Search

Background: Breast milk is the first, main, and best natural food for babies. Breast milk contains various nutrients needed in the process of growth and development of babies. Breastfeeding is a health behavior carried out by mothers. This study aimed to analyze the factors that influence the provision of breast milk substitutes. Methods: This was a quantitative study, using a cross-sectional design. Data collection was carried out from July to August 2022 on 71 mothers who had babies aged up to 6 months at the Bandar Baru Public Health Center, Pidie Jaya, Aceh, Indonesia. Consecutive sampling technique was used. The variables studied included behavior intentions, social support, accessibility of information, personal autonomy, and situational action. Chi-square was used to assess the relationship between independent variables and the dependent variables. Results: Most mothers were aged 20–35 years (70.4%), had junior high school education (78.9%), were unemployed (76.1%), and most did not provide breast milk substitutes (70.4%). Mothers who provided breast milk substitutes was significantly associated with the mother’s intention to give breast milk (p=0.002) and environmental conditions/situations for action (p=0.001). Mothers with low intentions tended to substitute breastmilk (53.8%). Furthermore, the situation of action influenced mothers to provide breast milk substitutes (48.6%). Conclusion: Factors that influence mothers to provide breast milk substitutes are low intention and environmental conditions/situations to act. Therefore, education for mothers to give exclusive breast milk is encouraged.

Adolescents are vulnerable to Coronavirus disease 2019 (COVID-19) infections; thus, their antibodies should be maintained above the protective value. This study aimed to evaluate the immune response and safety to the SARS-CoV-2 protein subunit recombinant vaccine (IndoVac®) as a heterologous booster dose against COVID-19 in Indonesian adolescents. This open-label prospective intervention study enrolled 150 clinically healthy adolescents aged 12–17 years who had received complete primary doses of the CoronaVac® vaccine from Garuda Primary Care Centres in Bandung City. The result of immunogenicity was presented with a 95% confidence interval (CI) and analyzed with t-tests from 14 days and 3, 6, and 12 months. The neutralizing antibody geometric mean titers (GMTs) (IU/mL) at baseline and 14 days after booster dose were 303.26 and 2661.2, respectively. The geometric mean fold rises (GMFR) at 3, 6, and 12 months after booster dose were 6.67 (5.217–8.536), 3.87 (3.068–4.886), and 2.87 (2.232–3.685), respectively. Both the neutralizing antibody and IgG antibody were markedly higher in the adolescents than in the adults at every timepoint. The incidence rate of adverse effects (AEs) until 28 days after booster dose was 82.7%, with a higher number of local events reported. Most reported solicited AEs were local pain followed by myalgia with mild intensity. Unsolicited AEs varied with each of the incidence rates < 10%, mostly with mild intensity. Adverse events of special interest (AESI) were not observed. At the 12-month follow-up after the booster dose, four serious adverse events (SAEs) not related to investigational products and research procedures were noted. This study showed that IndoVac® has a favorable immunogenicity and safety profile as a booster in adolescents and that the antibody titer decreases over time.

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.

According to the WHO target product profile for COVID-19 vaccines, the vaccine in development should be indicated for active immunisation in all populations. Therefore, PT Bio Farma developed a candidate vaccine in a subunit protein recombinant platform to help overcome the issue. This trial was an observer-blind, randomised, prospective intervention study. This study targeted individuals who had received complete primary doses of the authorised/approved COVID-19 vaccine. The groups were divided into the primary inactivated vaccine (CoronaVac®) group, the primary viral vector vaccine (ChAdOx1) group, and the primary mRNA vaccine (BNT162b2) group that received the recombinant protein (IndoVac®). The groups were compared with the control and primary mRNA vaccine (BNT162b2). The participants enrolled in the study were from two primary care centres in Bandung City and three primary care centres in Denpasar City. A total of 696 participants were enrolled from 1 September to 31 October 2022. The demographic characteristics of the all-vaccine group showed a uniform distribution. The results showed that, compared with the control, the investigational product had inferior effectiveness 14 days after the booster dose was administered. However, 28 days after the booster dose, the investigational product exhibited non-inferior effectiveness compared with the primary groups that received CoronaVac® (GMR 0.76 (0.57–0.99)) and ChAdOx1 (GMR 0.72 (0.56–59.93)), but the BNT162b2 group (GMR 0.61 (0.39–0.94)) was inferior to the control. At 12 months follow-up after the booster dose, three serious adverse events (SAEs) were reported in three participants, with causality not correlated with the investigated products. Neither AEs of special interest nor severe COVID-19 cases were reported throughout the follow-up period; thus, the IndoVac® vaccine as a booster was immunogenic and safe. Until the 6-month follow-up after the booster dose, the IndoVac® vaccine was well tolerated and all reported AEs resolved. This vaccine is registered and can be included in the immunisation programme.

Background: In order to fulfil the requirements of the national immunization program and sustain the production capacity of the monovalent Hepatitis B vaccine, this study aimed to assess the safety and immunogenicity of the recombinant Hepatitis B Vaccine (Bio Farma) using the new Hepatitis B bulk. Methods: This study was an experimental, randomized, double-blinded, and controlled Phase I clinical trial, with 100 healthy subjects divided into 50 adults and 50 adolescents. Subjects were randomly assigned to receive either the Bio Farma registered Recombinant Hepatitis B Vaccine (group A) or a new source of Hepatitis B bulk (group B). Subjects received one or three doses of vaccine, depending on the baseline anti-Hbs titer. Subjects were given diary cards to record solicited and unsolicited adverse events for 28 days following vaccination. Vaccine immunogenicity was assessed by measuring the level of HBsAg antibody titer elevation. Results: No serious adverse events were reported during clinical trials. The frequencies of adverse events were not significantly different between the two vaccine-randomized groups. The most immediately observed local reaction was local pain, reported by 35.7–42.8% of adults and 24.0–26.3% of adolescents, without any systemic reactions. Seroconversion in adults in group B reached 100% and 78.5% in group A, meanwhile in adolescent subjects in both groups it reached 100%. A substantial increase in geometric mean titer (GMT) was observed in the majority of subjects after immunization. Conclusion: Recombinant Hepatitis B Vaccine with a new source of HBsAg B bulk is safe, well tolerated, and highly immunogenic.

One of the newest strategies developed by the Global Influenza Strategy has been to broaden the composition of the current influenza vaccine formulations from trivalent products to quadrivalent products. This study aimed to assess the immunogenicity and safety of Quadrivalent Influenza HA vaccine (QIV) compared with Trivalent Influenza HA vaccine (TIV) and to evaluate three consecutive batches of QIV equivalence in Indonesian children and adults. This was an experimental, randomized, double blind, four arm parallel group bridging study involving unprimed healthy children and adults aged 9–40 years. A total of 540 subjects were enrolled in this study and randomized into four arm groups. Each subject received one dose of TIV or QIV with three different batch codes. Serology tests were performed at baseline and 28 days after vaccination. Hemagglutination inhibition (HI) antibody titers were analyzed for Geometric Mean Titer (GMT), seroprotection, and seroconversion rates. Solicited, unsolicited, and serious adverse events were observed up to 28 days after vaccination. A total of 537 subjects completed the study per protocol and were analyzed for immunogenicity criteria. All randomized subjects were analyzed for safety criteria. The percentage of the subjects with anti-HI titer ≥1:40 28 days after QIV vaccination was 99.5% for A/H1N1; 99.5% for A/H3N2; 93.1% for B/Texas, and 99.0% for B/Phuket. The seroprotection, GMT, and seroconversion rates of QIV were not significantly different from those of TIV for the common vaccine strains (p > 0.01) and were significantly different from those of TIV for the added B/Phuket strains (p < 0.01). Most solicited injection-site and systemic reactions with either vaccine were mild to moderate and resolved within a few days. Antibody response to QIV were equivalence among vaccine batches and comparable between age groups for each of the 4 strains. QIV was immunogenic and well-tolerated and had immunogenicity and safety profiles compared with TIV for all common strains. The immunogenicity of the three batches of QIV was equivalent for the four strains. Trial registration. Clinical Trial registration: NCT03336593.

Aim To investigate the influence of zinc supplementation on pregnant women for the prevention of stunting through an analysis of maternal serum zinc, cord blood osteocalcin and neonatal birth length. Methods This study was conducted with pre-test/post-test control groups and double-blind randomization. Patients were pregnant mothers in second or third trimester and with their newborns who met the inclusion criteria. A total of 71 pregnant mothers and their newborns completed this study. They were divided into two groups of 35 and 36 patients, the supplementation (20 mg/day) and placebo groups, respectively for 12 weeks. The parameters assessed were maternal serum zinc levels, cord blood osteocalcin and birth length measurements. Results The mean maternal serum zinc level was 54.6±8.7 µg/dL from 71 patients. The mean maternal serum zinc levels after zinc supplementation were significantly higher than those of the placebo group: 55.1±9.9 to 59.1±8.6) μg/dL (p=0.017) and 54.2±7.5 to 50±8.6 μg/dL (p=0.001), respectively. The comparison of mean cord blood osteocalcin levels and median neonatal birth lengths in the supplementation group was higher than in the placebo group: 131.8±35.3 vs 90.6±35.4 ng/ml (p=0.001) and 49.3 (46.5-51.3) vs 48.3 (46-50.8) cm (p=0.004), respectively. Maternal serum zinc levels after zinc supplementation had a positive significant correlation with cord blood osteocalcin and neonatal birth length: r=0.434 (p=0.001) and r=0.597 (p=0.001), respectively. Conclusion There was a significant correlation of maternal serum zinc with cord blood osteocalcin and neonatal birth length after zinc supplementation.

Ikatan Dokter Anak Indonesia secara periodik mengkaji rekomendasi jadwal imunisasi untuk menyesuaikan dengan berbagai perkembangan yang terkait dengan jadwal imunisasi di Indonesia. Jadwal imunisasi 2020 ini bertujuan agar dapat digunakan oleh anggota IDAI dalam memenuhi keinginan masyarakat mendapatkan vaksin yang lebih lengkap. Perubahan pada rekomendasi tahun 2020 adalah pada imunisasi Hepatitis B, IPV, BCG, DTP, Hib, Campak /MR/MMR, JE, Varicella, Hepatitis A dan Dengue. Jadwal imunisasi lain tidak ada perubahan. Untuk memudahkan dalam melaksanakannya dilampirkan juga tabel jadwal imunisasi tahun 2020. Untuk memahami dasar pertimbangan jadwal imunisasi dan perubahannya perlu mempelajari uraian di dalam artikel ini dan keterangan dibawah tabel tersebut untuk diterapkan ke dalam layanan imunisasi.

Latar belakang. Serebral palsi (CP) merupakan penyebab disabilitas kronik tersering pada anak. Anak CP mengalami pertumbuhan kurang baik, seiring dengan bertambah beratnya derajat fungsi motorik kasar. Tebal lipat kulit (TLK) dan lingkar lengan atas (LLA) merupakan parameter antropometri yang dapat digunakan untuk menilai status gizi anak CP tipe spastik. Tujuan. Menganalisis hubungan derajat fungsi motorik kasar dengan status gizi pada anak CP tipe spastik Metode. Penelitian dengan rancang potong lintang. Subjek adalah anak usia 1-18 tahun telah terdiagnosis CP tipe spastik, kontrol ke klinik neuropediatri, ilmu kedokteran fisik dan rehabilitasi (IKFR) RS.Hasan Sadikin Bandung dan klinik sekolah luar biasa Yayasan Pendidikan Anak Cacat (YPAC) Bandung, dipilih secara consecutive sampling pada Mei-Juni 2019. Dilakukan pemeriksaan derajat fungsi motorik kasar menggunakan gross motor function classification system (GMFCS), pengukuran LLA dan TLK triseps. Uji statistik menggunakan Uji chi–kuadrat, dengan nilai kemaknaan p

Abstract Background Bleeding as an adverse event following immunization (AEFI) that is rarely reported in children, although it can be a parental concern. Bleeding episodes ranging in severity from mild to severe and defined as any external and/or internal bleeding can be caused by acquired or hereditary disorders. This study analyzes whether bleeding episodes in children that were recorded as AEFIs are causally associated with immunization and elaborates their etiology. Methods A cross-sectional study of 388 AEFI cases in children from West Java Provincial Committee in Indonesia confirmed by case findings from 2000 until 2017. Results Of the total number of cases studied, 55 (14%) involved children aged 5 days to 12 years who presented with bleeding and were referred to a provincial hospital. Analysis revealed that 32 cases were most likely caused by acquired prothrombin complex deficiency (APCD) and 30 of these APCD cases were strongly suspected to be manifestations of vitamin K deficiency bleeding (VKDB). All VKDB subjects were aged 5 days to 3 months without a history of administration of prophylactic vitamin K. When a World Health Organization classification was used, most bleeding cases in this study became coincidental events with a temporal association with immunization. A causality assessment suggested that these cases were causally unrelated. Conclusion Most cases of bleeding reported as an AEFI were found to be VKDB, which is considered a coincidental event following immunization with a temporal association, and an unrelated category based on the results of a causality assessment. Vitamin K should be administered to all newborns as a prophylactic and AEFI surveillance should be improved based on the low numbers of AEFI reported in Indonesia.

Satisfying the needs of the national immunization program requires maintaining diphtheria–tetanus–pertussis (DTP)–hepatitis B (HB)–Haemophilus influenza B (Hib) production. Therefore, new hepatitis B sources are needed. This study aimed to evaluate the immunogenicity of the DTP–HB–Hib vaccine (Bio Farma) that used a different source of hepatitis B. A prospective randomized, double-blind, bridging study was conducted. Subjects were divided into two groups with different batch numbers. Healthy infants 6–11 weeks of age at enrollment were immunized with three doses of the DTP–HB–Hib vaccine after a birth dose of hepatitis B vaccine. Blood samples were obtained prior to vaccination and 28 days after the third dose. Adverse events were recorded until 28 days after each dose. Of the 220 subjects, 205 (93.2%) completed the study protocol. The proportion of infants with anti-diphtheria and anti-tetanus titers ≥ 0.01 IU/mL was 100%, with anti-HBsAg titers ≥ 10 mIU/mL was 100%, and with Polyribosylribitol Phosphate-Tetanus Conjugate (PRP-TT) titers > 0.15 µg/mL was 96.1%. The pertussis response rate was 84.9%. No serious adverse events related to the study vaccine occurred. The three-dose DTP–HB–Hib vaccine (Bio Farma) is immunogenic, well tolerated, and suitable to replace licensed-equivalent vaccines.

Drinking water refilling stations (DWRS) are a growing business, providing affordable drinking water for middle–low urban households in developing countries in the last two decades. However, quality control including water quality and compliance with regulations, is not fulfilled completely by all DWRS. This study aimed to assess water quality and risk of recontamination of DWRS and compliance with administrative–laboratory testing regulations and factors associated with it. A cross-sectional study was conducted from March-August 2017 in Bandung City, and 229 of 659 DWRS were selected randomly. The water quality and risk of recontamination from refill gallons and outlet taps were examined using cotton swab and membrane filter methods to identify total coliforms/Escherichia coli. Compliance with administrative–laboratory testing regulations was identified based on the regulations of the Ministry of Health. Results found that water quality was unsuitable in 37.6% of drinking water and 34.1% of raw water. The risk of recontamination was found in 40% of refill gallons and 25.3% of outlet taps. Only 10.5% of DWRS complied with administrative–laboratory requirements. Factors associated with compliance were certified training and good management. An integrated system to manage and control the quality of DWRS is needed to prevent the consumption of nonstandardized drinking water.

Latar belakang. Talasemia beta mayor merupakan penyakit genetik dengan gangguan sintesis rantai globin yang menimbulkan eritopoiesis tidak efektif sehingga membutuhkan transfusi darah rutin. Terapi tersebut menyebabkan kelebihan besi di berbagai organ termasuk di hati dan pankreas yang memengaruhi enzim hepatik lipase yang mengatur regulasi metabolisme lipid. Tujuan. Mengetahui korelasi kadar feritin dengan profil lipid pada penyandang talasemia beta mayor anak. Metode. Penelitian observasional analitik dengan rancang potong lintang, dilaksanakan November - Desember 2018. Subjek adalah penyandang talasemia beta mayor di Rumah Sakit Hasan Sadikin, secara consecutive sampling. Dilakukan pemeriksaan serum feritin, trigliserida, kolesterol total, low density lipoprotein (LDL), dan high density lipoprotein (HDL). Uji statistik menggunakan uji korelasi rank Spearman dengan kemaknaan nilai p0,05). Terdapat korelasi antara kadar feritin terhadap kadar serum kolesterol HDL dan trigliserida (r= -0,349, p=0,029 dan r= 0,460, p=0,003). Kesimpulan. Terdapat korelasi negatif antara kadar feritin terhadap kolesterol HDL dan korelasi positif terhadap trigliserida. Semakin tinggi feritin, semakin rendah HDL, semakin tinggi trigliserida.

Objectives: Nasopharyngeal carriage of Streptococcus pneumoniae underpins disease development and transmission. This study was performed to examine pneumococcal carriage dynamics, including density and multiple serotype carriage, in Indonesian infants during the first year of life. Methods: Two hundred healthy infants were enrolled at 2 months of age. Eight nasopharyngeal swabs were collected from enrolment until 12 months of age. Pneumococci were detected using quantitative PCR and serotyped by microarray. Regression models assessed factors influencing pneumococcal carriage and density. Results: Eighty-five percent of infants carried pneumococci at least once during the study. The median age at first acquisition was 129 days (interquartile range 41–216 days). The median duration of carriage was longer for the first pneumococcal acquisition compared with subsequent acquisitions (151 days vs. 95 days, p

Latar belakang. Sakit perut berulang (SPB) merupakan keluhan yang paling sering pada anak. Infeksi Helicobacter pylori (H. pylori) saat ini merupakan salah satu penyebab organik terbanyak pada anak SPB. Infeksi H. pylori dapat menyebabkan malnutrisi dan perawakan pendek, tetapi hal ini masih kontroversial. Tujuan. Mengetahui perbedaan status gizi dan perawakan pendek antara anak SPB dengan infeksi H. pylori positif dan negatif. Metode Penelitian potong lintang analitik dilakukan pada anak SMP dan SMA di Bandung yang mengalami SPB. Infeksi H. pylori berdasarkan pemeriksaan serologis menggunakan kit BioM pylori. Analisis perbedaan status gizi dan perawakan pendek antara anak SPB dengan infeksi H. pylori positif dan negatif menggunakan uji chi square. Hasil. Terdapat 224 subjek mengalami SPB dari 1658 subjek yang disurvey. Sebanyak 99 subjek memenuhi kriteria inklusi. H. pylori positif pada 45 subjek. Uji beda memperlihatkan perbedaan proporsi pada status gizi kurang dan infeksi H. pylori positif, namun belum bermakna secara statistik. Pada uji beda perawakan pendek dengan infeksi H. pylori positif tidak didapatkan perbedaan bermakna. Kesimpulan. Tidak terdapat perbedaan bermakna status gizi dan perawakan pendek pada anak SPB dengan infeksi H. pylori positif dan infeksi H. pylori negatif.

Immunization programs are implemented in Indonesia since 1956. Although the government has established a complete basic immunization program for infants aged 0–12 months, there are still more than 1.4 million child deaths in the world each year due to various infectious diseases. The diseases can be prevented by immunization. Low basic immunization coverage in infants is related to parental non-compliance in fulfilling primary immunization. The purpose of this study was to measure the differences in maternal compliance in completing basic immunization in two groups. Samples are a group of mothers provided with Maternal Child Health (MCH) book and special booklet, and another group provided with MCH book only. This study used a quasi-experiment design with quantitative methods with a sample of 76 respondents chosen by simple random sampling—this research conducted in August–October 2017 in Pir Batee Puteh Health Center, West Woyla district. The results indicate that there were differences in maternal compliance in completing basic immunization in mothers with MCH book and special booklet to mothers with only MCH book. Immunization health education interventions based on the MCH book and special booklet can improve the mother's compliance in completing the baby's basic immunization. PERBEDAAN KEPATUHAN IBU DALAM MELENGKAPI IMUNISASI DASAR ANTARA DUA KELOMPOK Program imunisasi mulai dilaksanakan di Indonesia sejak tahun 1956. Meskipun pemerintah telah menetapkan program imunisasi dasar lengkap pada bayi usia 0–12 bulan, masih terdapat lebih dari 1,4 juta kematian anak di dunia setiap tahun karena berbagai penyakit menular yang pada dasarnya dapat dicegah dengan imunisasi. Cakupan imunisasi dasar yang rendah pada bayi berkaitan dengan ketidakpatuhan orangtua dalam memenuhi kelengkapan imunisasi dasar. Tujuan penelitian ini adalah mengukur perbedaan kepatuhan ibu dalam memenuhi kelengkapan imunisasi dasar pada dua kelompok. Sampel adalah kelompok ibu yang diberikan buku Kesehatan Ibu dan Anak (KIA) dan booklet, serta kelompok ibu yang diberikan buku KIA saja. Penelitian ini menggunakan desain quasy-experiment dan metode kuantitatif dengan sampel 76 responden yang dipilih secara simple random sampling. Penelitian dilakukan pada Agustus–Oktober 2017 di wilayah kerja Puskesmas Pir Batee Puteh, Kecamatan Woyla Barat. Hasil penelitian menunjukkan bahwa terdapat perbedaan kepatuhan ibu dalam memenuhi kelengkapan imunisasi dasar pada ibu yang diberikan buku KIA dan booklet dengan ibu yang hanya diberikan buku KIA. Intervensi pendidikan kesehatan imunisasi berdasar atas buku KIA dan booklet dapat meningkatkan pengetahuan dan kesadaran ibu tentang pentingnya imunisasi pada bayi sehingga meningkatkan kepatuhan ibu dalam melengkapi imunisasi bayinya.

Abstract Background Potentially pathogenic bacteria Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus are commonly carried in the nasopharynx of young children. Host and environmental factors have been linked with pathogen carriage, and in many studies rural children have higher carriage rates than their urban counterparts. There are few published data on what factors contribute to increased pathogen density. The objectives of this study were to identify risk factors for nasopharyngeal carriage and density of S. pneumoniae, H. influenzae, M. catarrhalis, and S. aureus in young children in Indonesia. Methods Risk factor analysis was done using data on bacterial carriage and participant characteristics from a cross-sectional study that enrolled 302 children aged 12–24 months living in urban or semi-rural areas of Indonesia. Associations between host factors and odds of pathogen carriage were explored using logistic regression. Characteristics identified to be independent predictors of carriage by univariable analysis, as well as those that differed between urban and semi-rural participants, were included in multivariable models. Risk factors for increased pathogen density were identified using linear regression analysis. Results No differences in carriage prevalence between urban and semi-rural children were observed. Multiple children under the age of 5 years in the household (

Latar belakang. Perawakan pendek merupakan salah satu indikator kesehatan anak yang dipengaruhi berbagai faktor, salah satunya sosioekonomi. Faktor sosioekonomi di antaranya pendidikan, pekerjaan, penghasilan, jumlah anak kurang dari 5 tahun, dan interval usia dengan anak sebelumnya. Tujuan. Mengetahui hubungan status sosioekonomi dengan perawakan pendek. Metode. Studi potong lintang dilakukan pada anak usia 24–60 bulan yang datang ke Puskesmas Sukajadi dan Tempat Penitipan Anak Bunda Ganesa pada bulan Mei 2018. Sampel dipilih secara proporsional random sampling. Tinggi badan anak diperiksa dan diambil data status sosioekonomi. Analisis statistik menggunakan Chi kuadrat dan analisis multivariat dengan regresi logistik. Hasil. Seratus tiga puluh tiga anak terdiri dari 77 anak dari Puskesmas Sukajadi dan 56 anak dari Bunda Ganesa. Prevalensi perawakan pendek di Puskesmas Sukajadi 40,3%, sedangkan di Bunda Ganesa 16,1%. Tempat penelitian, pendidikan orang tua, berat badan menurut usia, pekerjaan ayah dan pendapatan keluarga memiliki hubungan bermakna dengan perawakan pendek. Analisis multivariat ayah pendidikan menengah dan rendah, serta berat badan menurut usia yang abnormal merupakan risiko perawakan pendek. Sementara anak yang tidak mendapat ASI eksklusif berisiko lebih rendah. Kesimpulan. Prevalensi perawakan pendek lebih besar pada anak dari keluarga sosioekonomi menengah kebawah. Pendidikan ayah dan ibu, berat badan menurut usia, pekerjaan ayah dan pendapatan keluarga memiliki hubungan yang bermakna terhadap perawakan pendek.

Background The prevalence of short stature in thalassemia patients ranges from 39.3 to 65%. The cause of short stature is complex and still up for debate. In Indonesia, data on the prevalence and risk factors of short stature in adolescents with thalassemia have been limited. Objective To assess for the prevalence and risk factors of short stature in adolescents with beta-thalassemia major. Methods This cross-sectional study was done from February to March 2017 at the Thalassemia Clinic at Dr. Hasan Sadikin General Hospital, Bandung. The baseline characteristics data of 80 adolescents with thalassemia aged 10-14 years were recorded. Short stature was assessed by height-for-age, (Z-score

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 A phase II study of DTwP-HB-Hib vaccine compared to Hib (monovalent) vaccine given simultaneously with DTwP-HB vaccine has been done following the success of phase I study in infants, where the new DTwP-HB-Hib has excellent safety profiles and antibody responses in infants. Objective To evaluate the titer (quantity), avidity, and bactericidal capacity (quality of anti-polyribosylribitol phosphate/anti-PRP), of a new combined Bio Farma DTwP-HB-Hib (pentavalent) vaccine, compared to the Hib monovalent vaccine given simultaneously with the DTwP-HB vaccine (DTwP-HB+Hib). Methods The study was a prospective, randomized, open label, phase II trial. Subjects aged 6-11 weeks were allocated according to the randomization list. The pentavalent group received the DTwP-HB-Hib vaccine, while the monovalent group received the Hib monovalent and DTwP-HB vaccines separately. Immunizations were given in three doses with 28-day intervals. Blood specimens were taken before the first dose and 28 days after the last dose. We evaluated anti-PRP titers quantity (geometric mean antibody concentration/GMC) and seroprotection), followed by avidity and bactericidal (quality) testing. Titer and avidity of anti-PRP were tested using a modified version of the improved Phipps ELISA. Bactericidal capacity was evaluated using a Hib killing assay. Immune responses against other antigens in the vaccine were reported separately. Results One hundred five subjects in the pentavalent group and 106 subjects in the Hib monovalent group were tested for anti-PRP titers. Only 102 specimens for each group were available for bactericidal testing, due to insufficient volume for testing. Both vaccines induced similar anti-PRP titers, for GMC and seroprotection. Avidity increases were 82.9% and 76.4% in the pentavalent and Hib monovalent groups, respectively. Bactericidal activities were 94.1% and 89.2%, respectively. Both avidity and bactericidal activity were not significantly different between groups. Conclusion DTwP-HB-Hib vaccine induced anti-PRP quantity and quality comparable to those of the Hib monovalent vaccine given simultaneously with the DTwP-HB vaccine.

Background Haemophilus influenzae type b (Hib) causes infection with predominant manifestations of pneumonia, meningitis, and other invasive diseases, occurring primarily in children aged under 2 years, particularly in infants. The World Health Organization (WHO) and Indonesian Technical Advisory Group for Immunization recommend to include the Hib vaccine into the national immunization program. The newly developed DTwP-HB-Hib combination vaccine is anticipated to be the preferred choice for Hib vaccine introduction; it is efficient, simple, and has higher coverage. Objective To evaluate the immunogenicity and safety of a new, combined Bio Farma DTwP-HB-Hib vaccine, compared to the registered Hib monovalent vaccine given simultaneously with the local DTwP-HB vaccine, when used as the primary vaccination of Indonesian infants. Methods A prospective, randomized, open-label, phase II study was conducted on the DTwP-HB-Hib vaccine compared to the Hib (registered) vaccine given simultaneously with the DTwP-HB vaccine, in Bandung from July 2011 to January 2012. Infants were serially vaccinated at 6-11, 10-15, and 14-19 weeks. Serological assessments were done prior to the first vaccine dose and 28 days after the third dose. Safety was assessed from the time of first injection until 1 month after the last injection. Results Of 220 healthy infants enrolled, 211 completed the study, with 105 receiving the combined vaccine and 106 the two separate vaccines. All vaccines were well tolerated. No differences in rates of local and systemic reactions were seen between the two methods of administration. No serious adverse events were considered to be related to the vaccines. In the DTwP-HB-Hib primary-vaccination group, at least 98% of the infants reached protective levels of antibodies (seropositivity) against the antigens employed in the vaccines while 96% in the control group. Conclusion The DTwP-HB-Hib combined vaccine is immunogenic and safe, as well as comparable to the Hib vaccine given simultaneously with to the DTwP-HB vaccine.

Imunisasi difteria, pertusis dan tetanus (DPT) telah lama masuk ke dalam program imunisasi nasional di Indonesia dan telah terbukti menurunkan angka kejadian maupun kematian yang disebabkan penyakit difteria, pertusis dan tetanus. Tujuan penelitian ini untuk melakukan evaluasi status kekebalan dan faktor keamanan terhadap penyakit difteria dan tetanus pada bayi yang mendapat imunisasi dasar DPT. Seratus enam puluh subjek bayi sehat yang dipilih secara random, dilakukan imunisasi secara intramuskular dengan dosis 0,5 ml sebanyak 3 kali pada umur 2, 3 dan 4 bulan, menggunakan vaksin DPT buatan PT. Bio-Farma Bandung. Penentuan titer antibodi difteria dan tetanus dilakukan sebelum dilakukan imunisasi dan 1 bulan setelah imunisasi ke-1, 2 dan 3, menggunakan metode ELISA. Apabila hasilnya < 0,01 IU/ml disebut kelompok rentan dan bila > 0,1 IU/ml disebut mempunyai kekebalan lengkap. Kejadian reaksi lokal (nyeri, kemerahan, bengkak, penebalan) dan sistemik (demam, iritabilitas) pasca imunisasi dicatat dalam buku catatan harian ibu. Hasil penelitian menunjukkan sebelum dilakukan imunisasi 57% subjek sudah tidak mempunyai perlindungan terhadap difteri dan 6% sudah tidak mempunyai perlindungan terhadap tetanus. Terhadap difteria, rata-rata geometrik titer (GMT) sebelum dan setelah mendapat imunisasi ke-1, 2 dan 3, memberikan hasil berturut-turut 0,008; 0,005; 0,038; dan 0,217 IU/ml; sedang jumlah subjek yang mempunyai titer > 0,01 IU/ml berturut-turut adalah 44, 28, 44 dan 80%. Terhadap tetanus, rata-rata geometrik titer (GMT) sebelum dan setelah mendapat imunisasi ke-1, 2 dan 3, memberikan hasil berturut-turut: 0,420; 0,273; 0,213; dan 0,758 IU/ml; jumlah subjek yang mempunyai titer > 0,01 IU/ml berturtut-turut adalah 94; 91; 100 dan 100%. Selama periode penelitian tidak ditemukan adanya reaksi vaksin berat. Reaksi lokal (nyeri, kemerahan, bengkak dan penebalan) dan reaksi sistemik (iritabilitas dan panas) sebagian besar dengan derajat ringan yang selanjutnya menghilang tanpa gejala sisa. Walaupun imunisasi DPT memberikan hasil kekebalan yang tinggi dan aman diberikan, namun pada kelompok yang masih rentan perlu mendapat perhatian.

Latar belakang. Indonesia menggunakan trivalent oral polio vaccine (tOPV) sejak tahun 1977 dan sejak tahun 1995 tidak pernah ditemukan lagi kasus poliomelitis. Pada Maret 2005 terjadi kejadian luar biasa (KLB) polio yang meluas ke seluruh pulau Jawa dan Sumatera. Berdasarkan pengalaman negara yang berhasil mengatasi KLB, penggunaan monovalent oral polio vaccine (mOPV) sesuai penyebab KLB memberikan hasil lebih cepat dibandingkan tOPV. Tujuan. Melihat manfaat pemberian mOPV1 dibandingkan dengan tOPV ditinjau dari imunogenisitas dan keamanan vaksin. Metode. Penelitian dilakukan pada anak berumur 0-12 bulan, menggunakan mOPV1 dan tOPV saat saat Pekan Imunisasi Nasional tahun 2005. Hasil. Penelitian menunjukkan sero konversi pada kelompok mOPV terdapat pada 19 subjek dan tOPV pada 2 subjek, dengan titer rerata masing-masing 69,47 dan 48. Proporsi kenaikan titer ≥4 kali kelompok mOPV1 40,5%, tOPV 27,2% (X2=5,49; p=0,014). GMT kelompok mOPV1 21,9 menjadi 54,84 (Zw=5,45; p

Latar belakang. Faktor yang memengaruhi pemberian ASI eksklusif pada ibu bekerja adalah pengetahuan, sikap, dan dukungan institusi. Petugas kesehatan berperan ganda, yaitu sebagai ibu bekerja dan panutan praktek pemberian ASI. Tujuan. Memperoleh hubungan antara pengetahuan, sikap, dukungan unit kerja terhadap praktek pemberian ASI eksklusif oleh tenaga kesehatan di Rumah Sakit Umum Dr. Hasan Sadikin (RSHS). Metode. Penelitian cross-sectional dengan metode consecutive sampling, dilakukan pada bulan Januari-Maret 2016 pada peserta program pendidikan dokter spesialis (PPDS), peserta program pendidikan profesi dokter (PSPD), perawat, dan bidan wanita; berusia ≤37 tahun; bekerja atau belajar di RSHS; memiliki anak lahir tunggal berusia 6−24 bulan; mengisi kuesioner dan dianalisis dengan multivariat Hasil. Pengetahuan (OR IK95%=3,7; p=0,013) dan dukungan tenaga kesehatan (OR IK95%=3,45; p=0,031) berhubungan dengan praktek pemberian ASI eksklusif. Kesimpulan. Pengetahuan ibu berhubungan dengan praktek pemberian ASI eksklusif, sementara dukungan unit kerja/departemen dan sikap tidak berhubungan dengan hal itu. Dukungan petugas kesehatan merupakan faktor perancu yang berhubungan dengan hal tersebut.

Latar belakang. Di Indonesia berpotensi terjadi reemerging disease difteri akibat belum ada program imunisasi ulang yang berkesinambungan pada remaja. Tujuan. Menilai imunogenisitas dan keamanan vaksin tetanus difteri (Td) yang diberikan sebagai imunisasi ulang pada remaja. Metode. Uji klinis randomized double-blind controlled dilakukan terhadap 296 pelajar remaja sehat di kota Bandung, usia 10–18 tahun, pada September 2007–September 2008. Didapatkan 296 remaja sebagai subjek penelitian, dibagi dalam 2 kelompok secara acak sederhana. Kelompok I mendapat vaksin Td 0,5 mL intramuskular. Kelompok II mendapat vaksin TT sebagai kontrol. Pemeriksaan kadar antibodi anti difteri dan anti tetanus dilakukan sebelum dan 1 bulan setelah imunisasi menggunakan teknik enzyme-linked immunosorbent assays (ELISAs). Data keamanan dikumpulkan sampai 1 bulan pasca imunisasi menggunakan buku harian Hasil. Konsentrasi antibodi seroproteksi (>0,1 IU/mL) terhadap difteri dan tetanus mencapai 93,2% dan 100,0%. The geometric mean titer (GMT) terhadap difteri meningkat dari 0,0618 IU/mL menjadi 0,7583 IU/mL (p37,5°C hanya terjadi pada sedikit subjek dari kedua kelompok (rentang Td: 0,7-4,7%; rentang TT: 3,4–6,7%). Tidak terdapat reaksi kejadian ikutan pasca imunisasi serius dan dapat ditoleransi dengan baik. Kesimpulan. Imunisasi ulang Td meningkatkan kadar antibodi protektif terhadap difteri dan tetanus, serta aman diberikan pada remaja.

Latar belakang.Sejak tahun 1986 tidak ditemukan lagi kasus difteri yang dirawat di Rumah Sakit Hasan Sadikin Bandung Jawa Barat. Namun, wabah difteri selalu terjadi di beberapa kabupaten di Jawa Barat seperti yang dilaporkan sejak tahun 1993 sampai tahun 2010. Kementerian Kesehatan juga melaporkan peningkatan kasus difteri di beberapa provinsi di Indonesia tahun 2010. Suatu penelitian saat wabah di Kecamatan Cikalong Wetan Kabupaten Cianjur tahun 2001 sebagai gambaran kejadian wabah di salah satu kabupaten di Jawa Barat. Tujuan. Menggambarkan kejadian wabah difteri, mengetahui tingkat kekebalan dengan mengukur kadar antibodi difteri dan untuk menemukan kemungkinan adanya kuman C. difteriaeberedar di masyarakat di daerah wabah. Metode. Data kejadian penyakit dan kematian diperoleh dari Puskesmas Cikalong Wetan RS Cianjur dan Dinas Kesehatan Kabupaten Cianjur. Data kadar antibodi diperoleh dengan mengukur kadar anti bodi terhadap difteri pada 698 subyek, yang dibagi menurut kelompok usia. Titer antibodi diukur dengan menggunakan teknik ELISA ganda. Hasil.Selama wabah terdapat 25 kasus yang dilaporkan dari Puskesmas Cikalong Wetan dengan angka kematian/crude fatality rate(CFR) 28%. Diduga kuat bahwa kasus pertama berasal dari kecamatan yang berdekatan dengan Kecamatan Cikalong Wetan. Beberapa bulan sebelumnya dijumpai kasus rawat inap 21 pasien, 55% di antaranya balita, dengan angka kematian 35% terutama disebabkan oleh miokarditis. Walaupun cakupan imunisasi difteri pertusis tetanus (DPT) tinggi pada anak kurang dari 1 tahun di Kecamatan Cikalong Wetan, hanya 19,3% anak usia 1 tahun memiliki tingkat kekebalan protektif yang memadai. Titer antibodi terus berkurang sesuai dengan meningkatnya usia anak, bahkan tidak ada subjek yang memiliki kadar protektif yang memadai pada kelompok usia 5 – 6 tahun. Enam dari 324 biakan apus tenggorokan pada masyarakat tumbuh strain toxigenic C. difteriae gravis. Kesimpulan.Wabah yang terjadi di Kecamatan Cikalong Wetan Kabupaten Cianjur disebabkan oleh karena rendahnya kadar antibodi terhadap toxigenic C.difteriaepada masyarakat.

Latar belakang. Di negara maju maupun berkembang, insiden sepsis neonatorum masih tinggi. Penggunaan antibiotik empiris, pada sepsis neonatorum, perlu pemantauan ketat untuk mencegah toksisitas dan resistensi. Tujuan. Menentukan perbedaan skor sepsis modifikasi Tollner dan kadar procalcitonin (PCT) serum sebelum dengan setelah pemberian antibiotik empiris serta hubungan perubahan keduanya pasca pemberian antibiotik empiris. Metode. Penelitian observasional analitik, rancangan one group pre-test and post-test, dilaksanakan Juli−Oktober 2013 di Unit Gawat Darurat dan Rawat Inap Divisi Neonatologi Rumah Sakit Dr. Hasan Sadikin, Bandung. Subjek penelitian terdiri atas 32 neonatus dan 2 dikeluarkan karena meninggal 10 masuk ke dalam penelitian) dan pemeriksaan kadar PCT serum sebelum dengan setelah mendapat antibiotik ampisilin dan gentamisin selama 48 jam. Perbedaan skor sepsis modifikasi Tollner dan kadar PCT sebelum dengan setelah pemberian antibiotik empiris dianalisis menggunakan Uji Wilcoxon. Korelasi perubahan skor sepsis dan kadar PCT diuji dengan Uji Rank Spearman. Faktor yang berhubungan dengan skor sepsis dan kadar PCT jenis kelamin, usia ≤48 jam, berat lahir rendah, dan kultur darah negatif dianalisis dengan Uji Mann-Whitney. Hasil. Skor sepsis dan kadar PCT serum awal (median (rentang)) berturut-turut 11,5 (10,5−16,5) dan 12,6 (0,30−100) ng/mL. Pasca pemberian antibiotik berturut-turut 5,5 (0,5−13,5) dan 2,65 (0,16−37,25) ng/mL. Skor sepsis dan kadar PCT berbeda bermakna sebelum dengan setelah pemberian antibiotik empiris. Terdapat korelasi positif bermakna perubahan nilai skor sepsis modifikasi Tollner dengan perubahan kadar PCT serum pasca pemberian antibiotik empiris selama 48 jam. Kesimpulan. Skor sepsis modifikasi Tollner dan kadar PCT serum berhubungan dengan pemberian antibiotik empiris pada sepsis neonatorum. Kenaikan perubahan skor sepsis modifikasi Tollner diikuti oleh kenaikan perubahan kadar PCT serum.

Latar belakang. Vitamin D berperan dalam fungsi pertahanan tubuh sehingga defisiensi vitamin D berhubungan dengan derajat keparahan penyakit. Tujuan. Membandingkan kadar vitamin D pada anak sakit kritis dan nonkritis. Metode. Penelitian potong-lintang dengan subjek terdiri atas 25 anak sakit kritis dan 25 anak sakit nonkritis. Kadar vitamin D dianalisis dengan Uji Mann Whitney, Uji Kolmogorov-Smirnov, dan Uji Korelasi Spearman. Kemaknaan dinyatakan pada p

Latar belakang. Berdasarkan riwayat implementasi program imunisasi Hepatitis B di Jawa Barat, diperkirakan anak periode remaja akhir (15–18 tahun) belum terlindungi terhadap infeksi Hepatitis B. Tujuan. Menilai kekebalan dan keamanan pasca imunisasi 3 dosis vaksin Hepatitis B rekombinan pada anak remaja sehat yang belum pernah mendapat imunisasi Hepatitis B. Metode. Penelitian intervensi dengan label terbuka terhadap remaja usia 15–18 tahun yang belum pernah mendapatkan imunisasi Hepatitis B, diberikan 3 dosis (1,0 ml=20 µg of HBsAg) Hepatitis B rekombinan secara intramuskular pada daerah lengan atas dengan interval waktu 1 bulan. Respons antibodi diukur menggunakan Chemiluminescent Microparticle Immunoassay (CMIA) Architect ausab reagent kit on architect i 1000sr, dilakukan pra dan 28 hari pasca dosis ke-3 vaksinasi. Reaksi lokal dan kejadian sistemik dicatat pada buku catatan harian selama 28 hari pasca tiap imunisasi. Hasil. Selama periode penelitian didapatkan seratus lima puluh subyek dengan Hbs Ag negatif. Dari jumlah tersebut 112 (75,3%) dengan kadar anti-HBs

Latar belakang.Pada umumnya usia 1-2 tahun pertama kehidupan akan menentukan kualitas hidup anak di kemudian hari. Tujuan. Mengetahui gambaran perkembangan anak usia 1-2 tahun dan status gizi. Metode.Penelitian dilakukan di tiga Puskesmas Garuda, Ibrahim Aji, dan Puter yang terdiri dari 24 Posyandu di Kabupaten Bandung. Penelitian dilakukan dilakukan secara cross sectionaldengan subjek anak usia 1-2 tahun yang sehat dan kooperatif pada saat pemeriksaan, serta orang tua menyetujui ikut dalam penelitian. Tes perkembangan dilakukan oleh satu dokter anak dan dua dokter (residen) dengan menggunakan KPSP (Kuesioner Pra Skrening Perkembangan). Empat aspek perkembangan yang dinilai yaitu motorik kasar, motorik halus, bicara dan bahasa, sosial dan kemandirian. Penelitian dilakukan dari tanggal 15 November 2010 sampai 30 November 2010. Hasil.Jumlah subjek 321 anak usia 1–2 tahun dan yang memenuhi kriteria inklusi 308 anak, terdiri dari 164 laki-laki (53,2%) dan 144 perempuan (46,8%). Anak yang mengalami perkembangan normal 278 anak (90,22%) dan meragukan 30 anak (9,78%). Sedangkan status gizi dinilai berdasarkan BB/PB, hasil normal 277 anak (89,9%) dan kurus 31 anak (10,10%). Dari 31 anak dengan status gizi kurang, di antara 2 anak di antaranya mengalami perkembangan meragukan dan dari 28 anak dengan perkembangan meragukan mempunyai status gizi normal. Kesimpulan.Tidak terdapat hubungan antara gangguan perkembangan dengan status gizi (p=0,394) begitu juga dengan status gizi dengan kondisi ekonomi (p=2,500) dan perkembangan dengan status ekonomi (p=0,336). Dari perkembangan dengan nilai meragukan adalah motorik kasar (6,17%), motorik halus (0,65%), bicara dan bahasa (4,54%), serta sosialisasi dan kemandirian (2,92%). Faktor-faktor yang berhubungkan dengan status perkembangan adalah umur anak (p=0,009). Perlu upaya untuk mengevaluasi perkembangan yang meragukan dan perlu penelitian lanjut dengan pembanding.

Latar belakang. Berbagai penelitian terhadap respons imun setelah imunisasi hepatitis B dengan menggunakan vaksin monovalen dari plasma maupun yang berasal dari teknik DNA rekombinan menunjukkan antara 5%-15% tidak memberikan respons (non-responder) atau kurang memberikan respons (hypo-responder) Center of Disease Control merekomendasikan terhadap anak yang tidak mempunyai tingkat proteksi antibodi (anti-Hbs) setelah mendapat imunisasi dasar, perlu diberikan 3 kali suntikan rangkaian ke-2. Setelah rangkaian ke-2 imunisasi Hepatitis B tersebut maka 30%-50% diantaranya akan mempunyai kadar yang protektif. Tujuan. Penelitian bertujuan mengeksplorasi lebih mendalam mengenai manfaat pemberian vaksinasi rangkaian kedua pada anak hipo dan non responder sebagai salah satu data yang dapat dipergunakan strategi menghadapi masalah hepatitis B di Indonesia. Metode. Penelitian dilakukan terhadap 144 anak yang telah melaksanakan imunisasi dasar hepatitis B secara lengkap (3 kali) yang merupakan bagian uji klinis vaksin pentavalen (DPT/hepatitis B/Hib). Enam bulan setelah mengetahui kadar anti-Hbs hasil uji klinik pentavalen dilakukan pemberian imunisasi rangkaian ke-2 pada anak-anak hipo/non-responder. Hasil. Sebelas anak mempunyai kadar anti-Hbs 10 mIU/ml, 8 orang anak (72,2%) mempunyai kadar 10 mIU/ml). Kesimpulan. Pemberian 3 dosis standar hepatitis B dapat digunakan untuk memberikan kekebalan pada anak sehat dengan hypo/non responder.

Background Developmental and behavioral problems are among the most common conditions of childhood. These problems affect 12−16% of children in the United States and 13−18% of children in Indonesia. Early detection of developmental deficits among children requires clinicians to screen with accurate tools. Cognitive function screening in children has been increasingly used in many clinical and educational settings. The School-Years Screening Test for Evaluation of Mental Status-Revised (SYSTEMS-R) is becoming a widely-used, reliable, and valid cognitive screening tool for children aged 4−15 years. Prior to our study, there was no Indonesian language version of the SYSTEMS-R. Objective To determine the reliability of the Indonesian translation of the SYSTEMS-R. Methods A cross-sectional study was conducted in children aged 4−15 years who understood the Indonesian language and did not have neurologic or communication impairments. Data were analysed to determine reliability (internal consistency and inter-rater reliability) of the Indonesian version of SYSTEMS-R. Internal consistency was determined using Cronbach’s alpha formula. Internal consistency is a reflection of inter-item correlation and item-to-total correlation. Inter-rater reliability was determined using the Bland-Altman method. Results This study was conducted on 133 children aged 4−15 years in a kindergarten, elementary, junior high, and senior high school in Bandung. The Indonesian version of SYSTEMS-R had significant internal consistency (Cron bach’s alpha 0.936−0.941), and the scores obtained by two raters had good agreement (difference within mean + 1.96 SD). Conclusion The Indonesian version of SYSTEMS-R is reliable for use as a cognitive screening tool for Indonesian children. [Paediatr Indones. 2016;56:149-54.].

Background: Prevalence of stunted adolescents is important because related with the cardiometabolic risk factor. Control of risk factors reduces the comorbidity including body mass index (BMI) control. Improvement of environmental factors such as energy and fiber intake contribute to reducing disease risk. Objective: This study aimed to analyze the relationship of a stunted adolescent with BMI, energy and fiber intake. Method: This study used cross-sectional design. The subject consisted of early adolescents with 10 to 14 years old in Jatinangor district, West Java. Determination of short stature and BMI refers to the WHO Growth Chart 2005. Data collection by the measure of height, weight, BMI calculation, and interviewed food intake by 3x24 hour food recall and analyzed with Nutrisurvey program. Statistical analysis by Mann-Whitney U test. Results: A total of 212 participants (106 stunted and 106 non-stunted) were enrolled. The proportion of stunted girls is 58 (54,9%) and stunted boys 48 (45,1%). Average of BMI in stunted is 17,15 (2,59) kg/m2 and 18,38 (3,33) kg/m2 in non-stunted, energy intake is 1.488,83 (513,52)kcal in stunted and 1.704,32 (663,49) in non-stunted, fiber intake is 4,36 (1,18) g in stunted and 4,53 (2,15) g in non stunted. There are significant differences in all variables between stunted and non-stunted with a p value for BMI 0,017, in energy intake 0,034 and fiber intake 0,032. BMI showed the correlation with disease risk. including cardiometabolic diseases in stunting. Energy intake and low fiber in growth age increase the risk of cardiometabolic diseases because in stunting have a low metabolic adaptation in protein synthesis and fat oxidation. Conclusion: The study shows there is a difference between BMI, energy intake and fiber in the stunted adolescent and non-stunted adolescent. Further research needs to analyze another risk fctor and intervention to improve nutrition status and metabolic condition.

Objective: To assess the safety and immunogenicity of the Haemophilus influenzae type b/polyribosylribitol phosphate-Tetanus (Hib/PRP-T) liquid vaccine in healthy adults. Methods: An open label prospective intervention phase I study was conducted in Dr. Hasan Sadikin General Hospital from November to December 2010. Healthy adults aged 18−40 years were eligible to participate. Participants received one dose of Hib/PRP-T liquid vaccine. Blood samples were taken before, 4 days, and 1 month after vaccination. For a 28-day period following vaccination, solicited adverse events were recorded in the subjects’ diary and assessed afterward. Results: No local reactions or immediate systemic events were observed during the 30-minute period after immunization. There were no serious local or systemic reactions in this study. All of local and systemic reactions observed were slight, transient, self-limiting, and lasting no more than 72 hours after the administration of the vaccine. These reactions resolved without any medical intervention. Hematological and biochemical indices before and 4 days after vaccination were in normal limits. All subjects reached protective levels of antibodies (seroprotectivity) against Hib. All subjects demonstrated antibodies performing high bactericidal activities 1 month after immunization. Conclusions: This study demonstrates that liquid Hib/PRP-T vaccine is highly immunogenic and beneficially safe when administered to healthy adults.

Background The life of patients with thalassemia major depends on blood transfusions, while repeated blood transfusions may cause adverse effects such as iron deposition in various organs, includ- ing heart and lungs, which eventually increases the pulmonary arterial pressure. Objective This study was proposed to know the occurrence of pulmonary hypertension in patients with thalassemia major, mea- sured by echocardiography in the Thalassemia Clinic, Department of Child Health, Medical School, Padjadjaran University/Hasan Sadikin Hospital, Bandung. Methods A descriptive cross-sectional study was carried out on 30 patients with thalassemia major, aged 10-14 year-old who received repeated blood transfusions. The study was conducted from April to May 2002. Subjects were examined right after a blood transfusion completed and the pulmonary arterial pres- sure was assessed using Doppler–echocardiography and 2-D echocardiography. Results Twenty two out of 30 subjects showed pulmonary hyper- tension, with pulmonary arterial pressure ranged between 32.3 to 46.2 mmHg. According to the age group, pulmonary hypertension was found in 12 out of 17 subjects aged 10-12 years old and 10 out of 13 subjects aged 13-14 years old. Conclusion The occurrence of pulmonary hypertension in patients with thalassemia major at Hasan Sadikin Hospital was 22/30 and seemed to increase with the age of the patients

Streptococcus pneumoniae is an important cause of infection and commonly colonizes the nasopharynx of young children, along with other potentially pathogenic bacteria. The objectives of this study were to estimate the carriage prevalence of S. pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus in young children in Indonesia, and to examine interactions between these bacterial species. 302 healthy children aged 12-24 months were enrolled in community health centers in the Bandung, Central Lombok, and Padang regions. Nasopharyngeal swabs were collected and stored according to World Health Organization recommendations, and bacterial species detected by qPCR. Pneumococcal serotyping was conducted by microarray and latex agglutination/Quellung. Overall carriage prevalence was 49.5% for S. pneumoniae, 27.5% for H. influenzae, 42.7% for M. catarrhalis, and 7.3% for S. aureus. Prevalence of M. catarrhalis and S. pneumoniae, as well as pneumococcal serotype distribution, varied by region. Positive associations were observed for S. pneumoniae and M. catarrhalis (OR 3.07 [95%CI 1.91-4.94]), and H. influenzae and M. catarrhalis (OR 2.34 [95%CI 1.40-3.91]), and a negative association was found between M. catarrhalis and S. aureus (OR 0.06 [95%CI 0.01-0.43]). Densities of S. pneumoniae, H. influenzae, and M. catarrhalis were positively correlated when two of these species were present. Prior to pneumococcal vaccine introduction, pneumococcal carriage prevalence and serotype distribution varies among children living in different regions of Indonesia. Positive associations in both carriage and density identified among S. pneumoniae, H. influenzae, and M. catarrhalis suggest a synergistic relationship among these species with potential clinical implications.

Vaksin Hib mulai digunakan pada Pogram Imunisasi Nasional sejak tahun 2013 secara bertahap dan di seluruh Indonesia mulai tahun 2014 dalam bentuk vaksin kombinasi DTP/HB/Hib (Pentabio®), yang memberikan kekebalan terhadap difteria, pertusis, tetanus, hepatitis B, dan Haemophilus influenzae tipe b. Studi ini menilai reaksi sitemik, reaksi lokal, dan reaksi yang serius pascaimunisasi dengan Pentabio®. Sebanyak 4.000 bayi penerima vaksin Pentabio®bergabung dalam studi ini. Reaksi yang timbul dicatat pada kartu harian oleh petugas yang sudah dilatih. Vaksin Pentabio®yang diamati pada PMS ini menggunakan vaksin rutin dari Program Imunisasi Nasional dalam waktu pengamatan 28 hari di empat propinsi, yaitu Nusa Tenggara Barat, Bali, Yogyakarta, dan Jawa Barat pada periode Mei–Desember 2014. Sebanyak 3.978 data dapat dianalisis karena 22 di antaranya tidak memberikan informasi yang valid. Reaksi sistemik yang paling banyak timbul adalah demam 0,85% pada 30 menit pertama, dan meningkat menjadi 14,03% pada satu hari pascaimunisasi, kemudian sembuh pada hari berikutnya. Reaksi lokal yang paling sering timbul adalah nyeri pada tempat suntikan pada 67,6% subjek pada 30 menit setelah imunisasi, dan meningkat menjadi 87,23% pada 1 hari pascaimunisasi namun sembuh pada hari berikutnya. Mayoritas nyeri yang timbul adalah kategori ringan. Tidak ditemukan kejadian ikutan pascaimunisasi serius selama pengamatan. Simpulan, reaksi lokal dan sistemik pascaimunisasi dengan Pentabio® dapat ditoleransi pada bayi.

Children living in orphanage are associated with delays in development. The children demostrate less developmental problems when they interact with caregivers. The aim of this study was to compare developmental and mental emotional problems between children living in orphanage and those who live with their parents. A comparative analytical cross sectional study by chi square to test the developmental problem using kuesioner preskrining perkembangan (KPSP) or the development pre-screening questionnaire, for motoric, language, and personal social assessment. The mental emotional problems are assessed using kuesioner masalah mental emosional (KMME) or mental emotional problem questionnaire for behavior assessment. These were followed by a qualitative study through interviews to evaluate the cause of developmental and mental emotional problems. Conducted from June 2011–January 2012, this study inclused children 3 to 6 years old who met the inclusion criteria as the subjects with a total of 102 subjects participated. From 51 children from the orphanages there were 8 children who had developmental problem while none was found in children living with their parents. The mental emotional problems in both group were equal (29 children). There was a higher number of developmental problem in children living in the orphanage (p=0.002), and a corelation between caregiver-children play time interaction and developmental problem (p=0.003) was found. In conclusion, children living in orphanage have higher risk for developmental problem while the risk for the mental emotional problems is not different between children living in orphanage and those who live with their parents.

Background The World Health Organization (WHO) has recommended the introduction ofhepatitis B (HB) and Haemophilus influenza type b (Hib) vaccines into routine childhood vaccination programs. A new diptheria/tetanus/pertussis (DTP) /hepatitis B/Hib pentavalent combination vaccine has been developed. Objective To evaluate the safety and immunogenicity of a new combination DTP/HB/Hib liquid vaccin e in infants. Met hods An open-label, uncontrolled, prospective intervention phase I study was con ducted on 30 healthy infants aged 6- 11 weeks. Each subject received 3 doses of DTP/HB/Hib vaccine, formulated by Bio Fanna, 0.5 mL intramuscularly at the left anterolateral thigh region using a 25-gauge n eedle of 25 mm length . Subjects were followed for 1 month after administration of each vaccine dose to evaluate its safety, while serum anti-diphteria, tetanus, HB, Hib, and per tussis antibodies were measured prior to the l '' dose and 1 month after the Jtd dose. Results Among 30 vaccinated subjects, 18 infants had fever within 24 hours after the first vaccination. Most cases of fever were mild in intensity and resolved within 24 hours. No other systemic or local reactions, or serious adverse events were observed in our subjects during the study. The immunogenicity results after Jtd vaccine dose showed that the geometric mean titer of the antipolyribosylribitol phosphate (PRP) antibody levels increased significantly from 0.0041μ,g/mL to 4.3 7 μ,g/mL after vaccination, and most infants h ad a fourfo ld or greater rise in antibody levels over their pre-injection levels . All subjects who received DTP/ HB/Hib liquid vaccine had seropro tective antibodies against tetanus, diphtheria,a and hepatitis B, while 29/30 infants had seroprotective antibodies against pertussis. Conclusion This new diphtheria/tetanus/pertusis/hepatitis B/Hib combination vaccine has excellent safety profile and antibody responses in infants. These results encourage further clinical evaluation in phase II.

Background Adolescence is a phase of dynamic development in human life, marked by rapid physical growth, in addition to mental, emotional, and social development. Adolescent obesity has been related to metabolic disease, in addition to psychological disorders, which may lead to a negative impact on academic performances. Objective To assess academic performances in adolescents with obesity Methods A cross-sectional study was conducted in Junior High School No. 14 in Bandung from December 2010 to July 2011. Subjects were aged 12 to 14 years, and were divided into two groups: obese or good nutritional status. Statistical analysis using Fisher's exact test was performed to assess the association of obesity and academic performances. T-test was used to compare subjects' mean mathematics and English performances in the two groups. Results There were 24D students who met the inclusion criteria. Since there were 40 obese subjects in the first group, we randomized the remaining students to obtain 40 subjects with good nutritional status for the second group. Best academic performances in mathematics and English was obtained mostly by subjects in the good nutrition group (38/40 and 39/40, respectively). Statistical analysis revealed a significant association of lower performances in mathematics (mean difference -2.8; 95%CI -5 to -0.6; P=0.043) and English (mean difference -1.9; 95%CI -3.5 to -0.2; P=0.001) to obesity. We also found a significant association of better mathematics (P=0.001) and English performances (P=0.004) to the father's occupation. Additional English lessons were not associated with higher English performances in the obese group (mean difference 0.2; 95%CI -2.9 to 3 .2; P=0.885). Conclusion Obese adolescents tend to have poorer academic performances compared to those with good nutritional status.

Background Trivalent inactivated influenza vaccines (TIV) containing antigens of two influenza A strains, A(H1N1) and A(H3N2), and one influenza B strain, are the standard {onnulation for influenza prevention. The vaccines must be updated annually to provide optimal protection against the predicted prevalent strains for the next influenza season. Objective To assess the immunogenidty and safety of the inactivated influenza vaccine (Flubio®) in adolescents and adults, 28 days after a single dose. Methods In this experimental, randomized, single-blind, bridging study, we included 60 healthy adolescents and adults. A single, 0.5 mL dose was administered intramuscularly in the deltoid muscle of the left ann. Blood samples were obtained before and 28 days after immunization. Standardized hemagglutination inhibition (HI) test was used to assess antibody response to influenza antigens. Results From January to February 2010, a total of 60 adolescents and adults enrolled in the study, but two participants did not provide the required blood samples. One hundred percent of the subjects had an anti-influenza titer ≥ 1:40 HI units to all three strains, A/Brisbane/59/2007 (H1N1), A/Uruguay/716/2007 (H3N2), and B/Brisbane/60/2008 (P=1.000) after immunization. The Geometric Mean Titers (GMT) after immunization increased for all strains: A/Brisbane, 76.4 to 992.7, A/Uruguay, 27.6 to 432.1, and B/Brisbane, 19.9 to 312.7. Twenty eight days after immunization, we found a 4 times increase in antibody titers in 75.8% of the subjects for A/Brisbane, 84.5% for A/Uruguay, and 77.6% for B/Brisbane. We also observed that 100% of seronegative subjects converted to seropositive for all 3 strains. All vaccines were well-tolerated. There were no serious adverse events reported during the study. Conclusion In adolescents and adults, the Flubio® vaccine was immunogenic and safe.

Common causes of acute febrile illness in tropical countries have similar symptoms, which often mimic those of dengue. Accurate clinical diagnosis can be difficult without laboratory confirmation and disease burden is generally under-reported. Accurate, population-based, laboratory-confirmed incidence data on dengue and other causes of acute fever in dengue-endemic Asian countries are needed.This prospective, multicenter, active fever surveillance, cohort study was conducted in selected centers in Indonesia, Malaysia, Philippines, Thailand and Vietnam to determine the incidence density of acute febrile episodes (≥ 38 °C for ≥ 2 days) in 1,500 healthy children aged 2-14 years, followed for a mean 237 days. Causes of fever were assessed by testing acute and convalescent sera from febrile participants for dengue, chikungunya, hepatitis A, influenza A, leptospirosis, rickettsia, and Salmonella Typhi. Overall, 289 participants had acute fever, an incidence density of 33.6 per 100 person-years (95% CI: 30.0; 37.8); 57% were IgM-positive for at least one of these diseases. The most common causes of fever by IgM ELISA were chikungunya (in 35.0% of in febrile participants) and S. Typhi (in 29.4%). The overall incidence density of dengue per 100 person-years was 3.4 by nonstructural protein 1 (NS1) antigen positivity (95% CI: 2.4; 4.8) and 7.3 (95% CI: 5.7; 9.2) by serology. Dengue was diagnosed in 11.4% (95% CI: 8.0; 15.7) and 23.9% (95% CI: 19.1; 29.2) of febrile participants by NS1 positivity and serology, respectively. Of the febrile episodes not clinically diagnosed as dengue, 5.3% were dengue-positive by NS1 antigen testing and 16.0% were dengue-positive by serology.During the study period, the most common identified causes of pediatric acute febrile illness among the seven tested for were chikungunya, S. Typhi and dengue. Not all dengue cases were clinically diagnosed; laboratory confirmation is essential to refine disease burden estimates.