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Abstract 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

Abstract Background Indonesia has high numbers of preterm birth, i.e., around 600,000 preterm births annually. It imposes a significant burden on the Indonesia’s healthcare system. Indonesia therefore requires its own evidence-based reference to manage premature neonates and ex-preterm infants who subsequently survived. No long-term study on preterm infants in Indonesia has been conducted, therefore we aim to evaluate growth and development on ex-preterm infants until the pre-pubertal stage. Methods We at the Cipto Mangunkusumo General Hospital (CMGH) designed a prospective cohort study of preterm infants, i.e., the Cohort of Indonesian Preterm Infants for Long-term Outcomes (CIPTO) study. At least 500 subjects will be recruited with an estimation of two-year recruitment (i.e., the recruitment phase will be completed before 2024). The CIPTO study will observe long-term outcomes of ex-preterm infants, primarily on growth and developmental milestones until 8 years old. Aims of this study are to determine the ex-preterm outcomes and to generate an evidence-based reference of preterm care for ensuring optimum outcomes. The pre-specified long-term outcomes in this study are survival rates, growth outcomes, neurodevelopmental outcomes, feeding behavior, as well as hearing and vision impairments. Growth and neurodevelopmental outcomes will be assessed at 0, 2, 4, 6, 9, 12, 15, 18 and 24 months of corrected age as well as at 3, 4, 5, 6, 7 and 8 years old. Discussion The CIPTO study is the first prospective cohort in Indonesia focusing on preterm infants born at the CMGH. With a follow up until 8 years old, this study may provide useful insights to generate an evidence-based, Indonesia’s health care reference in managing premature infants and ensuring the optimum outcomes of ex-preterm infants.

Background The COVID-19 pandemic necessitated the use of online schooling in order to comply with national and local lockdown guidelines. Online learning required students and teachers to adapt to a new method of schooling. The inability of adolescents to adapt to their environment can interfere with their psychosocial condition and become a risk factor for functional gastrointestinal disorders (FGID). Objective To determine the prevalence of FGID in adolescents and evaluate possible risk factors that existed during online learning. Methods This cross-sectional study was done in children aged 12-18 years who participated in online learning during the COVID-19 pandemic. The diagnosis of FGID was based on Rome IV criteria. Psychosocial problems were assessed using the Pediatric Symptom Checklist Questionnaire–17 (PSC-17) which includes internalization, externalization, and attention subscales. Subjects with a PSC-17 mixed subscale total score of >15 were considered as having an increased likelihood of having a behavioral health disorder. Data were collected by online questionnaires via Google Forms. Results Of 1,413 participants, 23% experienced FGID; of these, 32.6% had >2 FGID diagnostic criteria. Upon multivariate analysis, internalization psychosocial problems were the most common risk factors for FGID, followed by mixed subscale psychosocial problems, unstable internet connection, and not understanding of the material. ConclusionThe prevalence of FGID in adolescents in this study is 23%. Environmental and psychosocial conditions are interrelated as risk factors for FGID in adolescents during online learning in the COVID-19 pandemic.

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.

Satuan Tugas Imunisasi Ikatan Dokter Anak Indonesia (IDAI) secara berkala mengevaluasi jadwal imunisasi untuk menyesuaikan dengan vaksin baru, program imunisasi Kemenkes, WHO position paper dan sumber-sumber lain. Di dalam jadwal imunisasi rekomendasi IDAI tahun 2023 ini ada beberapa tambahan antara lain vaksin dengue baru, dan keterangan tambahan beberapa vaksin lain. Untuk memudahkan dalam melaksanakannya dilampirkan juga tabel jadwal imunisasi tahun 2023. Untuk memahami dasar pertimbangan jadwal imunisasi dan perubahannya perlu mempelajari uraian di dalam artikel ini dan keterangan di bawah tabel tersebut untuk diterapkan ke dalam layanan imunisasi.

Latar belakang. Kasus pertama pasien COVID-19 di Indonesia dilaporkan pada bulan Maret 2020. Pemerintah memberlakukan Pembatasan Sosial Berskala Besar termasuk penutupan sekolah tatap muka serta mengeluarkan protokol kesehatan untuk diterapkan oleh masyarakat. Pandemi menyebabkan perubahan besar dalam tatanan kehidupan, kebiasaan dan pola hidup remaja. Tujuan. Penelitian ini ingin melihat pengetahuan dan kepatuhan remaja terhadap implementasi protokol kesehatan pada tahun ke dua pandemi COVID-19. Metode. Penelitian ini menggunakan metode potong lintang menggunakan kuesioner yang diisi secara daring dan dilakukan pada tahun ke dua pandemi COVID-19 dari bulan April hingga Juli 2021. Subjek merupakan remaja usia 10-18 tahun di DKI Jakarta. Pemilihan sekolah dilakukan secara cluster sampling. Hasil. Sebanyak 406 responden dari 20 sekolah mengikuti penelitian. Hanya sekitar 5,42% responden yang menjawab dengan benar cara transmisi SARS-CoV-2 dan hanya 43,84% responden yang menjawab dengan tepat 6 langkah cuci tangan. Sebanyak 45,81% responden memiliki nilai total pengetahuan yang baik (nilai >7). Terdapat tren yang menunjukkan persentase remaja yang mendapatkan skor pengetahuan di atas tujuh lebih banyak pada kelompok remaja dengan nilai kepatuhan yang lebih tinggi. Kesimpulan. Pada tahun ke dua pandemi COVID-19 masih banyak remaja yang kurang pengetahuannya mengenai COVID-19 dan belum menerapkan protokol kesehatan dengan baik.

IntroductionTransitional-aged youths (17-to-24-years-old) are prone to mental-health problems. Students in higher education, especially medical students, are more exposed to stressors and thus need training to increase resilience. However, there have been limited mental-health strengthening modules specifically developed for medical students of transitional age, and none in Indonesia. This study intends to test the effectiveness of an online mental-health strengthening module in altering resilience.MethodsA pragmatic randomized trial with repeated measurements was employed to evaluate biopsychosocial outcomes of resilience. The intervention module was delivered in 4 weeks to 105 eligible students. Participants were divided into intervention group (n = 52) and control group (n = 53). Outcomes were measured in the 4th, 8th, and 12th weeks. Primary outcome was resilience level as measured by Connor-Davidson Resilience Scale (CD-RISC). Perceived Stress Scale (PSS), Depression Anxiety Stress Scale (DASS) were utilized to measure stress, depression and anxiety. Knowledge and attitude toward mental-health were also measured through validated questionnaires. Stress levels of participants were measured biologically by measuring salivary cortisol and alpha-amylase levels at the baseline and 12th-week.ResultsCompared to the control group, there were no significant difference in resilience score of the intervention group compared to control group [F(1, 103) = 2.243, P = .137]; however, there was a significant main effect of time [F(3, 309) = 18.191, P

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.

Background Malnutrition in infants remains a challenge in Indonesia. Malnutrition often arises as a result of errors in complementary feeding practices. An education module for Indonesian mothers may help them correctly implement complementary feeding practices. Objective To develop a module on correct complementary feeding practices for infants aged 6-9 months that can be read and understood by Indonesian mothers. Methods We performed qualitative research using the two-round Delphi method combined with group discussions. The first round listed the most important sub-themes of the module, while the second round sought approval for the module from experts. The Delphi team members were included using purposive and snowball sampling methods. Expert opinions were summarized and rearranged using the Steps for Coding and Theorization (SCAT) method. Results Ten experts were included in the Delphi team, with a mean duration of work experience of 28.5 (SD 12.37) years. The correct practices for giving complementary foods according to scientific evidence was named the ABC-Makanan PendampingASI/MPASI-Press (“Printed ABC of Complementary Feeding”) module and was summarized into four main topics: timely, adequate, safe, and responsive feeding. This module was made using language, photos, and images that were easily understood by mothers and included the suitable nutritional compositions to meet the needs of infants aged 6-9 months. Conclusion We developed the ABC-MPASI-Press module based on scientific evidence and experts’ reviews using the combined Delphi method. This educational guide is expected to inform mothers about correct complementary feeding practices for infants aged 6-9 months in order to prevent malnutrition.

Abstract Background Frozen embryo transfer procedure is becoming more common in assisted reproduction technology. The effect of this technology is still not yet well studied in developing countries with limited resources, including Indonesia. This study explores the clinical outcomes between frozen and fresh embryo transfer-conceived children aged 0–3 years in Indonesia. Results The participants were divided into frozen embryo (n = 30) and fresh embryo (n = 30) transfer groups. There were no differences in growth and development. However, in vitro fertilization (IVF) children with frozen embryo transfer had a lower risk of developing low birth weight compared to the fresh embryo group with an OR of 0.17 (95% CI: 0.03–0.85). All children, both in the fresh and frozen embryos, have normal development. Conclusions Frozen versus fresh embryo transfer does not affect child growth and development.

Background Visual acuity (VA) assessment is an important ocular examination to identify children with vision problems. Such early identification allows for early intervention to prevent childhood blindness. Objective To describe and compare visual acuity measurements in preschool children using two different visual acuity charts. Methods This cross-sectional study in children aged 36-60 months was done in a low-income area in the Central Jakarta District as a collaboration between Department of Ophthalmology and Department of Child Health, Universitas Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta. All children underwent visual acuity examinations using Lea symbols and Tumbling E charts. The VA results from two charts were analyzed with Bland-Altman plot for limits of agreement. Statistical analyses were performed to determine the differences between vision charts. Results A total of 113 children enrolled, but only 38 children completed the examinations. The mean age of subjects was 50.5 (SD 6.4) months. Overall, subjects’ mean VA was 0.29 (SD 0.18) for Lea symbols and 0.37 (SD 0.14) for Tumbling E. The mean difference of VA between Lea symbols and Tumbling E was 0.07 (SD 0.22) logMAR units, with upper and lower limits of agreement at 0.36 and 0.51, respectively. There was no statistical difference in VA score using Lea symbols and Tumbling-E based on gender and age. Conclusion Most preschool children in our study have normal visual acuity. Lea symbols and Tumbling E chart are comparable and can be used to efficiently measure VA in preschool children.

Background Post-chemotherapy febrile neutropenia results in high morbidity and mortality in children with malignancy. Many prognostic factors, such as microorganism patterns, as well as the use of antibiotics and antifungals can affect the outcomes. However, limited study is available in Indonesia. Objective To determine the microbial profiles, antibiotic sensitivity, and other factors that influence mortality from febrile neutropenia in pediatric malignancies with infections. Methods This retrospective cohort and descriptive study of 180 children with 252 episodes of neutropenic fever was done in Cipto Mangunkusumo Hospital, Jakarta, between 2015 and 2017. Medical history of possible predictive prognostic factors, including microorganism patterns and antibiotic sensitivity, were recorded. Prognostic factors were analyzed using multivariate logistic regression tests. Results The most common bacteria was Gram-negative (54.5%), while Candida sp. was the most common fungal infection (82.5%). Klebsiella sp. was mainly sensitive to amikacin (85.71%), while Pseudomonas aeruginosa was sensitive to ceftazidime (75%), as well as amikacin and gentamicin (100% sensitivity in combination). Staphylococcus sp. was mainly sensitive to amoxi-clav and ampi-sulbactam (76.9%). Almost all fungal groups were susceptible to fluconazole, ketoconazole, voriconazole (80-100%). Prognostic factors that increased mortality risk were central venous cannulation (RR 1.947; 95%CI 1.114 to 3.402), wasting (RR 1.176; 95%CI 1.044 to 1.325), severe wasting (RR 1.241; 95%CI 0.975 to 1.579), and hematologic malignancies (RR 0.87; 95%CI 0.788 to 0.976). Conclusion Central venous cannulation and wasting are significant prognostic factors of increased mortality in children with febrile neutropenia. Gram negative bacteria along with Candida sp. is the most common pathogen in such condition.

Background Normal-height children generally have better cognitive function than growth-stunted, short-stature children. Children’s cognitive function reportedly improves with stimulation. However, a correlation between stimulation and cognitive function in children with a history of short stature remains unclear. Objective To assess correlation between stimulation and cognitive function in normal-height vs. short-stature preschool children. Methods A cross-sectional study with consecutive sampling was performed in four sub-district areas in Jakarta. Preschool-aged children and their primary caregivers from previous studies on short stature were eligible for inclusion. An Indonesian version of a questionnaire was used to assess stimulation. A psychologist assessed verbal IQ (VIQ), performance IQ (PIQ), and full-scale IQ (FSIQ) with the Indonesian version of the Wechsler Preschool and Primary Scale of Intelligence (WPPSI). Data were analyzed using Pearson’s correlation and Chi-square tests, and P values

Abstract 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

Vaccines are one of the most successful health interventions in history. Yet, vaccine-preventable diseases still claim the lives of 2.5 million individuals globally every year. Approximately 60% of the 19.4 million infants that did not have access to routine immunization services in 2018 live in 10 countries, one of which is Indonesia. In order to reach global targets, it is critical for countries such as Indonesia to prioritize, tailor, and operationalize vaccination strategies to address immunization gaps. Pediatricians and national pediatric societies (NPS) are trusted stakeholders in their countries and are uniquely qualified to promote vaccination programs. The American Academy of Pediatrics (AAP) partnered with the Indonesian Pediatric Society (IPS), with support from the US Centers for Disease Control and Prevention (CDC), to initiate a multiyear project to build the capacity of IPS, individual members, and other child health clinicians to strategically advocate for improved immunization services across both public and private sectors.

Introduction: World Health Organization estimates the annual global incidence of typhoid fever at 11-21 million cases and approximately 128 000 to 161 000 deaths. The currently used Vi-polysaccharides (Vi-PS) vaccines have been proven to be safe and efficacious in children 2 years and above. However, poor immunogenicity of Vi-PS was observed in children below 2 years of age. This Phase II study is the continuation of the previously published Phase I study that aims to evaluate the safety and immunogenicity of a novel Vi-DT Typhoid Conjugate Vaccine (Bio Farma) in subjects 6 to

BackgroundAll sectors are affected due to COVID-19 pandemic occurring worldwide, including the education industry. School closure had been taking place for more than a year in Indonesia. Despite the controversies, Indonesian government had decided to begin school reopening.ObjectivesThis study aims to assess parental readiness for school reopening, and factors affecting parental attitude toward school reopening.MethodsA cross-sectional study using online questionnaire distributed via official Indonesian Pediatric Society (IPS) official social media account collected between March and April 2021. The questionnaire contained the general characteristics of study participants, parents' knowledge, and perspectives on COVID-19, and health protocols for school reopening.ResultsA total of 17,562 responses were collected, of which 55.7% parents were ready to send their children to school should school reopens. Factors significantly contribute to parental decision to keep their child at home were: presence of vulnerable population at home [OR = 1.18 (1.10–1.27), p < 0.001], children with comorbidities [OR = 2.56 (2.29–2.87), p < 0.001], perception of COVID-19 as a dangerous disease [OR = 28.87 (14.29–58.33), p < 0.001], experience with COVID-19 positive cases in the community [OR = 1.75 (1.61–1.90), p < 0.001], COVID-19 related death in the community [OR = 2.05 (1.90–2.21), P < 0.001], approval for adult COVID-19 vaccination [OR = 1.69 (1.53–1.87), p < 0.001], and ownership of private transportation [OR = 1.46 (1.30–1.66), p

Background and Aim: Mental health is an integral part of adolescent wellbeing. However, only few adolescents understand the importance of mental health and are aware of the right time to seek help. Lack of knowledge and stigma may impede help-seeking behavior. To assess these aspects, three questionnaires have been developed in the English language. This study aims to assess the validity and reliability of an Indonesian version of the Mental Health Literacy and Help-Seeking Behavior set of questionnaires among adolescents in Indonesia.Methods: This is a cross-sectional study that used The Mental Health Literacy and Help-Seeking Behavior set of questionnaires developed by Kutcher and Wei. The set consists of three questionnaires: the Mental Health Knowledge, Attitude Toward Mental Health, and Help-Seeking Behavior questionnaire. The study was conducted between October 2020 and January 2021 with 68 first-year medical students at the University of Indonesia, who represented adolescents in a transitional phase. The questionnaires were translated into the Indonesian language by a bilingual psychiatrist and reviewed by 10 expert psychiatrists to determine content validity [Item-Level Content Validity Index (I-CVI) and Scale-Level Content Validity Index (S-CVI)]. Cronbach's alpha values were used to assess internal consistency (reliability).Results: The content validity test produced positive results with an I-CVI scores of 0.7–1.0 and S-CVI scores of 0.87, 0.90, and 0.99 for the knowledge, attitude, and help-seeking behavior questionnaires, respectively. For the reliability test, Cronbach's alpha values were 0.780 for the attitude questionnaire and 0.852 for the help-seeking behavior questionnaire, while the value for the knowledge questionnaire was 0.521.Conclusion: The ability to properly measure mental health through the availability of accessible, valid, and understandable tools plays an important role in addressing mental health issues among adolescents. In the current study, the Indonesian translations of all three questionnaires examining knowledge, attitude, and help-seeking behavior were considered to be valid and reliable.

Background Growth and developmental delays are common among children under the age of five years (under-five children), especially in slum areas. Early detection and intervention may give better prognoses. Objective To detect growth and developmental delays and related risk factors among under-five children living in an inner-city slum area of the Indonesian capital. Methods This cross-sectional study was conducted from October to November 2018 in Tanah Tinggi, Johar Baru District, an inner-city slum area in Central Jakarta. Subjects were healthy children aged 3–60 months. Socioeconomic profile was obtained through questionnaires, anthropometric data through measurements, and developmental status through the Kuesioner Pra Skrining Perkembangan (KPSP) instrument. Development was considered to be delayed for KPSP scores

Objectives Nicotine narrows uterine blood vessels reducing the flow of oxygen and nutrients to the developing fetus. This study examined the effects of fetal exposure to secondhand smoke on neonatal anthropometry. Methods This cross sectional study recruited 128 pregnant women in the third trimester of single pregnancies who had no chronic illness, were not active or ex-smokers, and who were willing to participate in the study. Pregnant women who were exposed to secondhand smoke had umbilical cord blood nicotine concentrations of ≥ 1 ng/mL. Neonatal anthropometry was assessed according to the newborn birth weight and length. The independent t-test was used to determine the neonatal difference in mean birth weight and length between the women who were exposed to secondhand smoke, and those who were not exposed. A multiple linear regression analysis was employed to assess the effect of secondhand smoke exposure on birth weight and birth length, controlling for potential confounding variables (weight gain during pregnancy, body mass index, parity, maternal age, and maternal hemoglobin). Results There were 35 women exposed to secondhand smoke (nicotine ≥ 1 ng/mL). Neonate birth weight and birth length were lower among mothers who were exposed to secondhand smoke. However, only neonate birth weight was significantly reduced by exposure to secondhand smoke (p = 0.005). The mean birth weight of these neonates was 2,916.5 g ± 327.3 g which was 205.6 g less than in unexposed fetuses. Conclusion Exposure of mothers to secondhand smoke during pregnancy reduces fetal development and neonatal weight.

Latar belakang. Internet dan media sosial memberikan banyak kemudahan hidup, namun juga berpotensi untuk disalahgunakan, misalnya untuk perundungan-siber. Perundungan-siber memiliki efek negatif terhadap kesehatan fisik, psikologis, dan sosial pelaku maupun korbannya. Tujuan. Mengidentifikasi karakteristik perundungan-siber serta masalah emosi dan perilaku pelajar usia 12-15 tahun di Jakarta Pusat. Metode. Penelitian potong lintang dilakukan pada pelajar usia 12-15 tahun pada satu SMP di Jakarta Pusat. Perundungan-siber dinilai dengan kuesioner perundungan-siber Hinduja dan Patchin, yang telah diterjemahkan dan divalidasi dengan Cronbach’s α=0,72. Masalah emosi dan perilaku ditapis dengan menggunakan Strengths and Difficulties Questionnaire (SDQ). Hasil. Dari 274 pelajar yang berpartisipasi dalam penelitian ini, prevalens perundungan-siber adalah 48,2% (korban 11%, pelaku 14,2%, korban sekaligus pelaku 23%). Jenis perundungan-siber tersering yang dialami korban adalah tidak dihargai oleh orang lain (83,3%), disinggung-singgung oleh orang lain (80%), dan diacuhkan oleh orang lain (73,3%). Chat room di Line (60%) dan Instagram (60%), merupakan media sosial tersering yang digunakan. Teman sebaya laki-laki merupakan pelaku tersering (66,7%). Masalah hubungan dengan teman sebaya merupakan masalah emosi dan perilaku yang paling sering dialami oleh korban (10,2%), pelaku (13,5%), dan korban sekaligus pelaku (20,4%). Kesimpulan. Perundungan-siber merupakan suatu fenomena yang sering dijumpai pada pelajar usia 12-15 tahun di sebuah SMP di Jakarta Pusat. Masalah tersebut memerlukan perhatian yang lebih serius dari orangtua, guru dan tenaga kesehatan.

Background: Indonesia has a high number of COVID-19 cases and mortalities relative to not only among the Asia Pacific region but the world. Children were thought to be less affected by the virus compared to adults. Most of the public data reported combined data between adults and children. The Indonesian Pediatric Society (IPS) was involved in the COVID-19 response, especially in the area of child health. One of IPS's activities is collecting data registries from each of their chapters to provide a better understanding of COVID-19 in children.Objective: The objective of this study was to share the data of suspected and confirmed COVID-19 cases in children from IPS's COVID-19 data registry.Method: This is a retrospective study from the IPS's COVID-19 registry data. We collected the data of COVID-19 in children during March to December 2020 from each of the IPS chapters. We analyzed the prevalence, case fatality rate (CFR), age groups, diagnosis, and comorbidities of the children diagnosed with COVID-19.Result: As of December 21, 2020, there were 35,506 suspected cases of children with COVID-19. In total, there were 522 deaths, with a case fatality ratio (CFR) of 1.4. There were 37,706 confirmed cases with 175 fatalities (CFR 0.46). The highest mortality in confirmed COVID-19 cases was from children ages 10–18 years (42 out of 159 cases: 26%). The most common comorbidity and diagnosis found were malignancy (17.3%) and respiratory failure (54.5%).Conclusion: The CFR of confirmed COVID-19 cases in children in Indonesia is high and should be a major public concern.

Chronic kidney disease (CKD) is still a serious health problem in children with increasing morbidity and affecting children’s quality of life (QoL). The prevalence of children with CKD worldwide is approximately 82 cases/year/1 million children. From the Indonesian Basic Health Survey 2013, the prevalence of patients with CKD aged ≥15 years in Indonesia was 0.2%. To assess the QoL in children with CKD as well as its relationship with duration of diagnosis, severity, and related demographic factors, a cross-sectional analytic study was conducted. Individuals were recruited from July 2016 to May 2017 through consecutive sampling. CKD children aged 2–18 years who treated with conservative therapy and hemodialysis were included. Patients and their parents were asked to fill out the PedsQL™ generic score scale version 4.0 questionnaire. A total of 112 children were recruited, and QoL was assessed from parental reports (54.5%) and children’s reports (56.3%). The school and emotional aspects were the lowest score parameters studied. Factor related to QoL children with CKD were length of diagnosis >60 months (P = 0.004), female (P = 0.019), and middle school (P = 0.003). More than half of the children with CKD have disturbance of QoL in general from parental reports (54.5%) and children’s reports (56.3%). Length of diagnosis >60 months, female, and middle school education were all related to the QoL children with CKD.

Latar belakang. Manifestasi klinis yang bervariasi, patogenesis yang kompleks, dan perbedaan serotipe virus membuat sulit memprediksi perjalanan penyakit dengue. Banyak penelitian yang telah dilakukan tentang faktor prognosis terjadinya sindrom syok dengue (SSD), tetapi semuanya menggunakan pedoman World Health Organization (WHO) tahun 1997. Tujuan. Penelitian ini bertujuan mengetahui faktor-faktor prognosis terjadinya SSD berdasarkan pedoman WHO tahun 2011. Metode. Studi retrospektif menggunakan data rekam medik pasien anak usia 0 sampai

Latar belakang. Belum ada penelitian di Indonesia yang membandingkan kadar antibodi campak pada anak usia 1-4 tahun, setelah imunisasi campak 1 kali dibanding 2 kali. Tujuan. Menganalisis apakah kadar antibodi campak setelah pemberian imunisasi campak 2 kali mencapai kadar protektif dibanding imunisasi campak 1 kali. Metode. Penelitian potong lintang di 6 posyandu di 5 wilayah DKI Jakarta pada Juni - Agustus 2014. Anak yang memenuhi kriteria inklusi diperiksa kadar IgG campak, dievaluasi dan dilakukan uji korelasi untuk menilai hubungan antara imunisasi campak dosis ke-2 dengan kadar antibodi campak. Hasil. Dari 145 subjek penelitian, 125 subjek (86,2%) memiliki kadar antibodi campak mencapai kadar protektif (≥ 120 mIU/ml). Kelompok usia 3-4 tahun memiliki kadar antibodi campak yang mencapai kadar protektif terbanyak yaitu 56 subjek (91,8%) dibanding kelompok usia lainnya. Kesimpulan. Pemberian imunisasi campak 2 kali meningkatkan antibodi campak yang mencapai kadar protektif sebesar 1,2 kali dibanding pemberian imunisasi campak 1 kali.

Latar belakang. Diare masih merupakan penyebab utama kesakitan dan kematian pada balita di Indonesia. Tingkat pengetahuan, sikap, dan perilaku orangtua tentang diare dapat berpengaruh terhadap angka kejadian diare pada balita. Tujuan. Mengetahui tingkat pengetahuan, sikap, dan perilaku tentang diare, serta hubungan antar variabel tersebut. Metode. Penelitian potong lintang ini dilakukan di RSCM Kiara pada September 2015. Data diperoleh dari wawancara dengan orangtua berdasarkan kuesioner. Analisis statistik dilakukan dengan Chi-square atau uji Fischer. Hasil. Di antara 102 subyek, terdapat 101 (99%) subjek memiliki tingkat pengetahuan baik, 55 (54%) subjek memiliki sikap positif, dan 55 (54%) memiliki perilaku baik tentang diare. Tidak ada hubungan bermakna antara tingkat pengetahuan dengan perilaku (p=0,353) dan antara sikap dengan perilaku orangtua tentang diare (p=0,290). Kesimpulan. Hampir seluruh orangtua memiliki tingkat pengetahuan yang baik, dan mayoritas subyek mempunyai sikap dan perilaku yang baik tentang diare. Pengetahuan dan sikap orangtua tidak berhubungan dengan perilaku tentang diare pada anak.

Abstract 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

Background: The aim of this study was to determine the iron status and the prevalence and risk factors of iron deficiency anemia (IDA) among adolescent girls in Central Jakarta, Indonesia. Methods: A cross-sectional study was conducted among 12- to 15-year-old girls studying in junior high schools that were categorized into high and low socioeconomic status (SES). Their menstrual and nutritional status, parents’ education level and income, and iron intake were assessed. Tuberculin test and assessments for C-reactive protein levels and hematologic and iron parameters were also conducted. Results: Iron status was normal in 69.3% of 163 subjects. The prevalence of non-anemic iron deficiency was higher (17.2%; 3.1% iron depletion and 14.1% iron deficiency) than that of IDA (13.5%). The prevalence of IDA was lower among girls from the high SES than that among girls from the low SES (11.5% and 15.8%, respectively). There was no significant relationship among IDA and nutritional status, menstrual status and characteristics, SES, iron intake, and parents’ education level and income; however, bioavailable iron intake in all subjects was found to be less compared to the recommended daily allowance (RDA). Conclusions: The higher prevalence of non-anemic iron deficiency than IDA is a potential risk factor for increasing the prevalence of IDA in the future. No significant relationship was found between IDA and its risk factors; however, iron intake was less compared to the RDA in all subjects, which requires further attention.

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

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

Basic immunization coverage in Indonesia in 2013 was still low (59.2%) (IBHS, 2013). Physicians’ attitude and practice were among the determinant factors of a successful immunization program. This survey aimed to describe general practitioner’s (GP) and pediatrician’s attitude towards immunization and its coverage in private practices. This cross-sectional study was performed by distributing questionnaires consisting of 5 items on opinion and 10 items on immunization practices to 100 respondents in November 2014. Completed questionnaires were obtained from 29 GPs and 65 pediatricians. Most respondents considered that the Expanded Program in Immunization vaccine should be given. First dose of hepatitis B vaccine was mostly given in the first 12 hours after birth (90% GPs and 74% pediatricians). Oral polio vaccine was mostly given shortly before hospital discharge (65% of GPs and 81% pediatricians) while the DTwP-HB-Hib vaccine were given by 27% of GPs and 21% of pediatricians to >75% patients. Pneumococcal, rotavirus, hepatitis A, typhoid, and influenza vaccines were provided by less than 25% GPs and pediatricians, except for the influenza vaccine which was provided by 31% pediatricians. MMR vaccine was given to >75% patients by 16% of GPs and 29% of pediatricians. This pilot survey of immunization practice in private setting might be the first study in Indonesia that this can be considered as a preliminary report of immunization in private setting. Further studies need to be done, especially regarding problems in immunization in private practices. Key words: Attitude, general practitioners, immunization practice, private setting, pediatricians Gambaran Praktek Imunisasi Dokter Umum dan Dokter Spesialis Anak di Praktek Swasta Riset Kesehatan Dasar 2013 melaporkan bahwa cakupan imunisasi Indonesia masih rendah (59,2%). Sikap dan praktik imunisasi dokter merupakan salah satu faktor penentu keberhasilan. Tujuan penelitian ini mengetahui sikap dokter dan cakupan imunisasi di praktik swasta. Penelitian potong lintang dilakukan dengan menyebarkan kuesioner tentang sikap dan praktik imunisasi kepada responden, yaitu 29 dokter umum (DU) dan 65 dokter spesialis anak (DA) pada bulan November 2014. Mayoritas responden berpendapat bahwa vaksin program pengembangan imunisasi harus diberikan. Vaksin hepatitis B dosis I mayoritas diberikan dalam 12 jam setelah lahir (90% oleh DU dan 74% oleh DA). Vaksin polio oral mayoritas diberikan sebelum pulang perawatan (65% oleh DU dan 81% oleh DA), Vaksin DTwP-HB-Hib diberikan oleh 27% DU dan 21% DA kepada ≥75% pasien. Penggunaan vaksin pneumokokus, rotavirus, hepatitis A, tifoid dan influenza pada >75% pasien adalah kurang dari 25%, kecuali vaksin influenza, yaitu 31% digunakan oleh DA. Pemberian vaksin MMR pada >75% pasien dilakukan oleh 16% DU dan 29% DA. Penelitian imunisasi pada praktik swasta ini mungkin merupakan laporan yang pertama dipublikasi di Indonesia. Penelitian lebih lanjut diperlukan untuk mengetahui hambatan imunisasi di praktik swasta. Kata kunci: Cakupan imunisasi, dokter, imunisasi, praktik, spesialis

Latar belakang. Imunisasi merupakan upaya pencegahan terbaik terhadap berbagai penyakit infeksi. Vaksin difteri, tetanus, pertusis whole-cell (DTwP) dapat menimbulkan kejadian ikutan pasca imunisasi (KIPI) yang mengkhawatirkan orangtua. Vaksin difteri, tetanus, pertusis aselular (DTaP) memiliki KIPI lebih ringan, tetapi diduga kurang efektif. Tujuan. Mengetahui efektivitas vaksin DTaP dibandingkan dengan vaksin DTwP. Metode. Penelusuran literatur elektronik PubMed dan Cochrane dengan kata kunci “DTaP/acellular pertussis”, “DTwP/whole-cell pertussis”, “children”, “pertussis”, “vaccine” and “safety/efficacy/effectiveness” dalam 10 tahun terakhir (2006 – 2016). Hasil. Terdapat dua studi meta-analisis yang membandingkan efektivitas pemberian imunisasi DTwP dan DTaP serta satu studi kasus terkontrol yang membandingkan efek perlindungan jangka panjang pemberian imunisasi DTaP dengan DTwP. Efektivitas vaksin pertusis aselular berkisar 74% (IK95%, 51–86%) – 97% (IK95%, 91–99%). Efektivitas vaksin pertusis whole-cell sebesar 94% (IK95%, 88–97%; p

Ikatan Dokter Anak Indonesia melalui Satuan Tugas Imunisasi mengeluarkan rekomendasi Imunisasi IDAI tahun 2017 untuk menggantikan jadwal imunisasi sebelumnya. Jadwal imunisasi 2017 ini bertujuan menyeragamkan jadwal imunisasi rekomendasi IDAI dengan jadwal imunisasi Kementerian Kesehatan RI khususnya untuk imunisasi rutin. Jadwal imunisasi 2017 juga dibuat berdasarkan ketersediaan kombinasi vaksin DTP dengan hepatitis B seperti DTPw-HB-Hib, DTPa-HB-Hib-IPV, dan dalam situasi keterbatasan atau kelangkaan vaksin tertentu seperti vaksin DTPa atau DTPw tanpa kombinasi dengan vaksin lainnya. Hal baru yang terdapat pada jadwal 2017 antara lain: vaksin hepatitis B monovalen tidak perlu diberikan pada usia 1 bulan apabila anak akan mendapat vaksin DTP-Hib kombinasi dengan hepatitis B; bayi paling sedikit harus mendapat satu dosis vaksin IPV (inactivated polio vaccine) bersamaan (simultan) dengan OPV-3 saat pemberian DTP-3; vaksin DTPw direkomendasikan untuk diberikan pada usia 2,3 dan 4 bulan. Hal baru yang lain adalah untuk vaksin influenza dapat diberikan vaksin inaktif trivalen atau quadrivalen, vaksin MMR dapat diberikan pada usia 12 bulan apabila anak belum mendapat vaksin campak pada usia 9 bulan. Vaksin HPV apabila diberikan pada remaja usia 10-13 tahun, pemberian cukup 2 dosis dengan interval 6-12 bulan; respons antibodi setara dengan 3 dosis. Vaksin Japanese Encephalitis direkomendasikan untuk diberikan mulai usia 12 bulan pada daerah endemis atau pada turis yang akan bepergian ke daerah endemis. Vaksin dengue direkomendasikan untuk diberikan pada anak usia 9-16 tahun dengan jadwal 0, 6, dan 12 bulan. Dengan pemberian imunisasi sesuai rekomendasi, diharapkan anak-anak Indonesia terlindungi dari penyakit infeksi yang dapat dicegah dengan imunisasi.

Demam tifoid masih merupakan masalah kesehatan masyarakat. Upaya pencegahan meliputi perbaikan sanitasi lingkungan, higiene perorangan, persiapan makanan yang baik dan pemberian vaksin. Baik vaksin tifoid peroral maupun parenteral dapat mencegah gejala klinis demam tifoid. Kejadian ikutan pasca imunisasi (KIPI) vaksin antigen Vi polisakarida kapsuler pada anak Indonesia belum banyak dilaporkan. Penelitian ini bertujuan untuk mengetahui KIPI vaksin antigen Vi polisakarida kapsuler pada anak Indonesia. Metode. Penelitian deskriptif potong-lintang dilakukan pada anak Indonesia sehat umur 2-5 tahun yang mengunjungi Klinik Tumbuh Kembang Utan Kayu pada Juli 2000 atau Klinik Dokter Keluarga Kiara pada Agustus 2000. Digunakan vaksin antigen Vi polisakarida kapsuler (typhim-Vi) dalam kemasan 10 ml. Penyuntikan 0,5 ml vaksin dilakukan oleh dokter Peserta Pendidikan Spesialis Anak pada paha bagian anterolateral dengan menggunakan semprit steril sekali pakai. KIPI dimonitor dengan menggunakan formulir KIPI Departemen Kesehatan. Hasil. Dari 198 anak yang divaksinasi, KIPI yang berhasil dipantau 174 (87,9%) anak. Gejala klinis KIPI yang ditemukan adalah nyeri pada tempat suntikan (44,8%), demam > 38,5∞ C (14,4%), indurasi (9,2%), dan muntah (0,6%). Kesimpulan. KIPI vaksin antigen Vi polisakarida kapsuler penelitian ini cukup komparabel dengan penelitian lain dalam hal demam. Bengkak dan indurasi lebih tinggi dibanding penelitian lain. Hal yang mungkin berperan adalah vial multidosis yang rentan terhadap timbulnya kontaminasi.

Indonesia merupakan wilayah dengan endemis tinggi hepatitis B, maka vaksinasi hepatitis B (hep B) merupakan solusi terbaik untuk mencegah penyakit ini. Kombinasi hep B dengan DPwT (pertusis whole cell) = sel utuh dalam satu kemasan, memberikan kenyamanan pada pasien dan memudahkan pelayanan kesehatan. Di samping keuntungan ini, kejadian ikutan pasca imunisasi (KIPI) vaksin ini perlu diperhitungkan. Untuk mengetahui KIPI vaksin ini, dilakukan studi prospektif pada 74 bayi berumur 2-6 bulan di Bagian Ilmu Kesehatan Anak RSCM Jakarta antara Juli 2000 sampai dengan Maret 2001. Bayi-bayi tersebut diberi 3 dosis vaksin kombinasi DPT dan hep B (DPwT/hep B) dengan selang waktu 5 minggu. Kartu observasi harian terhadap gejala yang timbul selama 5 minggu pasca imunisasi diisi orangtua dan data dikumpulkan pada kunjungan berikutnya. Umumnya KIPI timbul kurang dalam 72 jam setelah pemberian vaksin. Frekuensi KIPI tersering adalah demam (58,8%) diikuti oleh rewel (31,7%) dan demam tinggi (16,2%). Kejang umum timbul pada 1 kasus setelah pemberian dosis pertama dan pada 1 kasus lain kejang disertai demam tinggi. Setelah pemberian dosis ketiga pada kedua kasus tersebut, pasien mendapat antipiretik dan kejang berhenti tanpa pengobatan anti kejang. Tidak ditemukan KIPI pada vaksin DPwT/hep B yang memerlukan perawatan di rumah sakit. KIPI yang didapatkan umumnya bersifat ringan sampai sedang.

Latar belakang. Penanganan nyeri pada bayi baru lahir masih belum menjadi perhatian. Larutan manis dapat digunakan untuk mengurangi nyeri. Premature infant pain profile (PIPP) merupakan salah satu skala nyeri yang telah divalidasi. Tujuan Penelitian. Mengetahui efek pemberian 0,5 mL larutan glukosa 30% per oral 2 menit sebelum tindakan terhadap skala PIPP saat pengambilan darah tumit bayi baru lahir. Metode. Penelitian ini merupakan uji klinis acak tersamar ganda pada bayi baru lahir bugar yang perlu pengambilan sampel darah melalui tumit di RSCM. Skala PIPP dilakukan oleh dua penilai secara tersamar berdasarkan rekaman video. Hasil. Tujuh puluh tiga bayi terbagi dalam kelompok intervensi (n=37) dan kontrol (n=35). Rerata nilai skala PIPP kelompok intervensi lebih rendah dibanding kelompok kontrol oleh kedua penilai, yaitu berturut-turut (4,5 ± 3,1) dan (6,3 ± 4) dibanding (6 ± 3,1) dan (8,4 ± 4,5) (p < 0,05). Koefisien Kappa antar dua penilai ialah 0,726. Kesimpulan. Pemberian 0,5 mL larutan glukosa 30% per oral 2 menit sebelum pengambilan darah melalui tumit bayi baru lahir dapat mengurangi nyeri.

Latar belakang. Diabetes melitus tipe-1 (DM tipe-1) merupakan penyakit kronis yang dapat mempengaruhi emosi dan perilaku anak dan remaja. Pasien mengalami tekanan yang berhubungan dengan bagaimana mengontrol metabolik dan tumbuh kembang yang sedang berlangsung. Tujuan. Mengetahui gangguan perilaku pasien DM tipe-1 dan faktor-faktor yang berhubungan dengan gangguan perilaku. Metode. Penelitian dilakukan secara potong lintang pada bulan Agustus 2006 di poliklinik Endokrinologi Departemen IKA FKUI RSCM. Subjek penelitian adalah pasien DM tipe-1 umur 4-18 tahun yang diambil secara purposive sampling. Sumber data diperoleh dari orangtua/ wali responden dengan wawancara terpimpin, menggunakan Pediatric Symptom Check List-17 (PSC-17) dan Kuesioner Masalah Mental Emosional (KMME). Hasil. Prevalensi gangguan perilaku pasien DM tipe-1 dijumpai kemungkinan gangguan psikososial 45,8%, paling banyak adalah gangguan internalisasi (33,3%). Kemungkinan gangguan mental emosional 41,7%. Lama sakit lebih dari 5 tahun dan pernah mengalami komplikasi memiliki risiko lebih besar mengalami gangguan mental emosional. Kesimpulan. Kemungkinan gangguan perilaku pada diabetes tipe-1 45,8%. Skrining gangguan perilaku pada pasien DM tipe-1 perlu dilakukan secara rutin di pusat pelayanan kesehatan sehingga dapat segera dievaluasi lebih lanjut.

Latar belakang. Salah satu penyebab keterlambatan bicara adalah gangguan pendengaran. Brain evoked response audiometry (BERA) memiliki sensitivitas dan spesifisitas yang tinggi dalam mendeteksi gangguan pendengaran, namun alat dan biaya pemeriksaan cukup mahal, dan tidak tersedia di pusat pelayanan kesehatan primer di daerah terpencil. The early language milestone scale (ELMS) diharapkan mempunyai sensitivitas dan spesifisitas yang baik sebagai uji tapis keterlambatan bicara yang disebabkan oleh gangguan pendengaran, karena mengandung unsur auditory receptive dan auditory expressive. Tujuan. Membandingkan sensitivitas, spesifisitas, nilai duga positif (NDP), nilai duga negatif (NDN), rasio kemungkinan positif (RKP), dan rasio kemungkinan negatif (RKN) ELMS dalam mendeteksi gangguan pendengaran dengan baku emas BERA. Metode. Penelitian uji diagnostik ELMS dengan baku emas BERA di Departemen IKA dan Pusat Kesehatan Telinga dan Gangguan Komunikasi (PKTGK) Departemen THT FKUI-RSCM. Pengambilan sampel secara konsekutif dari bulan Februari sampai Agustus 2006, terkumpul 42 subjek dengan usia 12 sampai 47 bulan. Hasil. Sensitivitas 93% (IK95%:92 sampai 94), spesifisitas 15% (IK95%:5 sampai 26), NDP 71% (IK95%:57 sampai 85), dan NDN 50% (IK95%:35 sampai 65). Hasil RKP 1 dan RKN 0,5. Kesimpulan. Mengingat spesifisitas yang rendah, ELMS tidak dapat digunakan sebagai uji tapis keterlambatan bicara yang diduga disebabkan gangguan pendengaran sensorineural.

Latar belakang. Pijat bayi dengan atau tanpa minyak telah menjadi bagian dari budaya masyarakat di sebagian besar belahan dunia, termasuk di Indonesia. Namun, manfaat pijat secara tersendiri dan manfaat penggunaan minyak pijat terhadap optimalisasi pertumbuhan neonatus masih menjadi perdebatan. Tujuan. Menilai pengaruh pijat bayi dan penggunaan minyak pijat yang berbeda, yaitu minyak mineral atau minyak kelapa, terhadap kecepatan kenaikan berat badan neonatus aterm. Metode. Studi eksperimental tidak tersamar dilakukan di sebuah Rumah Sakit Bersalin di Jakarta selama 2 bulan dimulai Juli 2006. Neonatus aterm dengan berat lahir 2500-4000 g dialokasikan dalam 1 kelompok pembanding dan 3 kelompok perlakuan pijat. Pemantauan berat badan dilakukan pada hari ketujuh pemijatan. Hasil. Dibandingkan kelompok pembanding, rerata kecepatan kenaikan berat badan lebih tinggi secara bermakna pada setiap kelompok perlakuan pijat kecuali kelompok pijat tanpa minyak. Rerata kecepatan kenaikan berat badan kelompok yang dipijat dengan minyak lebih tinggi dibandingkan rerata kecepatan kenaikan berat badan kelompok yang dipijat tanpa minyak (p

Terapi sensori integrasi, sebagai bentuk terapi okupasi, mulai populer diberikan untuk tata laksana anak dengan berbagai gangguan perkembangan, belajar, maupun perilaku. Namun dasar teori, bentuk gangguan pemrosesan sensori, dan efektivitas terapi umumnya belum diketahui secara luas di kalangan dokter spesialis anak. Bukti sahih tentang manfaat terapi sensori integrasi untuk tata laksana anak dengan gangguan spesifik memungkinkan aplikasi dan pemberian edukasi pada keluarga pasien secara lebih optimal.

Latar belakang. Gangguan tidur adalah kondisi yang ditandai dengan gangguan jumlah, kualitas, atau waktu tidur. Dampak gangguan tidur adalah gangguan belajar, memori, mood, perilaku, dan atensi. Tujuan. Mengetahui prevalensi, gambaran gangguan tidur, pengaruh intervensi sleep hygiene pada keluhan mengantuk, mood, kesulitan bangun, durasi tidur, nilai SDSC dan PDSS. Metode. Penelitian quasi eksperimental di SDN di Jakarta Pusat pada bulan Mei-Juni 2015. Skrining dan evaluasi pasca intervensi sleep hygiene selama 8 minggu menggunakan sleep disturbance scale for children (SDSC) dan pediatric daytime sleepiness scale (PDSS). Hasil. Prevalensi gangguan tidur 25,1%, terdiri atas disorder of initiating and maintaining sleep (DIMS) 61,5%, sleep wake transition disorder (SWTD) 61,5%, disorder of excessive somnolence (DOES) 55,4%, dan disorder of arousal (DA) 51,5%. Setelah intervensi dilaporkan perbaikan mengantuk, mood, kesulitan bangun pagi, nilai SDSC pre dan pasca intervensi (p

Latar belakang. Terapi yang adekuat pada hiperplasia adrenal kongenital (HAK) diharapkan dapat menghasilkan perkembangan pubertas dan pertumbuhan linear yang optimal. Saat ini, di Indonesia, belum ada data profil pubertas dan pertumbuhan linear penderita HAK yang sedang menjalani terapi. Tujuan. Mengetahui profil pubertas dan pertumbuhan linear pada HAK di Indonesia yang sedang menjalani terapi. Metode. Studi serial kasus terhadap 14 kasus HAK yang memasuki masa pubertas di Departemen Ilmu Kesehatan Anak Rumah Sakit Cipto Mangunkusumo Jakarta selama bulan November 2012 hingga April 2013. Pencatatan data berisi anamnesis, pemeriksaan fisis, pemeriksaan laboratorium, dan radiologi bone age. Hasil. Hasil penelitian ini merupakan riset pendahuluan (preliminary research) terhadap 14 kasus HAK. Mayoritas subjek adalah perempuan, berusia di atas 8 tahun, HAK tipe Salt-Wasting (SW), dan terdiagnosis sejak kurang dari satu tahun. Tujuh dari 14 subjek mengalami obesitas. Undertreatment terjadi pada 11/14 subjek memiliki bone age accelerated dengan perhitungan tinggi badan dewasa yang pendek. Tiga belas subjek sudah pubertas dan 10/14 subjek mengalami pubertas prekoks. Rekomendasi dosis glukokortikoid yang diberikan (median 18,12 mg/m2/hari) dengan median durasi terapi 8,1 tahun. Kontrol metabolik dengan menggunakan parameter 17-OHP bervariasi pada rentang 0,2-876 nmol/L (rerata 166,9 nmol/L). Kesimpulan. Sebagian besar subjek mendapatkan undertreatment sehingga memiliki bone age accelerated dengan estimasi tinggi badan dewasa pendek. Pubertas prekoks dialami oleh sebagian besar subjek. Pemberian glukokortikoid dengan dosis yang direkomendasikan. Ditemukan ketidakteraturan pengobatan dan pemantauan yang buruk.

Background Hepatitis B is one of the most common infectious diseases worldv.ide. Indonesia has moderate-high endemicity for hepatitis B infection. Perinatal transmission increases the risk for chronic hepatitis B. Infants from HBsAg-positive mothers should receive hepatitis B immunoglobulin (HBIG) and vaccination within 12 hours of birth, but this practice is not routinely done in Indonesia due to financial constraints. Objectives To detennine the influence of Hep-B immunization on preventing Hepatitis B vertical transmission. Methods A descriptive cohort study was conducted from May 2009 - January 2010. Subjects were term infants born from HBsAg-positive mothers v.ith no history of HBIG administration. They had received complete hepatitis B immunization and 1 month after the last dose were evaluated for HBsAg and anti-HBs. Cord blood was also taken during labor to measure HBsAg. Results There were 22 infants born from HBsAg-positive mother who met the inclusion criteria. HBsAgwas positive in 6 of22 cord blood specimens. There were 15 infants who completed this study. One of 15 infants had positive HBsAg after completed hepatitis B immunization and 12 of 15 infants had protective level of anti-HBs. Effectiveness of hepatitis B immunization to prevent vertical transmission in this study was 70-90%. Conclusion Hepatitis B immunization can prevent vertical transmission of hepatitis B in infants born to mothers who are HBsAg-positive even without administration of HBIG.

Background Hearing disorder may cause speech delay so that every child with speech delay should undergo hearing test. The gold standard for audiometric test is otoacustic emission (OAE) and brainstem evoked response audiometry (BERA). They have high sensitivity and specificity, but the availability is limited and expensive. Hence, both tests are not available at the primary health care centers. In 1997, the Department of Health, Republic of Indo- nesia, established a simple subjective test instrument, i.e. the hear- ing capability test (HCT). Objective To asses the accuracy of HCT compared to the gold standard hearing tests (OAE and/or BERA). Methods This study was a cross sectional study on 89 children aged less than 5 years who had speech delay and came to the Growth and Development Outpatient Clinic or the General Outpa- tient Clinic, Pediatric Neurology Clinic of the Department of Child Health, Cipto Mangunkusumo (CM) Hospital; and Center for Ear Care and Communicative Disorders (CECCD), Department of ENT, CM Hospital, during March to August 2005. Results HCT sensitivity and specificity were 92.9% and 27.7%, respectively. Positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likehood ratio (NLR) were 84%, 50%, 1.9, and 0.7, respectively. Conclusion The sensitivity and specificity of HCT as a screening test of hearing disorder in children with speech delay were 93% and 28%, respectively. Based on this result, HCT should only be used as screening test and not as a diagnostic test

Background Data in Indonesia show that adolescents still have the highest rate for rape and other sexual assaults among age group. There are gender differences in adolescent rape and sexual assault, with female victims exceeding males with a ratio of 3:1. Sexual assault and rape can affect numerous children and often lead to short-term and long-term consequences. Objectives To determine the characteristics and short-term im- pacts of adolescent rape. Methods A cross-sectional study was conducted on 31 adoles- cents who had been raped 1-9 months previously. Subjects and parents were assessed using Child Behavior Checklist, Draw a Person, House Tree Person, and Raven’s Progressive Matrices to determine psychological problems. History and physical examina- tion findings at the time of rape were reviewed. Results Thirty out of 31 female adolescents were 13-18 years old. Almost half of them came from low income families and large fam- ilies, two-thirds of all subjects were living with their parents. Nine- teen of 31 perpetrators were friends or acquaintances, only 4 were relatives. Tears of hymen were found in 21 subjects and only 8 of them had non-genital injuries. Nine of 31 subjects had a high aver- age range in non-verbal processing. Most subjects had a great tendency to feel insecure, anxiety, depression, and had interper- sonal relationship problems. Regression and aggressiveness were found in almost half of the subjects. All subjects felt that their mothers were protective and half of them had dominant fathers. Conclusion Almost half of the adolescent victims come from low- economic status and large families, most of the assailants were friends or acquaintances. Adolescent rape victims have ongoing behaviour problems. The most common problems are anxiety, depression, and relationship problems

IntroductionThere 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.MethodsAn 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.ResultOne 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.ConclusionThe 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.

[This corrects the article DOI: 10.1371/journal.pntd.0005621.].

Background Long-term anticonvulsant therapy, especially with enzyme inducers, has been associated with low 25-hydroxyvitamin D [25(OH)D] levels and high prevalence of vitamin D deficiency. However, there have been inconsistent results in studies on the effect of long-term, non-enzyme inducer anticonvulsant use on vitamin D levels. Objective To compare 25(OH)D levels in epileptic children on long-term anticonvulsant therapy and non-epileptic children. We also assessed for factors potentially associated with vitamin D deficiency/insufficiency in epileptic children. Methods This cross-sectional study was conducted at two pediatric neurology outpatient clinics in Jakarta, from March to June 2013. Subjects in the case group were epileptic children, aged 6-11 years who had used valproic acid, carbamazepine, phenobarbital, phenytoin, or oxcarbazepine, as a single or combination therapy, for at least 1 year. Control subjects were non-epileptic, had not consumed anticonvulsants, and were matched for age and gender to the case group. All subjects’ 25(OH)D levels were measured by enzyme immunoassay. Results There were 31 epileptic children and 31 non-epileptic control children. Their mean age was 9.1 (SD 1.8) years. Most subjects in the case group were treated with valproic acid (25/31), administered as a monotherapy (21/31). The mean duration of anticonvulsant consumption was 41.9 (SD 20) months. The mean 25(OH)D level of the epileptic group was 41.1 (SD 16) ng/mL, lower than the control group with a mean difference of 9.7 (95%CI 1.6 to 17.9) ng/mL. No vitamin D deficiency was found in this study. The prevalence of vitamin D insufficiency in the epileptic group was higher than in the control group (12/31 vs. 4/31; P=0.020). No identified risk factors were associated with low 25(OH)D levels in epileptic children. Conclusion Vitamin D levels in epileptic children with long-term anticonvulsant therapy are lower than that of non-epileptic children, but none had vitamin D deficiency.