverse events were deemed related to vaccine administration. The first and second doses of the Vi-DT vaccine induced seroconversion and higher geometric mean titers (GMT) in all subjects compared to that of baseline. However, in terms of GMT, the second dose of Vi-DT did not induce a booster response.

Conclusion

The Vi-DT vaccine is safe and immunogenic in adults and children older than two years. A single dose of the vaccine is able to produce seroconversion and high GMT in all individuals.

DTwP-HB-Hib: antibody persistence after a primary series, immune response and safety after a booster dose in children 18-24 months old

Background

The new combination of DTwP-HB-Hib vaccines has been developed in Indonesia following World Health Organization (WHO) recommendation and integrated into national immunization program. The aims of the study were to measure 1) antibody persistence 12–18 months after a primary series, 2) immune response and safety after a booster dose of DTwP-HB-Hib.

Methods

This was a multi-center, open-labeled, prospective, interventional study. Subjects who had received complete primary dose of DTwP-HB-Hib vaccine from the previous phase III trial were recruited in this trial. Subjects were given one dose of DTwP-HB-Hib (Pentabio®) booster at age 18–24 months old. Diphtheria, tetanus, pertussis, hepatitis B, Hemophilus influenza type B antibodies were measured before and after booster to determine antibody persistence and immune response. Vaccine adverse events were assessed immediately and monitored until 28 days after the booster recorded with parent’s diary cards.

Results

There were 396 subjects who completed the study. Increased proportion of seroprotected subjects from pre-booster to post-booster were noted in all vaccine antigens: 74.5 to 99.7% for diphtheria; 100 to 100% for tetanus; 40.4 to 95.5% for pertussis; 90.2 to 99.5% for hepatitis B; and 97.7 to 100% for Hib. Common systemic adverse events (AEs) were irritability (23.7–25%) and fever (39.9–45.2%). Local AEs such as redness, swelling, and induration were significantly less common in the thigh group (7.7, 11.3, and 7.1%) than in the deltoid group (28.9, 30.7, and 25%) (P < 0.001). Most AEs were mild and resolved spontaneously within three-day follow-up period.

Conclusions

Booster of DTwP-HB-Hib vaccine at age 18–24 months is required to achieve and maintain optimal protective antibody. The vaccine is safe and immunogenic to be used for booster vaccination.

Trial registration

NCT02095314 (retrospectively registered, March 24, 2014).

Immunogenicity and safety of a Trivalent Influenza HA vaccine in Indonesian infants and children

INTRODUCTION

High rate of influenza infection in children made influenza vaccination strongly recommended for all person aged >6 months in Indonesia. Bio Farma Trivalent Influenza HA (Flubio®) vaccine has been used in adolescents and adults, resulted in increased seroconversion, seroprotection rates and geometric mean titer (GMT). However, no data is available regarding its efficacy and safety in children. This study aimed to assess the immunogenicity and safety of Flubio® vaccine in infants and children.

MATERIALS AND METHODS

This was a phase II, open-labeled, clinical trial conducted on healthy children aged 6 month-11 years, vaccinated with 1 or 2 doses of Influenza HA vaccine, with a 28-day interval. Flubio® vaccine composed of A/California/7/2009 (H1N1) pandemic 09, A/Texas/50/2012 (H3N2), and B/Massachusetts/2/2012 strain. This study was held at East Jakarta, Indonesia from May until July 2014. A Total of 405 subjects were included and divided into three groups: A(6-35 months), B(3-8 years), and C(9-11 years). Antibody titer was measured at visit V1 (Day 0), V2 (28 days/+7days after the first dose) and V3 (28 days/+7days after second dose). The seroprotection and seroconversion rates were assessed. Safety was assessed up to 28 days following each dose.

RESULTS

A total of 404 subjects completed the study. After vaccination, all subjects achieved seroprotection and increased seroconversion rates, with post-vaccination antibody titer of ≥1:40 HI for all strains. The GMT also increased significantly. Within 30 min after vaccination, 14.6% and 2% had local and systemic reactions; meanwhile, between 30 min to 72 h after vaccination, 35.1% and 13.6% subjects had local and systemic reactions, respectively. Most reactions were mild. No serious adverse event (SAE) was reported related to vaccine.

CONCLUSION

Flubio® (Influenza HA Trivalent) vaccine is immunogenic and safe for children aged 6 months-11 years.

TRIAL REGISTRATION

The trial is registered at the US National Institutes of Health (ClinicalTrials.gov) #NCT02093260.

Efektivitas Seminar pada Perubahan Sikap Ibu dalam Pemberian Dukungan Nutrisi dan Stimulasi selama Pemantauan Tumbuh Kembang

Latar belakang. Kualitas tumbuh kembang balita ditentukan oleh nutrisi, kasih sayang, stimulasi, dan perlindungan terhadap penyakit. Ibu sebagai pengasuh utama anak berperan penting mengoptimalkan pertumbuhan dan perkembangan anak, sehingga harus memiliki sikap yang baik tentang pemantauan tumbuh kembang saat kunjungan ke tenaga kesehatan. Peningkatan pengetahuan Ibu dapat dilakukan dengan edukasi dan pelatihan.Tujuan. Menganalisis efektivitas seminar pada perubahan sikap ibu dalam pemberian dukungan nutrisi dan stimulasi selama pemantauan tumbuh kembang. Metode. Penelitian desain potong lintang dengan kuesioner pre dan post intervensi dilakukan pada ibu dengan balita. Perubahan sikap ibu dievaluasi dalam pemantauan tumbuh kembang anaknya. Intervensi berupa seminar mengenai kesehatan anak yang diadakan di 6 kota besar di Indonesia dengan purposive sampling peserta yang mengisi lengkap kuesioner. Analisis data digunakan metode paired T-test dalam software IBM SPSS statistics versi 22.Hasil. Terdapat 617 ibu yang mengisi lengkap kuesioner yang diberikan dalam seminar. Terjadi peningkatan yang bermakna (beda mean -0,15±0,26;95%CI -0,17sampai-0,13; p<0,001) pada rerata skor sikap ibu setelah mengikuti seminar yang diadakan oleh peneliti. Sumber informasi yang penting dan berkesan, antara lain, televisi, gawai, media sosial, tenaga kesehatan, dan seminar oleh tenaga kesehatan. Kesimpulan. Pemberian seminar oleh tenaga kesehatan mengubah sikap ibu pada pengasuhan anak selama pemantauan tumbuh kembang dengan efektif (p<0,001).

Maternal attitude and child interest in various play activities before and after mother-child play sessions

Background Play stimulates children’s growth and development. When mothers and their children play, a positive attitude from the mother and adequate interest from the child is required. Little is known about the play activities that effectively stimulate such positive maternal attitude and child interest.Objective To assess for associations between various play activities with maternal attitude and child interest before and after mother-child play sessions.Methods Pre-post intervention questionnaires were distributed to mothers before and after playing with their children. Children were aged 1-5 years, from two play sites (in Surabaya and Makassar), and included using purposive sampling. Eight types of toys/play activities were provided. The allocated time for answering the 17-question survey was 15 minutes. Average scores before and after the mother-child play sessions were analyzed using paired T-test.Results We collected 264 valid questionnaires, 235 in Surabaya and 29 in Makassar. Improvement of maternal attitude after the mother-child play session was found in 132 mothers [mean diff. 0.07 (SD 0.42); 95%CI -0.117 to -0.015; P=0.011]. Play activities with significant improvements in maternal attitude were jigsaw puzzle [mean diff. 0.09 (SD 0.66); 95% CI 0.007 to 0.167;P= 0.033), Lego blocks (mean diff.-0.10 (SD 0.69); 95%CI -0.186 to -0.018; P=0.017), mini-gardening (mean diff. -0.15 (SD 0.75); 95%CI -0.238 to -0.057; P=0.002), sandbox [mean diff.-0.24 (SD 0.83); 95%CI -0.339 to – 0.138; P < 0.001], fishing [mean diff. -0.17 (SD 0.68); 95%CI -0.253 to -0.088; P < 0.001], and animal figurines [mean diff. -0.21 (SD 0.75); 95%CI -0.3 to -0.117;P <0.001]. Improvement of child interest was found in 161 children [mean diff. 0.20 (SD 0.52); 95%CI -0.264 to -0.116; P<0.001]. Play activities with significant improvements in child interest were jigsaw puzzle, Lego blocks, origami, mini-gardening, fishing, and animal figurines.Conclusion Some mother-child play activities, but not all, significantly improve both maternal attitude and child interest toward play.

Maternal attitude and child interest in various play activities before and after mother-child play sessions

Background Play stimulates children’s growth and development. When mothers and their children play, a positive attitude from the mother and adequate interest from the child is required. Little is known about the play activities that effectively stimulate such positive maternal attitude and child interest.Objective To assess for associations between various play activities with maternal attitude and child interest before and after mother-child play sessions.Methods Pre-post intervention questionnaires were distributed to mothers before and after playing with their children. Children were aged 1-5 years, from two play sites (in Surabaya and Makassar), and included using purposive sampling. Eight types of toys/play activities were provided. The allocated time for answering the 17-question survey was 15 minutes. Average scores before and after the mother-child play sessions were analyzed using paired T-test.Results We collected 264 valid questionnaires, 235 in Surabaya and 29 in Makassar. Improvement of maternal attitude after the mother-child play session was found in 132 mothers [mean diff. 0.07 (SD 0.42); 95%CI -0.117 to -0.015; P=0.011]. Play activities with significant improvements in maternal attitude were jigsaw puzzle [mean diff. 0.09 (SD 0.66); 95% CI 0.007 to 0.167;P= 0.033), Lego blocks (mean diff.-0.10 (SD 0.69); 95%CI -0.186 to -0.018; P=0.017), mini-gardening (mean diff. -0.15 (SD 0.75); 95%CI -0.238 to -0.057; P=0.002), sandbox [mean diff.-0.24 (SD 0.83); 95%CI -0.339 to – 0.138; P < 0.001], fishing [mean diff. -0.17 (SD 0.68); 95%CI -0.253 to -0.088; P < 0.001], and animal figurines [mean diff. -0.21 (SD 0.75); 95%CI -0.3 to -0.117;P <0.001]. Improvement of child interest was found in 161 children [mean diff. 0.20 (SD 0.52); 95%CI -0.264 to -0.116; P<0.001]. Play activities with significant improvements in child interest were jigsaw puzzle, Lego blocks, origami, mini-gardening, fishing, and animal figurines.Conclusion Some mother-child play activities, but not all, significantly improve both maternal attitude and child interest toward play.

Dengue seroprevalence and force of primary infection in a representative population of urban dwelling Indonesian children

Background

Indonesia reports the second highest dengue disease burden in the world; these data are from passive surveillance reports and are likely to be significant underestimates. Age-stratified seroprevalence data are relatively unbiased indicators of past exposure and allow understanding of transmission dynamics.

Methodology/Principal Findings

To better understand dengue infection history and associated risk factors in Indonesia, a representative population-based cross-sectional dengue seroprevalence study was conducted in 1–18-year-old urban children. From October to November 2014, 3,210 children were enrolled from 30 geographically dispersed clusters. Serum samples were tested for anti-dengue IgG antibodies by indirect ELISA. A questionnaire investigated associations between dengue serologic status and household socio-demographic and behavioural factors. Overall, 3,194 samples were tested, giving an adjusted national seroprevalence in this urban population of 69.4% [95% CI: 64.4–74.3] (33.8% [95% CI: 26.4–41.2] in the 1–4-year-olds, 65.4% [95% CI: 69.1–71.7] in the 5–9-year-olds, 83.1% [95% CI: 77.1–89.0] in the 10–14-year-olds, and 89.0% [95% CI: 83.9–94.1] in the 15–18-year–olds). The median age of seroconversion estimated through a linear model was 4.8 years. Using a catalytic model and considering a constant force of infection we estimated 13.1% of children experience a primary infection per year. Through a hierarchical logistic multivariate model, the subject’s age group (1–4 vs 5–9 OR = 4.25; 1–4 vs. 10–14 OR = 12.60; and 1–4 vs 15–18 OR = 21.87; p<0.0001) and the number of cases diagnosed in the household since the subject was born (p = 0.0004) remained associated with dengue serological status.

Conclusions/Significance

This is the first dengue seroprevalence study in Indonesia that is targeting a representative sample of the urban paediatric population. This study revealed that more than 80% of children aged 10 years or over have experienced dengue infection at least once. Prospective incidence studies would likely reveal dengue burdens far in excess of reported incidence rates.

Indonesia reported to the WHO the world’s second highest average number of dengue cases and the highest in Asia from 2004 to 2010. These passive surveillance reports vary widely within the country and are likely to be a severe under-estimation of the full disease burden as frequently only dengue haemorrhagic fever is captured. Understanding the intensity of dengue virus transmission and associated risk factors nationwide is necessary to guide and prioritize appropriate prevention and control measures against dengue disease, especially considering the availability of the first dengue vaccine and recent recommendations for its use in areas of high endemicity, as measured by seroprevalence and other indicators. Age-stratified seroprevalence data provide robust estimates of past exposure and can inform on transmission intensity. Therefore, we conducted a seroprevalence study of anti-dengue IgG antibodies in a representative sample of urban-dwelling Indonesian children. We found an overall dengue seroprevalence of 69.4% with half of the children having been infected at least once by the age of 5 years. Age of the subject and the number of dengue cases diagnosed in the household were associated with serostatus. These results confirm the high dengue disease burden in Indonesia and the urgency of implementation of effective prevention and control measures.

Duration of watching TV and child language development in young children

Background Many factors contribute to language development in children. About 5-8% of children in Indonesia experience delayed language skills. Young children need appropriate stimulation for optimal development. Children who watch television (TV) for long periods of time may receive less two-way interaction, the appropriate stimulation for learning. As such, shorter duration of the appropriate stimulation may impede language development in small children.Objective To assess for an association between duration of watching TV and language development in young children.Methods This cross-sectional study was done with primary data collected from questionnaires. Subjects, aged 18 months to 3 years, were from a Jakarta-area community health center (Puskesmas) Jatinegara and the Pediatric Growth and Development Clinic, Cipto Mangunkusumo Hospital, Jakarta. Their language development was tested using the Developmental Pre-screening Questionnaire (Kuesioner Pra Skrining Perkembangan, KPSP) and the Early Language Milestone (ELM Scale 2) test.Results From a total of 84 subjects, 47 (56%) had normal and 37 (44%) had delayed language development. Duration of watching TV was categorized as <4 hours per day or >4 hours per day. Children who watched TV >4 hours/day (OR 4.4; 95%CI 1.68 to 11.7; P=0.002), and children who watched both Indonesian and English language TV programs (OR 14.7; 95%CI 1.77 to 123.0; P=0.004) had higher risk of language delay. Other variables such as sex, first age exposed to TV, use of gadgets, and TV in the bedroom had no significant associations with delayed language development.Conclusion Children who watch TV >4 hours/day had four times higher risk of developing language delay. In addition, those who watch TV programs in both Indonesian and English, also have a 14.7 higher risk of delayed language development.