Understanding stunting risk factors in Kampar Regency: Insights from mothers with stunted children (qualitative study).

Objective: To assess the perceptions of mothers with stunted children regarding the factors contributing to stunting in Kampar Regency, Riau Province, Indonesia. Introduction: Stunting is intricately linked to underlying risk factors, and understanding these factors is crucial for preventing its recurrence, particularly for mothers who play a central role in caring for stunted children. Methods: The research sample consisted of mothers referred by the Perhentian Raja Community Health Center with stunted children. Purposive sampling was employed to select informants and thematic analysis was used for data analysis. Results: A total of 15 informants were interviewed, leading to the identification of five themes related to stunting risks: (1) before pregnancy, (2) during pregnancy, (3) postnatal, (4) infectious disease factors, and (5) socio-demographic factors. Conclusion: The study indicates that mothers hold diverse opinions about factors contributing to stunting, with their views being shaped by health programs and personal experiences, specifically focusing on aspects like breastfeeding and weaning foods. Additionally, it underscores that education and economic challenges introduce complexity to understanding how mothers perceive the risk factors associated with stunting.

LSTM algorithm optimization for COVID-19 prediction model.

The development of predictive models for infectious diseases, specifically COVID-19, is an important step in early control efforts to reduce the mortality rate. However, traditional time series prediction models used to analyze the disease spread trends often encounter challenges related to accuracy, necessitating the need to develop prediction models with enhanced accuracy. Therefore, this research aimed to develop a prediction model based on the Long Short-Term Memory (LSTM) networks to better predict the number of confirmed COVID-19 cases. The proposed optimized LSTM (popLSTM) model was compared with Basic LSTM and improved MinMaxScaler developed earlier using COVID-19 dataset taken from previous research. The dataset was collected from four countries with a high daily increase in confirmed cases, including Hong Kong, South Korea, Italy, and Indonesia. The results showed significantly improved accuracy in the optimized model compared to the previous research methods. The contributions of popLSTM included 1) Incorporating the output results on the output gate to effectively filter more detailed information compared to the previous model, and 2) Reducing the error value by considering the hidden state on the output gate to improve accuracy. popLSTM in this experiment exhibited a significant 4% increase in accuracy.

Transcription factor WOX11 modulates tolerance to cyst nematodes via adventitious lateral root formation.

The transcription factor WUSCHEL-RELATED HOMEOBOX 11 (WOX11) in Arabidopsis (Arabidopsis thaliana) initiates the formation of adventitious lateral roots upon mechanical injury in primary roots. Root-invading nematodes also induce de novo root organogenesis leading to excessive root branching, but it is not known if this symptom of disease involves mediation by WOX11 and if it benefits the plant. Here, we show with targeted transcriptional repression and reporter gene analyses in Arabidopsis that the beet cyst nematode Heterodera schachtii activates WOX11-mediated adventitious lateral rooting from primary roots close to infection sites. The activation of WOX11 in nematode-infected roots occurs downstream of jasmonic acid-dependent damage signaling via ETHYLENE RESPONSE FACTOR109, linking adventitious lateral root formation to nematode damage to host tissues. By measuring different root system components, we found that WOX11-mediated formation of adventitious lateral roots compensates for nematode-induced inhibition of primary root growth. Our observations further demonstrate that WOX11-mediated rooting reduces the impact of nematode infections on aboveground plant development and growth. Altogether, we conclude that the transcriptional regulation by WOX11 modulates root system plasticity under biotic stress, which is one of the key mechanisms underlying the tolerance of Arabidopsis to cyst nematode infections.

Study on physicochemical characteristics of local colored rice varieties (black, red, brown, and white) fermented with lactic acid bacteria (SBM.4A).

In this study, the physicochemical properties of local colored rice flour were studied after modification through fermentation with lactic acid bacteria (LAB) SBM.4A. SBM.4A was LAB isolated from the rice washing water and was in the cladogram of the Pediococcus pentosaceus strain SRCM102739 CP028266.1 and Pediococcus pentosaceus strain SRCM102738 CP028264.1. The studied rice varieties were wakacinda (white rice), wakawondu (red rice), warumbia (brown rice), and wakaombe (black rice). Characterizations of both fermented and native rice flour included chemical composition, FTIR profile, crystallinity, morphology, and pasting properties. Fermentation did not introduce new chemical functional groups to the flour and only slightly increased crystallinity from approximately 22.5% to 25.05%. In contrast, fermentation greatly affected the chemical composition and pasting properties of rice flour. Protein content of the fermented flour increased up to 214% relative to the native rice flour. Effect of fermentation on pasting properties varied between rice varieties. Increase in peak and final viscosities was observed in red, brown, and black rice. The opposite effect was found in white rice. However, fermentation improved the stability of flour to retrogradation for all rice varieties. These showed that the fermentation improved the properties of the local-colored rice flour and may widen their application as food ingredients.

Identification and Determination of the Seminiferous Epithelium Stages and Spermatid Development in the Testis of Aceh Bull (Bos indicus).

This study was conducted to describe the stages of seminiferous epithelium (SE), determine the relative frequency of the stages, and identify the steps of spermatid development during spermatogenesis in the testicular tissue of Aceh bull. Seven pairs of the testicular organs of Aceh bull (Bos indicus) were used and then processed in a histological manner for staining using haematoxylin and eosin (H&E) and periodic acid-Schiff-haematoxylin (PAS-H). The stages of seminiferous tubules were examined using a tubular morphology method while spermatid development was observed based on the acrosome formation during spermatid development. Eight stages (stages I to VIII) of SE were found in the testicular seminiferous tubules of Aceh bull. Furthermore, the percentage of the relative frequency of each stage was 25.48, 15.38, 12.92, 4.74, 14.97, 10.69, 10.74, and 5.08%, respectively, with the relative frequency of premeiotic, meiotic, and postmeiotic phases being 53.78, 4.74, and 41.48%, respectively. Spermatid development from round to elongated spermatids occurred in 14 steps. Steps 1 to 7 were observed in stage I, steps 8 and 9 in stage II, steps 10 and 11 in stage III, step 12 in stage IV, step 13 in stages V and VI, and step 14 in stages VII and VIII. These findings can be used as a basis for further studies, particularly in evaluating the abnormality of the cellular composition of the seminiferous tubule in each stage of spermatogenesis and also in determining daily sperm production in Aceh bull.

Comprehensive approaches for assessing extinction risk of endangered tropical pitcher plant Nepenthes talangensis.

It has been 23 years since the conservation status of highland tropical pitcher plant Nepenthes talangensis was assessed in 2000. A number of existing threats (anthropogenic and environmental) may be increasing the risk of extinction for the species. A better understanding of the ecology and conservation needs of the species is required to manage the wild populations. Specifically, better information related to population distributions, ecological requirements, priority conservation areas, the impact of future climate on suitable habitat, and current population structure is needed to properly assess extinction risks. A better understanding of the requirements of the species in its natural habitat would benefit for successfully securing the species at Botanic Gardens. We have identified 14 new occurrence records of N. talangensis in Mount Talang. Study on the ecological requirement using Random Forest (RF) and Artificial Neural Network (ANN) suggested that elevation, canopy cover, soil pH, and slope are four important variables. The population of N. talangensis was dominated by juvenile and mature (sterile) individuals, we found only a few mature males (7 individuals) and females (4 individuals) in the sampled areas. Our modelling of current conditions predicted that there were 1,076 ha of suitable habitat to very highly suitable habitat in Mount Talang, which is 14.7% of the total area. Those predicted habitats ranged in elevation from 1,740-2,558 m. Suitable habitat in 2100 was predicted to decrease in extent and be at higher elevation in the less extreme climate change scenario (SSP 1-2.6) and extreme climate change scenario (SSP 5-8.5). We projected larger habitat loss in the SSP 5-8.5 compared to the SSP 1-2.6 climate change scenario.. We proposed the category CR B1ab(iii,v), C2a(ii) as the new conservation status of N. talangensis. The status is a higher category of threat compared to the current status of the species (EN C2b, ver 2.3). Nepenthes talangensis seedlings and cuttings established in a Botanic Garden have relatively high survival rate at about 83.4%. Sixty percent of the seeds germinated in growth media successfully grew to become seedlings.

'Treasure hunt': Using loose parts media to develop social financial education model for early children.

A globalized world demands every country's citizen to proceed to build a creative economy to adapt to the rapid changes that follow. Therefore, promoting social and financial education should be engaged with children early. However, a learning model available to awaken children's socio-financial capabilities is vividly rare, if not none. Furthermore, the Early Childhood Education Institution is the best place for children to experience social and financial education. This research aims to develop a social financial education model for early childhood. This study employed Research and Development (R&D) in the development process of the educational model. The data were collected through questionnaires and focus group discussions. The data analysis used descriptive quantitative and t-tests to explain the results of field studies, FGD, and trials and to measure the effectiveness of models during experimental and operational trials. In the analysis, the researchers found that the Model Script and Financial Social Education Guide for early childhood using loose parts media were very suitable. Further, the t-test result between the pretest and post-test was 0.924 (92.4%) at α = 0.05. In conclusion, the financial social education model using loose parts of media effectively develops children's social and financial abilities.

Transplantation of Aceh cattle ovary into the uterus of pseudopregnant local rabbits: Effect of post-transplant stress on uterine histopathology and ovarian follicle dynamics.

Background and Aim: The increase in the levels of the cortisol hormone caused by the stress conditions generated by an ovary transplantation procedure can damage the uterus of the transplant recipient as well as the transplanted ovaries. This study aimed to analyze the histopathological changes that occur in the uterine horn of pseudopregnant local rabbits (recipients), as well as the ovarian follicular integrity of the donor Aceh cattle after transplantation. Materials and Methods: After 30 days of adaptation, all rabbits were divided into three treatment groups: R1 (the group of rabbits that underwent ovarian transplantation for 3 days, n = 5), R2 (the group of rabbits that underwent ovarian transplantation for 5 days, n = 5), and R3 (the group of rabbits that underwent ovarian transplantation for 7 days, n = 5). Pseudopregnancy induction was performed using the pregnant mare's serum gonadotropin (PMSG) and human chorionic gonadotropin (hCG) methods. The rabbits were injected with 100 IU of PMSG intramuscularly, followed by an injection of 75 IU of hCG intravenously 3 days later. Ovarian transplantation was performed on day 8 (day 0 was the day of hCG injection). The concentration of cortisol hormone metabolites was measured from fecal samples using an enzyme-linked immunosorbent assay technique. The uterus and ovaries were collected for histopathological and follicular dynamics examination after the transplantation process was completed. Results: The mean cortisol levels (ng/g) recorded before versus after the transplant in the R1, R2, and R3 groups were 146.23 ± 17.60 versus 338.84 ± 302.79, 128.97 ± 81.56 versus 174.79 ± 101.70, and 124.88 ± 43.61 versus 321.91 ± 221.63 (p < 0.05), respectively. The examination of the histopathological appearance of the uterus revealed edema in the uterine lumen, hyperemia and hemorrhage in the endometrium, necrosis of the epithelium, and infiltration of inflammatory cells. Hemorrhage and hyperemia were severe and filled the endometrium in the R1 compared with the R2 and R3 animals. Ovarian follicle development occurred in all treatment groups, although some histopathological features were observed. The number of tertiary follicles in R1, R2, and R3 animals was 24.67 ± 7.37, 20.67 ± 7.57, and 9.67 ± 3.79 (p < 0.05), respectively. Conclusion: Based on the results of this study, it can be concluded that the transplantation of ovaries from Aceh cattle into pseudopregnant local rabbits triggered an increase in the levels of the cortisol hormone and uterine histological changes; however, follicles were still detected at various stages of development in the transplanted Aceh cattle ovaries. The results of this study are valuable for clinicians and researchers because they provide information regarding an alternative in vivo ovarian preservation technique using pseudopregnant rabbits.

MadureseSet: Madurese-Indonesian Dataset.

MadureseSet is a digitized version of the physical document of Kamus Lengkap Bahasa Madura-Indonesia (The Complete Dictionary of Madurese-Indonesian). It stores the list of lemmata in Madurese, i.e., 17809 basic lemmata and 53722 substitution lemmata, and their translation in Indonesian. The details of each lemma may include its pronunciation, part of speech, synonym and homonym relations, speech level, dialect, and loanword. The framework of dataset creation consists of three stages. First, the data extraction stage processes the scanned results of the physical document to produce corrected data in a text file. Second, the data structural review stage processes the text file in terms of the paragraph, homonym, synonym, linguistic, poem, short poem, proverb, and metaphor structures to create the data structure that best represents the information in the dictionary. Finally, the database construction stage builds the physical data model and populates the MadureseSet database. MadureseSet is validated by a Madurese language expert who is also the author of the physical document source of this dataset. Thus, this dataset can be a primary source for Natural Language Processing (NLP) research, especially for the Madurese language.

Neonatal mortality in two districts in Indonesia: Findings from Neonatal Verbal and Social Autopsy (VASA).

BACKGROUND: The Government of Indonesia is determined to follow global commitments to reduce the neonatal mortality rate. Yet, there is a paucity of information on contributing factors and causes of neonatal deaths, particularly at the sub-national level. This study describes care-seeking during neonates' fatal illnesses and their causes of death. METHODS: We conducted a cross-sectional community-based study to identify all neonatal deaths in Serang and Jember Districts, Indonesia. Follow-up interviews were conducted with the families of deceased neonates using an adapted verbal and social autopsy instrument. Cause of death was determined using the InSilicoVA algorithm. RESULTS: The main causes of death of 259 neonates were prematurity (44%) and intrapartum-related events (IPRE)-mainly birth asphyxia (39%). About 83% and 74% of the 259 neonates were born and died at a health facility, respectively; 79% died within the first week after birth. Of 70 neonates whose fatal illness began at home, 59 (84%) sought care during the fatal illness. Forty-eight of those 59 neonates went to a formal care provider; 36 of those 48 neonates (75%) were moderately or severely ill when the family decided to seek care. One hundred fifteen of 189 neonates (61%) whose fatal illnesses began at health facilities were born at a hospital. Among those 115, only 24 (21%) left the hospital alive-of whom 16 (67%) were referred by the hospital. CONCLUSIONS: The high proportion of deaths due to prematurity and IPRE suggests the need for improved management of small and asphyxiated newborns. The moderate to severe condition of neonates at the time when care was sought from home highlights the importance of early illness recognition and appropriate management for sick neonates. Among deceased neonates whose fatal illness began at their delivery hospital, the high proportion of referrals may indicate issues with hospital capability, capacity, and/or cost.

Care-seeking and health insurance among pregnancy-related deaths: A population-based study in Jember District, East Java Province, Indonesia.

BACKGROUND: Despite the increased access to facility-based delivery in Indonesia, the country's maternal mortality remains unacceptably high. Reducing maternal mortality requires a good understanding of the care-seeking pathways for maternal complications, especially with the government moving toward universal health coverage. This study examined care-seeking practices and health insurance in instances of pregnancy-related deaths in Jember District, East Java, Indonesia. METHODS: This was a community-based cross-sectional study to identify all pregnancy-related deaths in the district from January 2017 to December 2018. Follow-up verbal and social autopsy interviews were conducted to collect information on care-seeking behavior, health insurance, causes of death, and other factors. FINDINGS: Among 103 pregnancy-related deaths, 40% occurred after 24 hours postpartum, 36% during delivery or within the first 24 hours postpartum, and 24% occurred while pregnant. The leading causes of deaths were hemorrhage (38.8%), pregnancy-induced hypertension (20.4%), and sepsis (16.5%). Most deaths occurred in health facilities (81.6%), primarily hospitals (74.8%). Nearly all the deceased sought care from a formal health provider during their fatal illness (93.2%). Seeking any care from an informal provider during the fatal illness was more likely among women who died after 24 hours postpartum (41.0%, OR 7.4, 95% CI 1.9, 28.5, p = 0.049) or during pregnancy (29.2%, OR 4.4, 95% CI 1.0, 19.2, p = 0.003) than among those who died during delivery or within 24 hours postpartum (8.6%). There was no difference in care-seeking patterns between insured and uninsured groups. CONCLUSIONS: The fact that women sought care and reached health facilities regardless of their insurance status provides opportunities to prevent deaths by ensuring that every woman receives timely and quality care. Accordingly, the increasing demand should be met with balanced readiness of both primary care and hospitals to provide quality care, supported by an effective referral system.

Neem Leaf (Azadirachta indica A. Juss) Ethanolic Extract on the Liver and Kidney Function of Rats.

Neem (Azadirachta indica A. Juss) is one of the tropical plants found in Indonesia that has been used to prevent and treat various diseases. This study aimed to investigate the effect of the ethanol extract of neem leaves on the concentration of aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea, and creatinine in male rats. Twenty-four male Wistar rats were randomly divided into four groups (T0, T1, T2, and T3) with 6 rats in each group. T0 is the control group, and T1, T2, and T3 are the treatment groups that were administered 100, 200, and 300 mg/kg body weight of neem leaf ethanolic extracts for 48 days, respectively. On day 49, blood samples were collected to measure the concentration of AST, ALT, creatinine, and urea followed by an evaluation of liver and kidney histology. The results showed that the ethanolic extract of neem leaves did not affect the concentration of AST, ALT, and creatinine, The ethanol leaves reduced extract on the urea concentration, no abnormal changes were observed in the liver and kidney organs. In the future, it is required to carry out a comprehensive safety evaluation of the neem leaf ethanol extract for herbal medicines.

Profiles of progesterone and bovine interferon-τ in repeat breeding and non-repeat breeding Aceh cows.

AIM: This study aimed at determining the profiles of progesterone and bovine interferon-τ (bIFN-τ) and the correlation between the two in repeat breeding (RB) Aceh cattle and non-RB Aceh cattle. MATERIALS AND METHODS: The study was performed on five RB and five non-RB Aceh cows. These cows were subjected to estrous synchronization using the prostaglandin F2 alpha hormone, which was followed by artificial insemination (AI). Serum samples were collected on days 5, 6, 7, 15, 16, and 17 after AI to measure the concentration of progesterone at the beginning and end of the luteal phase and from days 14 to 18 after AI to measure the concentration of bIFN-τ. The concentrations of progesterone and bIFN-τ were determined using enzyme-linked immunosorbent assay. Pregnancy examinations were performed by ultrasonography on days 25, 35, 45, and 55 after AI. Data for progesterone and bIFN-τ concentrations were analyzed using the Mann-Whitney and t-tests, and the correlation between progesterone and bIFN-τ was analyzed using the Spearman correlation test. RESULTS: The average concentration of progesterone in RB Aceh cows tended to be lower than non-RB Aceh cows, but it was not significantly different (p>0.05). Similar results also found in the concentration of bIFN-τ which RB Aceh cows tended to have lower bIFN-τ concentrations compared to non-RB Aceh cows, but it was also not significantly different (p>0.05). Moreover, the concentrations of progesterone and bIFN-τ in RB and non-RB Aceh cows did not show a significant correlation (p>0.05). These results of the ultrasonography showed that non-RB Aceh cows were pregnant from day 25 to day 55 after AI, whereas RB Aceh cows were not pregnant and had early embryonic death. CONCLUSION: The concentrations of progesterone and bIFN-τ in non-RB Aceh cows tended to be higher than those in RB Aceh cows, although, it was not significantly different. Non-RB Aceh cows were able to maintain pregnancy until day 55, whereas RB Aceh cows were diagnosed with early embryonic death before day 25 after AI.

The concentration of androgen receptor and protein kinase A in male chicken following the administration of a combination of the epididymis and testicular extracts.

BACKGROUND AND AIM: Testis (T) and epididymis (E) are waste from the abattoir that is rarely used. In fact, both organs contain important chemicals needed for spermatogenesis (e.g., hormones, proteins, and other molecules). Therefore, administration of a combination of testis and epididymis (CTE) extracts may activate androgen receptors (AR) and protein kinase A (PKA) molecules that play a prominent role in spermatogenesis. We, therefore, aimed at investigating the influence of the CTE extracts on the concentration of AR and PKA in male chicken. MATERIALS AND METHODS: This study used a completely randomized design with four treatment groups (K0, K1, K2, and K3) and five replications per group. K0 is a control group that received 1 mL normal saline, whereas K1, K2, and K3 are the test groups that received 1, 2, and 3 mL of CET extracts, respectively. Twenty male chickens (strain: broiler Mb 89), 3 weeks of age, weighing 500-700 g were used. We administered the injections in a 13-day period and on the 14th day; we collected and processed blood samples as serum to measure the AR and PKA concentrations using commercial chicken AR and PKA enzyme-linked immunosorbent assay kits, respectively. We performed analyses by analysis of variance using SPSS 20.0. RESULTS: The AR concentrations in K1, K2, and K3 groups increased by 4.26%, 10.97%, and 28.04%, respectively, compared to the K0 (control group). However, this increase was not significantly different between the groups (p>0.05). Moreover, the PKA concentrations increased by 2.97%, 2.60%, and 4.08% in K1, K2, and K3 groups, respectively, compared to the control group. However, this increase was not significantly different between the groups as well (p>0.05). CONCLUSION: The CTE extracts tended to increase the AR and PKA concentrations even though it is not significant. Therefore, it needs further study when using the CTE extracts for spermatogenesis in male chicken.

Acceptance and willingness to pay for a hypothetical vaccine against monkeypox viral infection among frontline physicians: A cross-sectional study in Indonesia.

BACKGROUND: A clinical trial is ongoing to evaluate the safety and efficacy of a monkeypox vaccine among healthcare workers (HCWs). The critical question that needs to be addressed is whether HCWs are willing to accept and purchase this vaccine. The objective of this study was to evaluate the acceptance and willingness to pay (WTP) for the vaccine among HCWs. METHODS: From May to July 2019, a cross-sectional study was conducted among registered general practitioners (GPs) in Indonesia. A contingent valuation method was employed to evaluate the WTP. Besides acceptance and WTP, various explanatory variables were also collected and assessed. A logistic regression and a multivariable linear regression were used to explore the explanatory variables influencing acceptance and WTP, respectively. RESULTS: Among 407 respondents, 391 (96.0%) expressed acceptance of a free vaccination. The mean and median WTP was US$ 37.0(95%CI:US$ 32.76-US$ 41.23) and US$ 17.90(95%CI:US$ 17.90-US$ 17.90), respectively. In an unadjusted analysis, those 30 years old or younger had 2.94 times greater odds of vaccine acceptance compared to those who were older (95%CI: 1.07-8.08). Location of alma mater, type of workplace, length of individual medical experience, and monthly income of GPs were all significantly associated with WTP. CONCLUSION: Although the vast majority of GPs would accept a freely provided vaccine, they were also somewhat price sensitive. This finding indicates that partial subsidy maybe required to achieve high vaccine coverage, particularly among GPs at community health centres or those with a shorter duration of medical practice.

BCR-ABL Gene Transcript Types of Patients with Chronic Myelogenous Leukemia in Yogyakarta, Indonesia.

The aim of this study was analyzing the BCR-ABL transcript types of patients with chronic myeloid leukemia (CML) in Dr Sardjito General Hospital, Yogyakarta, Indonesia. This study is very relevant because the data concerning BCR-ABL gene transcript types is very limited in Indonesia. Furthermore, it is important for patient's management, particularly in defining the tyrosine kinase inhibitors (TKIs) therapy and monitoring after therapy. The introduction of TKIs has become a major advance in the management of patients with CML, especially in the chronic phase (CML-CP), in which most patients are diagnosed. METHODS: One hundred eighty five (185) of 370 recruited patients were included in this study (2010-2014). RNA samples were isolated from mononuclear cells of peripheral blood of the subjects taken at primary diagnosis. Detection of BCR-ABL gene transcript types was done using multiplex reverse transcriptase PCR (multiplex RT-PCR) and/or nested PCR following the cDNA synthesis. When the first PCR set failed to amplify the BCR-ABL gene, RT-conventional PCR and/or nested PCR would be applied. The proportion of each transcript type was calculated among the BCR-ABL positive CML patients. RESULTS: Approximately 99% (183/185) of CML patients are BCR-ABL positive, with the most common type is major b3a2 (136/183; 74.3%), followed by major b2a2 (41/183; 22.4%). Two samples (1.1%) showed co-expression of b3a2 and b2a2; 1 sample showed co-expression of b3a2 and fragment at 500bp; and 3 samples showed uncommon fragments. CONCLUSION: Ninety nine percent (99%) of CML patients in Yogyakarta, Indonesia are BCR-ABL positive, with 74.3% have b3a2 transcript, 22.4% have b2a2 trascript, 1.1% have co-expression of b3a2 and b2a2 transcript, and the rest (2.2%) have uncommon bands that still need to be confirmed.

Confidence in managing human monkeypox cases in Asia: A cross-sectional survey among general practitioners in Indonesia.

The current re-emergence of human monkeypox (HMPX) is a global concern for endemic and non-endemic countries, but healthcare workers in some regions, like Asia, have less experience with identifying and treating HMPX cases. This study aimed to assess the confidence and its predictors in HMPX case management among general practitioners (GPs), the frontline doctors in Indonesia, and to explore their perspectives on HMPX. Between May and July 2019, GPs in Indonesia completed an online-based survey. The questionnaire collected information on GPs' confidence, perspective, sociodemographic, workplace and professional characteristics, exposure to HMPX information and knowledge on HMPX. A logistic regression analysis was employed to explore the explanatory variables influencing the confidence and the perspective. We included 395 GPs in our analysis (77.4% out of 510 responses received) of which 10.1% and 34.9% were classified having good confidence using an 80% and 70% cut-off for confidence score, respectively. In the adjusted analysis, receiving information about HMPX during medical training was the only variable significantly associated with good confidence (adjusted odds ratio 2.74, 95% confidence interval 1.57 to 4.78 and p < 0.001). Approximately 73.6% and 77.9% of GPs agreed that HMPX is an important infectious disease and it has potential to detrimentally impact the Indonesian economy, respectively. In addition, 88.8% of GPs suggested that the disease should be incorporated into the National Medical Curriculum of Indonesia. In conclusion, in case of HMPX outbreak, majority of the GPs in Indonesia seem to be less confident in diagnosing and treating cases, using their current knowledge, skills and their workplace facilities. Therefore, a systematic strategy to improve their confidence in managing HMPX is required.

Knowledge of human monkeypox viral infection among general practitioners: a cross-sectional study in Indonesia.

After the first, imported, laboratory-confirmed case of monkeypox in human was reported in Singapore on May 2019, countries in Asia started to strengthen disease surveillance systems. One challenge in preventing monkeypox is a lack of knowledge, particularly among healthcare workers. The aim of this study was to assess the knowledge of monkeypox among general practitioners (GPs) in Indonesia. A cross-sectional online survey was conducted. The survey collected participants' knowledge on a 21-item scale and explanatory variables. A two-step logistic regression analysis was employed to assess the predictors of knowledge of monkeypox. A total of 432 GPs were included; 10.0% and 36.5% of them had a good knowledge using an 80% and 70% cutoff point for knowledge domain, respectively. No explanatory variables were associated with knowledge when using 80% cutoff point. Using the lower cutoff, there was lower knowledge among GPs who graduated from universities located in Sumatra or other islands versus Java (adjusted odds ratio (aOR): 0.53; 95%CI: 0.28-0.97, p = 0.041) and among those were older than 30 years compared to younger GPs (aOR: 0.61; 95%CI: 0.39-0.96, p = 0.033). GPs working in private clinics had less knowledge compared to GPs in community health centers (aOR: 0.55; 95%CI: 0.31-0.99, p = 0.047). In conclusion, knowledge of monkeypox among GPs in Indonesia is relatively low in all groups. Increasing knowledge of monkeypox will be key to improving the capacity of GPs to respond to human monkeypox cases and to report into a disease surveillance system.

Physicians' willingness to be vaccinated with a smallpox vaccine to prevent monkeypox viral infection: A cross-sectional study in Indonesia.

Background: Although there is no licensed vaccine for monkeypox, smallpox vaccine has been shown to be 85% effective in preventing the monkeypox. This study was conducted to assess the willingness of frontline healthcare providers to be vaccinated with smallpox vaccine to prevent monkeypox. Methods: A cross-sectional study was conducted in Indonesia. The willingness was assessed under two scenarios: fully subsidized and non-subsidized vaccine. Explanatory variables such as sociodemographic profile, workplace and professional characteristics, and knowledge of monkeypox were collected. A logistic regression assessed the influence of these explanatory variables on participants' willingness. Results: Out of 510 received participants' responses, 407 (79.8%) were analyzed. With a fully subsidized vaccine scenario, 381 (93.6%) of the participants were willing to be vaccinated and in an unadjusted analysis, gender, education, monthly income, and type of workplace were associated with willingness. With a non-subsidized vaccine (i.e. the vaccine price was US$ 17.9), the proportion who were willing to be vaccinated decreased to 71.9%. In adjusted analyses for both scenarios, gender was the only independent predictor for willingness; men were less willing to be vaccinated than women, adjusted odds ratio (aOR): 0.37; 95% confidence interval (CI): 0.16, 0.87 and aOR: 0.42; 95%CI: 0.27, 0.67, respectively for subsidized and non-subsidized scenario. Conclusion: Vaccine price and gender are important factors for physicians' willingness to be vaccinated for smallpox vaccine prevent monkeypox in Indonesia. These findings indicate that achieving high vaccine converge may require partially or fully subsidized vaccines, along with a clear guideline and recommendation from authorities.