Biomarker-Determined Nonylphenol Exposure and Associated Risks in Children of Thailand, Indonesia, and Saudi Arabia.

Nonylphenol (NP) is an endocrine disruptor and environmental contaminant. Yet, data on individual body burdens and potential health risks in humans, especially among children, are scarce. We analyzed two specific urinary NP metabolites, hydroxy-NP (OH-NP) and oxo-NP. In contrast to parent NP, OH-NP has a much higher urinary excretion fraction (Fue), and both are insusceptible to external contamination. We investigated spot urine samples from school children of Thailand (n = 104), Indonesia (n = 89), and Saudi Arabia (n = 108) and could quantify OH-NP in 100% of Indonesian and Saudi children (median concentrations: 8.12 and 8.57 µg/L) and in 76% of Thai children (1.07 µg/L). Median oxo-NP concentrations were 0.95, 1.10, and <0.25 µg/L, respectively, in line with its lower Fue. Median daily NP intakes (DIs), back-calculated from urinary OH-NP concentrations, were significantly higher in Indonesia and Saudi Arabia [0.47 and 0.36 µg/(kg bw·d), respectively] than in Thailand [0.06 µg/(kg bw·d)]. Maximum DIs were close to the preliminary tolerable DI of 5 µg/(kg bw·d) from the Danish Environmental Protection Agency. Dominant sources of exposure or relevant exposure pathways could not be readily identified by questionnaire analyses and also potentially varied by region. The novel biomarkers provide long-needed support to the quantitative exposure and risk assessment of NP.

Urinary Concentrations of Major Phthalate and Alternative Plasticizer Metabolites in Children of Thailand, Indonesia, and Saudi Arabia, and Associated Risks.

Phthalates are widely used in consumer products and are well-known for adverse endocrine outcomes. Di-(2-ethylhexyl) phthalate (DEHP), one of the most extensively used phthalates, has been rapidly substituted with alternative plasticizers in many consumer products. The aim of this study was to assess urinary phthalate and alternative plasticizer exposure and associated risks in children of three Asian countries with different geographical, climate, and cultural characteristics. Children were recruited from elementary schools of Saudi Arabia (n = 109), Thailand (n = 104), and Indonesia (n = 89) in 2017-2018, and their urine samples were collected. Metabolites of major phthalates and alternative plasticizers were measured in the urine samples by HPLC-MS/MS. Urinary metabolite levels differed substantially between the three countries. Metabolite levels of diisononyl phthalate (DiNP), diisodecyl phthalate (DiDP), di(2-ethylhexyl) terephthalate (DEHTP), and 1,2-cyclohexane dicarboxylic acid diisononyl ester (DINCH) were the highest in Saudi children: Median urinary concentrations of oxo-MiNP, OH-MiDP, 5cx-MEPTP, and OH-MINCH were 8.3, 8.4, 128.0, and 2.9 ng/mL, respectively. Urinary DEHP metabolite concentrations were the highest in the Indonesian children. The hazard index (HI) derived for the plasticizers with antiandrogenicity based reference doses (RfDAA) was >1 in 86%, 80%, and 49% of the Saudi, Indonesian, and Thai children, respectively. DEHP was identified as a common major risk driver for the children of all three countries, followed by DnBP and DiBP depending on the country. Among alternative plasticizers, urinary DEHTP metabolites were detected at levels comparable to those of DEHP metabolites or higher among the Saudi children, and about 4% of the Saudi children exceeded the health based human biomonitoring (HBM)-I value. Priority plasticizers that were identified among the children of three countries warrant refined exposure assessment for source identification and relevant exposure reduction measures.

Experience of healthcare workers in combatting COVID-19 in Indonesia: A descriptive qualitative study.

Background: The number of COVID-19 cases in Indonesia continues to rise. The roles and responsibilities of healthcare workers are crucial in the battle of the COVID-19. Objective: This study aimed to explore the experience of healthcare workers in combatting COVID-19 in some parts of Indonesia. Methods: This study employed a descriptive qualitative study design. Online semi-structured interviews were conducted in April 2020 among thirteen participants who were purposively selected. Data were analyzed using thematic analysis. Results: Eight themes emerged from data, including lack of personal protective equipment, lack of referral hospitals and limited facilities, dealing with patients with unknown status, feeling worried about getting infected or being a source of viral transmission, being creative, too long shift and fatigue, being surrender to God, and government issues. Conclusion: Findings of this study could be used as the input for the government, healthcare workers, and the general population in combatting COVID-19.

Correlation between weather and Covid-19 pandemic in Jakarta, Indonesia.

This study aims to analyze the correlation between weather and covid-19 pandemic in Jakarta Indonesia. This study employed a secondary data analysis of surveillance data of covid-19 from the Ministry of Health of the Republic of Indonesia and weather from the Meteorological Department of the Republic of Indonesia. The components of weather include minimum temperature (°C), maximum temperature (°C), temperature average (°C), humidity (%), and amount of rainfall (mm). Spearman-rank correlation test was used for data analysis. Among the components of the weather, only temperature average (°C) was significantly correlated with covid-19 pandemic (r = 0.392; p < .01). The finding serves as an input to reduce the incidence rate of covid-19 in Indonesia.

Climate variability and dengue hemorrhagic fever in Southeast Sulawesi Province, Indonesia.

To determine the association of climatic factors and dengue hemorrhagic fever and to develop the prediction approach of future dengue transmission. The study used totally monthly dengue hemorrhagic fever cases at Health Office Kendari, Southeast Sulawesi, Indonesia. Monthly meteorological data, consisting of temperature, rainfall, and humidity, was obtained from the Meteorology, Climatology and Geophysics Agency in Kendari district. All data analysis, including Spearman and Poisson distribution, was carried out in R Studio (version 3.3.2) utilizing the R statistical language version 2.15. The highest rate of dengue hemorrhagic fever cases was found in January, February, and March. Temperature averages at lag 2 (p = 0.53, p < 0.0001), lag 3 (p = 0.59, p < 0.0001), and lag 4 (p = 0.41, p < 0.01)) correlated with the incident rate of DHF. The average temperature at lag 2 was found to have a positive impact on the incidence of DHF by Poisson function. This study provides preliminary evidence of the influence of climatic factors on dengue transmission.

The outbreak of diphtheria in Indonesia.

Diptheria is commonly caused by the aerobic gram-positive bacteria, corynebacterium diphtheria. We herein report an unusual case of diphtheria outbreak in Indonesia in 2017 and its possible causes and current management.

Factors related to the exclusive breastfeeding in the working area of PHC Poasia, Kendari City

Introduction: Inadequate exclusive breastfeeding is responsible for more than 236,000 child deaths each year and significantly increases the risk of death in infancy and childhood. While the COVID-19 Pandemic continues, this should not be a barrier for breastfeeding mothers to breastfeed their babies. This study aims to analyze the factors related to exclusive breastfeeding during the COVID-19 pandemic in the working area of the Poasia Health Center, Kendari City. Methods: This cross-sectional study involves 100 participants in the working area of the Poasia Public Health Center, Kendari City. The dependent variable in this study was exclusive breastfeeding during the COVID-19 pandemic, while the independent variables were age, employment status, education level, parity, family support, and support from health workers. Data analysis was carried out in stages, including univariate, bivariate, and multivariate analysis. Results: The results showed a relationship between parity (p-value = 0.006), family support (pvalue = 0.001), and support from health workers (p-value = 0.003) with exclusive breastfeeding in the working area of the Poasia Health Center, Kendari City. At the same time, age (p-value = 0.524), status, occupation (p-value = 0.452), and education level (p-value = 0.708) are not related. The results of multivariate analysis using logistic regression showed that family support was most associated with exclusive breastfeeding (Exponent (B) = 8.549). Conclusions: The lower the mother's parity, the more likely she is to give exclusive breastfeeding. Good and maximal family and staff support will stimulate the mother to give exclusive breastfeeding. (AU)

Introducción: La lactancia materna exclusiva inadecuada es responsable de más de 236.000 muertes infantiles cada año y aumenta significativamente el riesgo de muerte en la infancia y la niñez. Mientras continúa la pandemia de COVID-19, esto no debería ser una barrera para que las madres que amamantan amamanten a sus bebés. Este estudio tiene como objetivo analizar los factores relacionados con la lactancia materna exclusiva durante la pandemia Covid-19 en el área de trabajo del Centro de Salud Poasia, ciudad de Kendari. Métodos: Este estudio transversal involucró a 100 participantes en el área de trabajo del Centro de Salud Pública de Poasia, ciudad de Kendari. La variable dependiente en este estudio fue la lactancia materna exclusiva durante la pandemia de COVID-19, mientras que las variables independientes fueron edad, situación laboral, nivel educativo, paridad, apoyo familiar y apoyo de los trabajadores de la salud. El análisis de los datos se realizó por etapas, incluyendo análisis univariante, bivariado y multivariado. Resultados: Los resultados mostraron una relación entre la paridad (valor p = 0,006), el apoyo familiar (valor p = 0,001) y el apoyo de los trabajadores de la salud (valor p = 0,003) con la lactancia materna exclusiva en el área de trabajo de la Salud Poasia. Centro, ciudad de Kendari. Al mismo tiempo, la edad (valor de p = 0,524), el estado, la ocupación (valor de p = 0,452) y el nivel de educación (valor de p = 0,708) no están relacionados. Los resultados del análisis multivariado mediante regresión logística mostraron que el apoyo familiar estaba más asociado con la lactancia materna exclusiva (exponente (B) = 8.549). Conclusiones: Cuanto menor sea la paridad de la madre, mayor es la probabilidad de que dé lactancia materna exclusiva. Un buen y máximo apoyo familiar y del personal estimulará a la madre a dar lactancia materna exclusiva. (AU)