The association between prenatal and or post natal growth disorder and lipid profile in adolescents aged 12 - 15 years old in Tanjungsari Subdistrict, Sumedang, West Java.

AIM: to investigate association between growth disorders in pre and post natal period and abnormal lipid profile in adolescents aged 12 -15 years old in Tanjungsari population. METHODS: a cohort study was conducted in 3350 children who were born in 1988-1990 in Tanjungsari Subdistrict, Sumedang, West Java. A complete anthropometric data since their birth were collected from October 2002-February 2003. INCLUSION CRITERIA: Children who had birth weight in the range of +/- 3 of standard deviation (SD). Post natal growth disorder based on Z score of height according to age group and height changes at the age of 0-12 months and 12-36 months. SGA criteria were determined based on cross tabulation between weight and birth length at birth. Study subjects were divided into control group, groups of pre natal, post natal and pre-postnatal growth disorder. All subjects were checked for lipid profiles. Statistical calculation used analysis of variance, t test and logistic regression. 312 subjects were included in this study, 73 were in control group, 90 subjects in postnatal, 96 subjects were in pre natal and 53 subjects were in pre-post natal growth disorder group. RESULTS: this study has not shown significant difference in risk factor of having abnormal lipid profile between normal control group and growth disorder group except for those in prenatal growth disorder group with RR = 2.375 (p = 0.014). CONCLUSION: the post natal growth disorder had not influenced lipid profile in adolescents with SGA. Recent BMI was an additional risk factor for pre-post natal growth disorder group.

An integrated village maternity service to improve referral patterns in a rural area in West-Java.

The Regionalization of Perinatal Care, an intervention study carried out in Tanjungsari, a subdistrict in rural West Java, aimed to develop a comprehensive maternal health program to improve maternal and perinatal health outcomes. The main inputs included training at all levels of the health care system (informal and formal) and the establishment of birthing homes in villages to make services more accessible. Special attention was given to referral, transportation, communication and appropriate case management, A social marketing program was conducted to inform people of the accessible birthing homes for clean delivery, located near the women, and with better transportation and communications to referral facilities should complications arise. The study design was longitudinal, following all pregnant women from early pregnancy until 42 days postpartum in an intervention and a comparison area. The population was +/- 90,000 in the intervention area and 40,000 in the comparison area. Inclusion criteria were all mother and infant units delivered between June 1st, 1992 and May 31st, 1993. Analysis showed the following results: Most women sought antenatal care (> 95%). In Tanjungsari, nearly 90% sought such care from professional providers as versus 75% in the control area of Cisalak. Most women with bleeding or bleeding and edema during pregnancy sought professional assistance in both the study and control areas. However, fever for more than 3 days received more attention in the study area versus control area (93 vs. 69%). Greater than 85% of deliveries in both areas were conducted by TBAs. However, in the study area, nearly one-third of those with intrapartum complications (17%) delivered in a health facility compared to one-tenth in the control area. This meant a hospital delivery, primarily with assistance of a doctor or doctor/midwife combination. Overall referral rates by TBAs were low -13% of women with complications in Tanjungsari and 6% in Cisalak. More women with intrapartum complications were referred in the study area than in the control, and more complied when referred. Women who suffered intrapartum complications were more likely to have a perinatal death. Perinatal deaths declined in Tanjungsari, but not significantly. However, the trend over the period of the intervention shows an improvement in the deliveries managed by TBAs with more deaths resulting in the hands of professionals. Either women were arriving too late or the quality of care could not meet the needs. There was no change in the levels or place of perinatal deaths in Cisalak.

Hepatitis B virus vaccination and antenatal transmission of HBV markers to neonates.

The high prevalence of hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) in pregnant women is considered to be the most important factor contributing to the high carrier rate of HBsAg in some populations. Several factors, including the age at which infection occurs, predispose to the acquisition and frequency of the carrier state. The proportion of infected people who become chronic carriers ranges from about 80 to 95% for babies born to HBsAg/HBeAg-positive mothers. In this study of Indonesian infants receiving only active immunization against HBV, we measured the HBV markers passively acquired from their HBsAg-positive mothers. The relationship of these markers with vaccination response and with HBV infection status was studied longitudinally in the infants. In the exposed neonates from the HBsAg-positive mothers (n=61), the seroconversion rate to hepatitis B surface antibody (HBsAb) positivity was 95% after the first booster vaccination, with a geometric mean titre (GMT) of 2017 IUl-1. After 60 months, the GMT in this group decreased to 50 IUl-1. Four newborns in this group became HBsAg carriers. Of the four vaccination failures, three newborns were HBsAg/HBeAg positive at birth, suggesting that they had been infected in utero. No vaccination strategy (active alone, or passive/active) can prevent this transmission from occurring. One carrier was HBsAg negative at birth and up to month 4 but was HBsAg positive at month 12 and subsequently, suggesting a postnatal infection. Vaccination early in life can, to a large extent, prevent perinatal transmission and hepatitis B virus (HBV) infection later in infancy and childhood. In this study, the protective efficacy of the vaccination was 85% in the subcohort of neonates from HBeAg-positive mothers and 100% in the subcohort of neonates from HBeAg-negative mothers. Lack of maternal antibodies to hepatitis B core antigen (HBcAb) correlated strongly with transmission of HBV infection.

Perinatal mortality and morbidity in rural West-Java, Indonesia. Part I: Vital statistics based on cross-sectional surveys.

The first part of this article gives the summary result of 4 cross-sectional surveys conducted in 3 rural villages in West Java. It is expected that these surveys provide the researchers with more precise data on perinatal mortality and its associated causes in order to plan and implement the Tanjungsari Intervention Study (1986-1990). This comprises a mapping and numbering survey, and a census survey. Based on a sampling frame of 7964 houses, a systematic sample (one in eleven) was drawn for the Household and for the Married Women Surveys. The survey results yield some basic demographic indicators, occupational information and data on education. Also data on environmental health and vital statistics are presented. It is shown that the crude birth rate is 40 per thousand and that the estimated infant mortality rate reaches a figure of 120%. Furthermore, during individual interviews data was collected on characteristics, attitudes habits as well as on reproductive behaviour, of all married women under 50 years of age.

Perinatal mortality and morbidity in rural West-Java, Indonesia. Part II: The results of a longitudinal survey on pregnant women.

The main objective of this prospective survey is to obtain more information on the natural history of pregnancy and its outcome, including low birth weights, and of the factors closely associated with it. During the survey period the birth rate was 40 per thousand and the perinatal death rate 48 per thousand. The main causes of neonatal deaths are infections (predominantly tetanus) and hypoxia/birth asphyxia. Perinatal mortality is significantly associated with the following risk factors: age of mother less than 20 years; birth interval shorter than 18 months, twins, and breech presentation. The incidence of low birth weight is 14.7%. Statistically significant associations have been found between low birth weight and several risk factors.

PIP: Traditional birth attendants made 5 home visits to each pregnant woman in Ujung-Berung area of rural West Java in Indonesia between September 1978-February 1980 to determine the natural history of pregnancy and its outcome and the factors associated with the different outcomes. They performed 87% of the deliveries. 4 mothers died (1.7% of all live births). The birth rate was 40% and 2335 infants were born. The perinatal mortality rate stood at 44.5. The percentage of fetal deaths was 13.7% (32) and of early neonatal deaths was 31.2% (72). The leading cause of early neonatal death was infection (50.2%) and tetanus neonatorum contributed to mortality in 79% of these cases (case fatality rate 100%). In the early neonatal period, the tetanus specific perinatal mortality was 17%. Further it stood at a high of 9.5/1000 live births due to low tetanus immunization coverage. Intrauterine hypoxia and birth asphyxia contributed the most to perinatal deaths (57.8%) followed by infections (23.6%). Twin births posed 4.14 times the risk of perinatal mortality than did singleton births (p.05). The single most significant risk factor for perinatal mortality, however, was breech delivery (relative risk [RR] 5.7; p.05). Mother's age 20 years (RR 1.28) and birth interval between 6-17 months (2.76) comprised the only other 2 significant risk factors (p.05). 14.7% of the infants weighed 2500 g. For low birth weight (LBW) infants, twin births posed the greatest risk to mortality (RR 5.65) followed by complications before delivery (RR 3.7), breech birth (RR 2.3), and 1st birth (RR 2.06) [all significant at p.05]. LBW infants had a high percentage of illnesses during the neonatal period (30.2%). Overall morbidity during this time stood at 16.9%.

Prevalence of anti-delta antibodies in pregnant women in Bandung, Indonesia.

Knowledge of the epidemiology of hepatitis D virus (HDV)-infection is very scarce in many parts of the world. The endemicity of delta-infection is believed to be maintained and spread through the network of hepatitis B surface antigen (HBsAg) carriers in the community. In the Far East and the Pacific area, the prevalence of chronic HBsAg carriers is mostly high. Markers of HDV infection are very frequent in some regions (e.g. parts of China, Fiji Isles, Samoa), in other regions they are almost absent (e.g. Taiwan, Thailand, parts of China). In the Bandung region (West Java, Indonesia) we found 26 (2.8%) HBsAg carriers among 926 pregnant women. Most of them are chronic carriers (anti hepatitis B core (HBc) IgM negative). Although HBsAg is frequent in this Indonesian population, we could not find any anti-HD positive. This data warrants the conclusion that HDV infection has not yet been introduced in that densely populated area of Indonesia.

Anti-HBs kinetics after HBV vaccination in neonates.

BACKGROUND AND OBJECTIVES: We report the results of a study using a recombinant DNA HBV vaccine in newborns from an endemic area for HBV and compare the anti-HBs kinetics with observations in adults in order to make estimates about the need for booster vaccinations. STUDY DESIGN: One hundred and forty-eight neonates were vaccinated and followed for 62 months. Based on the presence or absence of hepatitis B surface antigen in the mother, cohorts of 'exposed' and of 'non-exposed' neonates were identified. RESULTS: A maximum concentration is normally observed after the booster vaccination followed by a rapid decline. According to Ambrosch et al. and Gesemann et al., titer calculations as a function of time, yielded 37 IU/1 and 47 IU/1 at month 60 respectively. The mean titer for the three groups of neonates investigated was at that time 74 IU/1. The prospective time intervals to arrive at an anti-HBs level of at least 10 IU/1 can be individually calculated from the individual titer after the booster vaccination. These calculated estimates show respectively: that 8.3% of the vaccinated neonates need a new booster vaccination within 14 months; that 26.7% will need a new booster within 50 months; and that only 65% need a new booster in 50 or more months. CONCLUSION: It can be concluded that anti-HBs kinetics in very young children and adults are comparable. The least expensive way of maintaining protection against HBV in neonates seems to be the determination of the individual titers after the first booster vaccination and calculation of the prospective time interval to arrive at a minimum titer of 10 IU/1 and the need for a new booster vaccination.

Immunogenicity of a recombinant DNA hepatitis B vaccine in neonates.

Infants of HBsAg-positive mothers (Group I) as well as those born to women without HBV markers (Group II) were vaccinated with a 10 micrograms dose of a recombinant DNA hepatitis B vaccine within 24 hours after birth according to a 0, 1, and 2 month schedule, with a booster dose planned 12 months later. Vaccination results in 14 (Group I) and 47 (Group II) neonates showed that at two months after the third dose of vaccine, 86% (6/7) and 100% (37/37), respectively, seroconverted, with anti-HBs geometric mean titres of 80 IU/l and 266 IU/l in the respective groups. No adverse reactions to the vaccine were observed. These preliminary results indicate that the recombinant DNA hepatitis B vaccine is safe and highly immunogenic in newborns.

Thermal control of the newborn: knowledge and practice of health professional in seven countries.

Hypothermia is a common problem in neonates, particularly in developing countries where it is an important contributory factor to neonatal mortality and morbidity. An evaluation of the knowledge and practices of health professionals on the thermal control of newborns was carried out in seven countries: Brazil, India, Indonesia, Kazakhstan, Mozambique, Nepal and Zimbabwe. The evaluation, conceived as a preliminary phase for a one-day training course on thermal control, involved 28 health facilities and 260 health professionals (61 doctors and 199 nurses and midwives). It included an assessment of thermal control practices carried out in each health facility by external investigators and a questionnaire on knowledge about thermoregulation administered to health professionals involved in newborn care. The findings of the evaluation were consistent across countries and showed that thermal control practices were frequently inadequate in the following areas: ensuring a warm environment at the time of delivery; initiation of breastfeeding and contact with mother, bathing; checking the baby's temperature; thermal protection of low birth weight babies, and care during transport. Knowledge on thermal control was also insufficient, especially concerning the physiology of thermoregulation and criteria for defining hypothermia. During the one-day course that followed the evaluation, participants were able to recognize the existing gaps and to identify appropriate interventions. Knowledge and practice on the thermal control of the newborn are currently insufficient. However, awareness of the importance of thermal control and basic knowledge on thermal regulation and thermal protection can be easily acquired and on this basis motivation for improving thermal control practices can be developed.