Determinants of child stunting in the dryland area of East Nusa Tenggara Province, Indonesia: insights from a national-level survey.

Stunting remains a critical public health issue in Indonesia, particularly in the province of East Nusa Tenggara. This region, characterized by its archipelagic dryland geography, has reported the highest prevalence of stunting among children under five from 2007 to 2021. The study aimed to examine the relationship between various characteristics of children under five and household factors with the occurrence of stunting. This observational study, with a cross-sectional design, used secondary data from the 2021 Indonesian Nutrition Status Survey, covering 7,835 children under five. We analyzed the data to identify patterns and relationships, using univariate analysis to display percentage distributions and bivariate analysis through multiple binary logistic regression tests. The results of the multiple logistic regression test showed that indicators of family characteristics such as age, gender, low birth weight, body length, possession of birth certificates, and receiving complementary feeding were all related to stunting. Additionally, household factors such as toilet type, National Health Insurance coverage, ownership of a Prosperous Family Card, and residential area were significant determinants. Factors contributing to stunting in dryland areas include a range of elements from both family characteristics-such as age, gender, birth certification, low birth weight, and initial body length, to the introduction of supplementary feeding-and household indicators, including the use of specific types of latrines (Plengsengan and Cemplung types without covers), health insurance coverage, possession of Prosperous Family Cards, and the family's residential area.

Seroconversion, genotyping, and potential mosquito vector identification of Japanese encephalitis virus in pig sentinel settings in Bali, Indonesia.

Background and Aims: Despite the endemicity of Japanese encephalitis virus (JEV) in humans and animals in the Province of Bali, Indonesia, there is little data on whether seroconversion to the virus occurs in pigs, JEV genotypes circulating, and it's potential mosquito vectors in the area. The aims of this study were to (i) Determine whether JEV infection in Balinese pigs occurs before reaching their sexual maturity, (ii) identify the genotypes of circulating JEV, and (iii) identify potential JEV mosquito vectors at the study sites in urban and peri-urban areas of Bali. Materials and Methods: Sixteen 1-week-old Landrace piglets from two different sows were housed in Denpasar. Similarly, 18 one-week-old mixed-breed piglets of two different sows were housed in Badung Regency. The piglets were bled every 1 to 4 weeks for up to 24 weeks. Serum samples from the 11 piglets were tested for antibodies against JEV, and seroconversion-suspected sera were titrated using an enzyme-linked immunosorbent assay. Blood of seroconverted sera from pigs were tested using polymerase chain reaction (PCR) to detect the genetic sequence of JEV. The mosquitoes in the sentinels were trapped throughout the study period to identify the potential mosquito vectors of JEV. Results: Antibodies were detected in most of the selected piglets' sera from weeks 1 to 24 of their age. However, sera of pig B9 collected from the sentinel setting in Badung Regency showed a four-fold increase in antibody titer from week 4 to week 8, indicating seroconversion. PCR testing of blood from B9 (pooled blood sample collected from week 5 to week 8) identified JEV nucleic acids, which were phylogenetically classified as belonging to the JEV genotype III. Meanwhile, 1271 of two genera of mosquitoes, Anopheles spp. and Culex spp. were trapped in the pig sentinels. Conclusion: JEV seroconversion likely occurs before the pig reaches sexual maturity in Badung Regency. Sequence data indicate that JEV genotype III is circulating in the pig sentinel setting in the regency; however, circulating genotypes need to be clarified through increased surveillance. Meanwhile, Culex spp. and most likely Culex quinquefasciatus and Anopheles spp. were the dominant mosquitoes present in the study sites set in the urban area of Denpasar and peri-urban areas of Badung, Bali, indicating that these are likely vectors in spread of JEV in the region.

Path analysis model for preventing stunting in dryland area island East Nusa Tenggara Province, Indonesia.

BACKGROUND: The problem of stunting is still a fundamental problem in Indonesia's human development. East Nusa Tenggara Province is an archipelago dryland area where in 2007-2021 it has contributed to the highest number of stunting children prevalence in Indonesia. This study aims to determine the relationship of variables in individual, household and district level with the prevalence of stunting. METHODS: This type of research is observational study with a cross sectional design. This study used individual secondary data from the Indonesian Nutritional Status Survey in 2021 consisting of 7,835 toddlers and National Social Economics Survey 2021. RESULTS: This research found that both specific & sensitive intervention programs had an influence in accelerating the decline in stunting prevalence (higher score on Z Score). Results also revealed the positive influence of the food access variable on nutritional intake. The results of the path analysis test showed that sensitive intervention program variables have a positive effect on food access variable and environmental variable (environmental sanitation) such as the habit of open defecation and healthcare. There was significant relationship on disease history, environment and intake to Height for Age (HAZ) score. CONCLUSIONS: In conclusion, direct and indirect factors have important roles to prevent stunting. Sensitive and specific intervention program, food access, macro determinants and environment are the indirect indicators which contribute significantly to the stunting. The risk of children under five years old experiencing malnourished nutritional status increases with a history of infectious disease (diarrhea, ARI, worms). The risk of children under five years experiencing malnourished nutritional status decreases with adequate nutritional intake. It is hoped that there will be a special model of stunting control interventions at the individual level and at the family, household and district level that are integrated and of high quality through multisectoral cooperation in the dryland areas of the islands of East Nusa Tenggara Province.

Individual and Herd-Level Seroprevalence in Association with Potential Risk Factors of Japanese Encephalitis in Pigs Collected from Urban, Periurban, and Rural Areas of Bali, Indonesia.

A study to assess the seroprevalence antibodies against JEV in pigs in Denpasar, Badung, and Karangasem as the representatives of urban, periurban, and rural areas in the province of Bali was conducted. Sampled pigs' blood was collected and their sera were tested for antibody detection using commercial IgG ELISA. A standard questionnaire was used to interview the pig owners or farmers to identify the determinants associated with the seropositivity of the antibodies. Overall, 96.6% (95% CI: 94.5-98.1) of 443 pig sera in individual animal-level seroprevalence were seropositive to the ELISA. Karangasem had the highest test prevalence at 97.3% (95% CI: 93.1-99.2) while Badung had a slightly lower prevalence at 96.6% (95% CI: 92.2-98.9), and Denpasar had the lowest prevalence at 96% (95% CI: 91.5-98.5) (p=0.84). In herd-level seroprevalence, all sampled herds contained one or more seropositive pigs (overall herd-level seroprevalence 100% [95% CI: 97.7-100]). No animal-level factors were significantly associated with seropositivity (all p values >0.05). For the herd-level risk factors relating to pig management and husbandry practices adopted, no analysis model could be generated, as all the sampled herds were seropositive. More than 90% seroprevalence detected in this study indicates high natural JEV infection occurred in pigs, which highlights the high public health risk of the infection in the areas.

First survey on seroprevalence of Japanese encephalitis in long-tailed macaques (Macaca fascicularis) in Bali, Indonesia.

Background and Aim: Japanese encephalitis (JE) is a zoonotic infectious inflammatory brain disease caused by the JE virus (JEV). Considerable research into the seroprevalence of JE in domestic animals has been conducted, but there have been no reports of its occurrence in wild animals, including long-tailed macaques (Macaca fascicularis). This study aimed to estimate the seroprevalence of JEV infection and its determinants in long-tailed macaques in Bali and the prevalence of mosquito vectors. Materials and Methods: Blood samples (3 mL) were collected from a population of M. fascicularis (92 heads) inhabiting a small forest with irrigated rice field nearby (wetland area) in Ubud, Gianyar, and from two populations in dryland areas with no wet rice field (Uluwatu, Badung, and Nusa Penida, Bali Province, Indonesia). The collected sera were tested for antibodies against JEV using a commercially available enzyme-linked immunosorbent assay kit (qualitative monkey JE Immunoglobulin G antibody kit). The seropositivity of the antibodies was then compared based on different variables, namely, habitat type, age, and sex. Results: The seroprevalence of the JEV antibodies in all the samples tested was found to be 41.3%. The seropositivity of the monkey serum samples collected from the wetland area was 46.4%, which was higher than the seropositivity of the sera samples collected from the dried field areas (1.25%). Monkey sera collected from the wetland areas were 6.1 times (odds ratio [OR]: 6.1; 95% confidence interval [CI]: 0.71-51.5, p>0.05) more likely to be seropositive compared to the monkey sera collected from the dried field areas. Meanwhile, female monkeys were 1.79 times (OR: 1.79; 95% CI: 0.76-4.21; p>0.05) more likely to be seropositive to JEV than males. Similarly, juvenile monkeys were 2.38 times (OR: 2.38; 95% CI: 0.98-5.79); p>0.05) more likely to be seropositive against the JEV than adult monkeys. However, none of these differences achieved statistical significance. Regarding the JEV mosquito vector collection, more Culex mosquitoes were found in the samples from the wetland areas than from the dried field areas. Conclusion: The study confirms the existence of JEV infection in long-tailed macaques in Bali. There were patterned seropositivity differences based on habitat, age, and sex of the monkeys, but these were not significant. The possibility of monkeys as a JEV reservoir and the presence of the mosquitoes as the JEV vector are suggested but require more study to confirm.

Japanese encephalitis in Bali, Indonesia: ecological and socio-cultural perspectives.

The increasing number of cases of acute encephalitis syndrome, a key presenting clinical sign of Japanese encephalitis infection in humans, along with increasing laboratory confirmed cases in Bali over recent years have led to the Indonesian government developing a national program of vaccination against Japanese encephalitis virus. In order to inform multidisciplinary management, a review was conducted to assess Japanese encephalitis virus-related cases in humans and animals including their determinants and detection in vectors. Along with published literature, key data from local authorized officers in Bali have been used to convey the recent situation of the disease. Related surveys detected up to 92% of the local children had antibodies against the virus with the annual incidence estimated to be 7.1 per 100,000 children. Additionally, reports on young and adult cases of infection within international travellers infected in Bali were documented with both non-fatal and fatal outcomes. Further seroprevalence surveys detected up to 90% with antibodies to the virus in animal reservoirs. The detection of the virus in certain Culex mosquito species and high levels of seropositivity may be associated with greater risk of the virus transmission to the human population. It was also highlighted that local sociocultural practices for agriculture and livestock were potentially associated with the high density of the vector and the reservoirs, which then may lead to the risk of the disease transmission in the ecology of Bali.

The efficacy of binary ethylenimine-inactivated vaccines of Gianyar-1/AK/2014 virulent strain in protecting chickens against Tabanan-1/ARP/2017 virulent Newcastle disease virus isolates.

AIM: This study aimed to prepare binary ethylenimine (BEI)-inactivated virulent Newcastle disease virus (NDV) vaccine and to examine their ability to induce a protective antibody response in commercial chickens. MATERIALS AND METHODS: A virulent NDV field isolate Gianyar-1/AK/2014 was propagated in chicken-embryonated eggs and was then inactivated with BEI at a concentration of 4 mM. Three groups of chickens with low-level (2 log2 hemagglutination inhibition [HI] units) maternally derived antibodies against NDV were then immunized with the BEI-inactivated vaccine. A commercial live vaccine (LaSota strain) was used as positive control, and phosphate-buffered saline (PBS) was used as negative control. A challenge experiment with a virulent NDV of Tabanan-1/ARP/2017 was performed at 3 weeks post-vaccination. RESULTS: At 2 weeks post-immunization, the mean titers of antibodies against NDV in serum samples of chickens immunized with 0.2 mL of BEI-inactivated NDV (Group I), with live commercial NDV vaccine (Group II) and with PBS (Group III) were 3±0.94 log2 HI units, 4.9±0.99 log2 HI unit, and 0.0±0.0 HI units, respectively. At week 3 post-immunization, the mean titers of the antibodies for the three groups were 5±1.09 log2 HI units, 6.9±0.32 log2 HI units, and 0.00 HI units, respectively. The antibody titer induced by inactivated NDV Gianyar-1/AK/2014 isolates examined at 2 and 3 weeks post-vaccination was still at a significantly (p<0.01) lower level as compared to those induced by commercial life vaccine. However, the challenge test with virulent NDV of Tabanan 1/ARP/2017 isolates showed that all immunized chickens (Group I and II) survived without exhibiting any clinical sign post-challenge with the protection rates of 100%, whereas all chickens injected with PBS (Group III) died with clinical signs of ND. CONCLUSION: This finding shows that the BEI-inactivated vaccines prepared using virulent NDV of Gianyar-1/AK/2014 strain was able to induce protective antibody response in chickens but still at a lower level than those induce by commercial live NDV vaccine.

Isolation and characterization of a pathogenic Newcastle disease virus from a natural case in indonesia.

This study was performed to isolate a velogenic Newcastle disease virus (NDV) strain currently found in Indonesia for establishing a domestic reference virus for future pathological and molecular epidemiological studies. A chicken suspected to have contracted Newcastle disease (ND) in a local outbreak in Bali was selected for NDV isolation. Atrophy of lymphoid tissues such as the bursa of Fabricius, thymus, and spleen; intestinal haemorrhage; and oedema of the brain were observed in the chicken. Histopathological examination revealed severe non-suppurative meningoencephalomyelitis characterised by neuronal necrosis, multifocal to diffuse gliosis, and perivascular cuffing of mononuclear cells, hemorrhagic necrosis of the trachea, intestines and bursa of Fabricius, and various degree of lymphoid depletion and necrosis of the lymphoid tissues. After ND was confirmed immunohistochemically, the NDV was propagated by inoculating tissue homogenate of the diseased chicken in embryonated eggs. Phylogenetic analysis based on the F gene nucleotide sequence revealed that this isolate belonged to genotype VII. The deduced amino acid sequence of the isolated NDV F protein at the cleavage site was (112)RRQKRF(117), which is typically found in virulent NDV isolates. Pathogenicity indexes such as the mean death time (MDT) and intracerebral pathogenicity index (ICPI) were 54 hr and 1.77, respectively. Pathological findings, phylogenetic analysis, amino acid sequence of the F protein cleavage site, and pathogenicity index test results revealed the NDV isolate, designated as NDV/Bali-1/07, to be a novel Indonesian velogenic NDV strain belonging to group VII.