Search

The development of coffee plants in Indonesia shows increasingly rapid growth to meet both domestic and foreign needs. However, certain farmers are yet to fully utilize their cultivation technology and market opportunities by employing post-harvest techniques to enhance value addition, primarily because of limited access to farming capital. Therefore, this research aimed to identify the potential sources of farming capital and determinant factors in choosing farming sources. In this experiment, the population of coffee farmers in the Pangalengan Subdistrict was surveyed. The sampling method was a proportional random sampling technique based on 235 respondents. To answer the first objective, descriptive analysis was used, while logit regression analysis was carried out for the second objective. The results showed that most farmers (54.66%) depended on internal capital, while the rest used external capital such as banks (28.39%), non-banks (1.69%), and non-formal financial institutions (15.25%). Characteristics of informal non-financial institutions, especially unsecured loans, include repayment in the form of coffee or money, with repayment terms typically set at harvest time. Conversely, formal institutions offer loans with an interest rate of 9% per annum, requiring collateral in the form of securities, and repayment is typically made on a monthly or quarterly basis. In short, factors influencing farmers in accessing credit from financial institutions are the farmer’s age, number of coffee trees, distance to financial institutions, coffee farming income, education, and credit payment deadlines.

Jasa Tirta I Public Company is a state-owned company engaged in the management of water resources. The quality of the performance of an organization can be known by measuring the performance of the achievement of performance indicators. Comprehensive planning of performance indicators is needed. This study aims to determine the performance measurement of Perum Jasa Tirta I by the Balanced Scorecard method and then analyzed by the PDCGA (Plan-Do-Check-Goal-Action) method for continuous improvement to improve company performance. The research method used in this study uses a mixed-method approach. The results showed that the measurement of public performance based on the Balanced Scorecard Perum Jasa Tirta I 2015-2019 method is divided into 4 approaches: financial perspective, customer perspective, internal business process perspective, and learning & growth perspective including good performance. Judging from the financial perspective it is included in the very good category. From the customer perspective, it is included in the excellent category. From the internal business perspective it is classified as quite good, Electricity Raw Water Service indicators reached 93% of the 100% target and environmental management achieved 97% of the 100% target. From the perspective of learning & growth in the excellent category.

Background: In resource-limited settings, addressing infections remains a substantial challenge in the management of children with Acute Myeloid Leukemia (AML). In Indonesia, infection-related mortality (IRM) is thought to be high compared to high-income countries. However, there has been no previous study of infection profile and IRM in Indonesian patients with AML., Objective: This study aimed to describe infections and IRM in children with AML treated according to the Indonesian National AML protocol and to describe the implementation of infection control practices in resource-limited settings., Methods: This retrospective observational study used secondary data from the medical records of pediatric patients with AML treated with the National Protocol at Dr. Sardjito Hospital, Yogyakarta, Indonesia, from April 2012 to September 2018. Essential patient characteristics, time of IRM, and cause of death were recorded, and infection control practices were observed. Data were analyzed using descriptive statistics., Results: 113 patients with AML were treated with the National protocol, and 83 met the inclusion criteria. Infections occurred in 69 (83%) patients with a total of 123 episodes (mean 1.8/patient). Death was seen in 48 (58%) patients, with 19 (23%) IRM. The majority of infections were in the gastrointestinal tract ( n = 51, 30.5%), sepsis ( n = 29, 17%), and respiratory tract ( n = 28, 17%). Infections mostly occurred during the first induction (41%). There were 90 (73%) episodes of clinically documented infection and 33 (27%) episodes of microbiologically documented infection. The positivity rate of blood cultures was only 27%. The majority of bacteria detected were gram-negative ( n = 25, 69%), and among them were Klebsiella pneumonia (19%) and Escherichia coli (19%). Candida albicans was detected in 1 (2%) culture. Suboptimal infection prevention and control were found in the clinical practice., Conclusion: Infections and infection-related mortality in children with AML treated using the National protocol were frequent, mainly occurring during the first induction phase. Compliance with infection prevention and control measures needs improvement. Urgent attention is required for better supportive care, including isolation rooms, antibiotics, and antifungals. The predominance of Gram-negative bacterial infections highlights the necessity for further research into effective prophylaxis. Enhanced healthcare and nursing professional vigilance and tailored antibiotic strategies are vital. Improving compliance and ensuring adequate supportive care resources are essential, emphasizing nursing's pivotal role. Further research is crucial to drive advancements in infection control strategies., Competing Interests: The authors have declared there is no conflict of interest in this study., (© The Author(s) 2024.)

In low- and middle-income countries (LMICs), limited resources, suboptimal risk stratification, and disproportionate patient-to-infrastructure ratio result in low survival of patients with acute myeloid leukemia (AML). A high incidence of relapse, inherent to the biology, renders management arduous. The challenge of treating AML in LMICs is of balancing the intensity of myelosuppressive chemotherapy, which appears necessary for cure, with available supportive care, which influences treatment-related mortality. The recommendations outlined in this paper are based on published evidence and expert opinion. The principle of this adapted protocol is to tailor treatment to available resources, reduce preventable toxic death, and direct limited resources toward those children who are most likely to be cured., (© 2019 The Authors. Pediatric Blood & Cancer published by Wiley Periodicals, Inc.)

Purpose: The asparaginase's (ASP) utility for ALL treatment is limited by neutralizing antibodies, which is problematic in countries whose access limited to alternative preparations. ASP antibody levels and activity was measured during remission induction and associated with allergy manifestations., Methods: E. coli ASP was dosed at 7500 IU/m2. ASP IgG antibody levels were quantified at the beginning and end of induction. ASP activity was measured 24 hours after 1st and 5th dose (standard-risk) or 7th dose (high-risk patients) administration, and within 24 hours in case of allergic reactions. Allergy was monitored by CTCAE version 3. Parametric and non-parametric was performed for data analysis., Results: ASP antibody and activity levels were available in 41/63 consecutive patients. Allergic manifestations occurred in 13/41, with urticaria being the most frequent. There were no significant differences in subject characteristics based on allergic reactions. The 5th dose was the most frequent time of onset. Antibody levels in allergy group at the end of induction did not differ from those at baseline (p<0.05). Using a 24-hour level of 100 mU/mL as a threshold for adequate ASP activity, 6/13 patients with allergy had adequate levels compared to 26/28 patients without (p<0.05). The ASP activity level at the end of induction phase in both groups did not show a significant decrement., Conclusion: The E. coli ASP activity with adequate levels were significantly higher in non-allergy group. Its activity level was not accompanied by increment of IgG in allergic group indicates other factors might affect activity levels in allergy group.

Background: A mobile health (mHealth) application can encourage parents and pediatric patients to be involved in caring for their child's health condition by providing the ability to identify and actively manage chemotherapy-related symptoms in their child. Several monitoring systems available today are diverse in features and system basis. This study aimed to develop and trial the Chemo Assist for Children (CAC) mHealth application for symptom management in children with acute lymphoblastic leukemia (ALL)., Methods: In this study, the development of the CAC application went through multiple phases and methods. Study phases included: (1) development of the application's feature based on the need assessment, (2) creation of content of application based on literature review, (3) develop prototyping of CAC, (4) expert review and feedback on the application content, (5) usability testing by targeted end-user., Results: Based on need assessment, it was determined that parents with leukemia children were interested in symptom management of chemotherapy and preferred mobile applications. Therefore, a mHealth application was designed to include features to identify symptoms and provide recommendation strategies to manage the symptom. Usability evaluation by end-user revealed that mHealth is a valid, accessible, and appropriate application for users., Conclusions: The CAC mHealth application developed can meet the needs of technology users to identify symptoms and manage chemotherapy-related symptoms in children with ALL. The CAC mHealth application can accommodate data not recorded at out-of-hospital care, increase the independence of symptom management, and improve communication between parents of children with ALL and health workers., (© 2023. The Author(s).)

Aim: To define the prevalence of mortality and identify factors associated with mortality in pediatric patients with extraocular retinoblastoma attending the tertiary hospital in Indonesia., Methods: We retrospectively collected medical records from 2013 to 2019 of patients who were diagnosed with extraocular retinoblastoma. Cox proportional hazard regression analysis with 95% confidence interval (CI) was used to evaluate the association of mortality predictors with patient outcomes (Hazard Ratio [HR], 95% CI) with significance set as p < .05., Results: Overall, 60 patients were included in this study for a retrospective chart review, with 55% males and 45% females. The median age at diagnosis was 13 (5-24) months. About 60% of the patients did not survive, while 2-year survival probability was 45%. The overall median survival time was 21.5 (7.25-40.75) months. Predictors of mortality were laterality (unilateral/bilateral): HR 2.15 (95% CI: 1.07-4.28; p = .03), nutritional status: HR 2.65 (95% CI: 1.34-5.25; p = .05), and lag time to diagnosis: HR 3.12 (95% CI: 1.56-6.2; p = .001)., Conclusion: Laterality, nutritional status and lag time to diagnosis were identified to be mortality predictors in extraocular retinoblastoma. The 2-year survival for children with extraocular retinoblastoma was 45% with 21 months for median survival., (© 2022 John Wiley & Sons Australia, Ltd.)

Background: The prognosis of childhood acute lymphoblastic leukemia (ALL) in Indonesia, a lower-middle-income country (LMIC), is lower than in high income countries (HICs). The Indonesian ALL2013 protocol resulted in too many toxic deaths (21%) and abandonments (11%). Therefore, we drafted an adapted protocol, ALL2016. Main changes: no anthracyclines in standard risk (SR), prednisone replaced dexamethasone at induction in high risk (HR), and anthracyclines and cyclophosphamide were rescheduled in HR., Procedure: Patients (aged: 1-18 years) were stratified into SR and HR. HR was defined as age over 10 years, leucocyte count over 50 × 10 9 /L, central nervous system (CNS) involvement, mediastinal mass, T-cell phenotype, testicular involvement, or poor prednisone response., Results: ALL2013 included 174 patients (106 SR and 68 HR) and ALL2016 188 (91 SR and 97 HR). Although the number of HR patients was significantly higher in ALL2016 (51.6% vs. 39.1%; p = .017), the outcome of ALL2016 improved over ALL2013 (4-year-probable overall survival (pOS) 60.1% vs. 50.0%; p = .042 and 4-year-probable event-free survival (pEFS) 49.5% vs. 36.8%; p = .018). ALL2016 showed a nonsignificant advantage for SR patients (4-year-pEFS 56.0% vs. 47.2%; p = .220 and 4-year-pOS 70.3% vs. 61.3%; p = .166), but less toxic deaths (7% vs. 20%; p = .011). In HR group, the outcomes were significantly better in ALL2016 (4-year-pEFS 43.3% vs. 20.6%; p = .004; 4-year-pOS 50.5% vs. 32.4%; p = .014) especially due to less relapses (31% vs. 62%; p = .001). Isolated CNS relapses went down from 18 to 8% in HR (p = .010) and 11 to 5% in SR (p = .474). Both SR and HR showed lower numbers of abandonment in ALL2016 (6% vs. 14%; p = .039)., Conclusions: Overall ALL2016 results improved over ALL2013. Modest changes in protocol resulted in less initial toxicity and abandonments., (© 2022 Wiley Periodicals LLC.)

Objective: There is an increased awareness to identify symptomatic experiences in children undergoing chemotherapy. An Internet-based health technology accessible and friendly for children and parents to report health problems during chemotherapy has been well-developed in developed countries. The purpose of this scoping review is to provide a comprehensive view of relevant research related to the emergence of health applications in pediatric oncology so that it can provide information for design and evaluation in the future., Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines support this scoping review. To investigate the evidence on the development of Internet-based health technology, Science Direct, Scopus, PubMed, EBSCOHOST Medline, IEEEXplore, ProQuest, and Nature databases were searched between 2015 and 2021., Results: 14 articles met the inclusion criteria with nine Internet-based health technologies. Moreover, four of nine mobile health apps use a theoretical foundation (SPARK for children and family member, Empower Stars!, THRIVE, and Facebook-based "Healthy Teens for Soaam"), three apps apply four stages of development and testing, and all apps have met the category of the degree of attachment of patients to the application., Conclusion: The effect of Internet-based health technology through a scientific process by paying attention to the underlying theories, user needs, developer passion, application testing, and evaluation methods is the key to success.

Background: Starting from 2014, the Indonesian government has implemented Universal Health Coverage (UHC) with the aim to make healthcare services accessible and affordable to all Indonesian citizens. A major reason for childhood cancer treatment failure in low- and middle-income countries, particularly among families with low socioeconomic status (SES), is abandonment of expensive cancer treatment. Our study compared childhood cancer treatment outcomes of the overall, low, and high SES population before and after introduction of UHC at a large Indonesian academic hospital., Methods: Medical records of 1040 patients diagnosed with childhood cancer before (2011-2013, n = 506) and after (2014-2016, n = 534) introduction of UHC were abstracted retrospectively. Data on treatment outcome, SES, and health-insurance status at diagnosis were obtained., Findings: After introduction of UHC, the number of insured patients increased from 38% to 82% (P < 0.001). Among low SES population, insurance coverage increased from 40% to 85% (P < 0.001), and among high SES population from 33% to 77% (P < 0.001). In the overall population, treatment abandonment decreased from 36% to 22% (P < 0.001). Event-free survival estimates at four years after diagnosis of overall population improved from 16% to 22% (P < 0.001). Hazard ratio for treatment failure was 1.26 (CI: 1.07-1.48, P = 0.006) for uninsured versus insured patients. In the low SES population, treatment abandonment decreased from 36% to 19% (P < 0.001). Event-free survival estimates at four years after diagnosis of low SES population improved from 14% to 22% (P < 0.001)., Interpretation: Introduction of UHC in Indonesia contributed significantly to better treatment outcome and event-free survival of children with cancer from low SES families., (© 2021 Wiley Periodicals LLC.)

The administration of high-dose methotrexate (HD-MTX) requires an accurate monitoring of blood MTX levels to determine the regimen of leucovorin rescue and urine alkalinization to prevent toxicity. However, it is technically and logistically challenging to screen patients routinely in limited-resource settings. This study aimed to evaluate blood MTX levels at 24- and 48-hours from start of infusion in relation to clinical toxicity in childhood ALL., Methods: A prospective cohort study was conducted on 32 consecutive children with acute lymphoblastic leukemia (ALL) who had received at least one cycle of 1 g/m2 HD-MTX intravenous infusion as a part of consolidation treatment based on the 2013 Indonesian ALL Protocol. In total, 68 cycles were evaluated. Serum MTX concentrations were measured using enzyme immunoassay. MTX toxicity was categorized using common toxicity criteria (CTCAE) 3.0 version. The association between MTX level and clinical toxicity was assessed by non-parametric analysis., Results: The 24-hours MTX level was median 29.8 ng/mL (0.065 µmol/L) (IQR 8.1-390.6) with a modest decrease in 48-hours MTX serum level in all cycles (median 28.3 ng/mL and 0.062 µmol/L; IQR 0.35-28.7; p <0.05). The two most common toxicities were hepatotoxicity (32.2%) and neutropenia (30.9%). Nephrotoxicity and febrile neutropenia occurred in 8.8% and 5.8% of patients, respectively, with low percentage of mucositis (4.3%) and thrombocytopenia (5.6%) recorded.  No statistically significant association was found between MTX levels and clinical toxicity, except for liver toxicity., Conclusion: Serum MTX levels at 24-hours and 48-hours are low, followed by only 4.4% grade III/IV hepatotoxicity and 26,4% grade III/IV neutropenia. There is no significant association between the clinical toxicity and MTX levels at the two points of measurement. An attempt to increase the MTX dose and/or to introduce a loading dose should be considered in subsequent ALL protocol as supported by further pharmacokinetic MTX studies in the Indonesian population.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale., Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis., Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017., Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis., Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68])., Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs.

Population-based cancer registries generate estimates of incidence and survival that are essential for cancer surveillance, research, and control strategies. Although data on cancer stage allow meaningful assessments of changes in cancer incidence and outcomes, stage is not recorded by most population-based cancer registries. The main method of staging adult cancers is the TNM classification. The criteria for staging paediatric cancers, however, vary by diagnosis, have evolved over time, and sometimes vary by cooperative trial group. Consistency in the collection of staging data has therefore been challenging for population-based cancer registries. We assembled key experts and stakeholders (oncologists, cancer registrars, epidemiologists) and used a modified Delphi approach to establish principles for paediatric cancer stage collection. In this Review, we make recommendations on which staging systems should be adopted by population-based cancer registries for the major childhood cancers, including adaptations for low-income countries. Wide adoption of these guidelines in registries will ease international comparative incidence and outcome studies., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

At the government, hospital, and health-care provider level, corruption plays a major role in health-care systems in Africa. The returns on health investments of international financial institutions, health organisations, and donors might be very low when mismanagement and dysfunctional structures of health-care systems are not addressed. More funding might even aggravate corruption. We discuss corruption and its effects on cancer care within the African health-care system in a sociocultural context. The contribution of high-income countries in stimulating corruption is also described. Corrupt African governments cannot be expected to take the initiative to eradicate corruption. Therefore, international financial institutions, health organisations, and financial donors should use their power to demand policy reforms of health-care systems in Africa troubled by the issue of corruption. These modifications will ameliorate the access and quality of cancer care for patients across the continent, and ultimately improve the outcome of health care to all patients., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

The frequency of acute lymphoblastic leukemia (ALL) patients expressing myeloid antigens on their ALL cells varies between 5 and 36% in several different studies. The clinical relevance of myeloid antigen expression in childhood ALL is controversial. In Indonesian patients, no data were present. Therefore, in Yogyakarta, Indonesia, we analyzed 239 ALL patients who were immunophenotyped including myeloid markers (CD13, CD33, CD117, and/or cMPO). Myeloid antigen expression was found in 25% of patients. Expression of myeloid antigen in B-lineage leukemia was 27%, and in T-lineage leukemia, it was 18% (P = 0.15). No association was found between myeloid antigen expression and clinical or biological features. In the whole cohort of patients we did not find a significant association between myeloid antigen expression and survival, although leukemia-free survival at 3 years was higher in the myeloid-negative patients (73% ± 6%) compared to myeloid-positive patients (67% ± 8%). Interestingly, in T-ALL patients, expression of myeloid antigens was an independent adverse prognostic factor (hazard ratio: 3.26, 95% CI: 1.06-9.98, P = 0.04). Kaplan-Meier analysis for event-free survival was also significant (log rank P = 0.03) in this subgroup. In conclusion, in the Indonesian ALL population, in particular, myeloid antigen-expressing T-ALL patients had a higher chance of having induction failure.

Introduction: In July 2001, a 'twinning' project was undertaken between University Gadjah Mada, Indonesia, and the Saskatchewan Cancer Agency, Canada to create a computerised Pediatric Cancer Registry at Sardjito Hospital, Yogyakarta city., Objectives: To analyse information from the Yogyakarta Pediatric Cancer Registry (YPCR) in order to i) determine the prevalence of pediatric cancers in Yogyakarta Special Region and, ii) compare the demographics of pediatric malignancies in the Special Region (population: 3.3 million), with those of the Saskatchewan Cancer Registry in the province of Saskatchewan (population: 1 million)., Methodology: In May 2001, a computer dedicated to the YPCR was installed at Sardjito Hospital. Bilingual (English/Indonesian) data capture forms were developed for data extraction from hospital health records. Data items were then entered into a data base using the Statistical Package For Social Sciences (SPSS) program. Two projects were initiated: i) a prospective study from 2000-2009 of pediatric cancer cases from the YPCR, and ii) a comparison of demographics from both Cancer Registries during the time period 1996-2003. Comparative data were obtained for age, sex, diagnoses, and referral patterns. Results were analysed using the SPSS software program., Results: i) In the 10 year prospective study, 1,124 pediatriccancer cases were accrued in the Yogyakarta Registry, the majority being in the age group 0-5 years. Male:female: 7:1. Leukemias were the most common diagnosis, followed by retinoblastoma and neuroblastoma. The majority of patients (68%) were referred from outside the catchment area of Yogyakarta Special Region. ii) In the 8 year archival comparative analysis, the most striking contrasts were a higher proportion of children with retinoblastoma and negligible numbers of pediatric brain tumors in the Yogyakarta Registry., Conclusion: This is the first published report of a computerised pediatric cancer registry in Indonesia. The differences in diagnostic frequencies noted above may, in part, be due to comparisons between the population-based Saskatchewan Cancer Registry versus the hospital-based Yogyakarta Pediatric Cancer Registry. The contrasts in demographics are multifactorial, and require further investigation.

Genetic variations in the polymorphic tandem repeat sequence of the enhancer region of the thymidylate synthase promoter (TSER), as well as in methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism, influence methotrexate sensitivity. We studied these polymorphisms in children with acute lymphoblastic leukaemia (ALL) and in subjects without malignancy in Indonesia and Holland. The frequencies of TT and CT genotypes were two-fold higher in Dutch children. The TSER 3R/3R repeat was three-fold more frequent in the Indonesian children, while the 2R/2R repeat was only 1% compared to 21% in the Dutch children. No differences of these polymorphisms were found between ALL cells and normal blood cells, indicating an ethnic rather than leukemic origin. These results may have implications for treatment of Indonesian children with ALL.