Whole genome sequencing analysis on antibiotic-resistant Escherichia coli isolated from pig farms in Banten Province, Indonesia.

IMPORTANCE: The emergence and rapid increase in the incidence of multidrug-resistant (MDR) bacteria in pig farms has become a serious concern and reduced the choice of effective antibiotics. OBJECTIVE: This study analyzed the phylogenetics and diversity of antibiotic resistance genes (ARGs) and molecularly identified the source of ARGs in antibiotic-resistant Escherichia coli isolated from pig farms in Banten Province, Indonesia. METHODS: Forty-four antibiotic-resistant E. coli isolates from fecal samples from 44 pig farms in Banten Province, Indonesia, were used as samples. The samples were categorized into 14 clusters. Sequencing was performed using the Oxford Nanopore Technologies MinION platform, with barcoding before sequencing with Nanopore Rapid sequencing gDNA-barcoding (SQK-RBK110.96) according to manufacturing procedures. ARG detection was conducted using ResFinder, and the plasmid replicon was determined using PlasmidFinder. RESULTS: Three phylogenetic leaves of E. coli were identified in the pig farming cluster in Banten Province. The E. coli isolates exhibited potential resistance to nine classes of antibiotics. Fifty-one ARGs were identified across all isolates, with each cluster carrying a minimum of 10 ARGs. The ant(3'')-Ia and qnrS1 genes were present in all isolates. ARGs in the E. coli pig farming cluster originated mainly from plasmids, accounting for an average of 89.4%. CONCLUSIONS AND RELEVANCE: The elevated potential for MDR events, coupled with the dominance of ARGs originating from plasmids, increases the risk of ARG spread among bacterial populations in animals, humans, and the environment.

Differential impacts of health systems and sociocultural environment on vulnerable populations during the COVID-19 pandemic: lessons from four Asia-Pacific countries.

BACKGROUND: This study aims to evaluate healthcare systems and pandemic responses in relation to marginalized and vulnerable groups, identify populations requiring urgent care, and assess the differential impacts on their health during the pandemic. METHODS: Data were collected by the Asia-Pacific Observatory on Health Systems and Policies (APO)-National University of Singapore and APO-International Health Policy Program consortium members: Korea, Indonesia, Philippines, and Singapore. Data were collected through a combination of semi-structured interviews, policy document reviews, and analysis of secondary data. RESULTS: Our findings reveal that the pandemic exacerbated existing health disparities, particularly affecting older adults, women, and children. Additionally, the study identified LGBTI individuals, healthcare workers, slum dwellers, and migrant workers as groups that faced particularly severe challenges during the pandemic. LGBTI individuals encountered heightened discrimination and limited access to health services tailored to their needs. Healthcare workers suffered from immense stress and risk due to prolonged exposure to the virus and critical working conditions. Slum dwellers struggled with healthcare access and social distancing due to high population density and inadequate sanitation. Migrant workers were particularly hard hit by high risks of virus transmission and stringent, often discriminatory, isolation measures that compounded their vulnerability. The study highlights the variation in the extent and nature of vulnerabilities, which were influenced by each country's specific social environment and healthcare infrastructure. It was observed that public health interventions often lacked the specificity required to effectively address the needs of all vulnerable groups, suggesting a gap in policy and implementation. CONCLUSIONS: The study underscores that vulnerabilities vary greatly depending on the social environment and context of each country, affecting the degree and types of vulnerable groups. It is critical that measures to ensure universal health coverage and equal accessibility to healthcare are specifically designed to address the needs of the most vulnerable. Despite commonalities among groups across different societies, these interventions must be adapted to reflect the unique characteristics of each group within their specific social contexts to effectively mitigate the impact of health disparities.

Low serum lipase levels in mothers of children with stunted growth indicate the possibility of low calcium absorption during pregnancy: A cross-sectional study in North Sumatra, Indonesia.

Stunting is caused by various factors, including low nutritional intake in the first two years of life. This study aimed to investigate the differences in sociodemographic factors and mineral, vitamin, and enzyme parameters in mothers associated with the occurrence of stunting in children. We conducted a cross-sectional study from September to November 2020 on North Sumatra Island, Indonesia. The data collected included sociodemographic characteristics, pregnancy history, birth history, food intake, and laboratory examinations, including measurements of calcium, iron, zinc, vitamin D, pancreatic amylase, and serum lipase levels. This study included 50 healthy mothers aged 18-50 years old with children aged 2 to 60 months. There was a significant difference in serum calcium levels between the groups of mothers of children with normal and stunted growth (p = 0.03, mean difference±standard error (SE) = 0.23±0.12, 95% CI: 0.19-0.45). All of the study subjects were categorized as vitamin D deficient. The mean lipase level in the group of mothers of children with stunted growth was significantly lower than that in the group of mothers of children with normal growth (p = 0.02, mean difference±SE = 4.34±1.83, 95% CI: 0.62-8.06). The conclusion was that serum lipase levels were significantly lower in mothers of children with stunted growth compared to mothers of children with normal growth. Serum lipase levels this low are likely to indicate that a mother is unable to meet her child's calcium needs during pregnancy, increasing the child's risk of stunted growth.

Indirect Effects of PM2.5 Exposure on COVID-19 Mortality in Greater Jakarta, Indonesia: An Ecological Study.

Background: Air pollution, including PM2.5, was suggested as one of the primary contributors to COVID-19 fatalities worldwide. Jakarta, the capital city of Indonesia, was recognized as one of the ten most polluted cities globally. Additionally, the incidence of COVID-19 in Jakarta surpasses that of all other provinces in Indonesia. However, no study has investigated the correlation between PM2.5 concentration and COVID-19 fatality in Jakarta. Objective: To investigate the correlation between short-term and long-term exposure to PM2.5 and COVID-19 mortality in Greater Jakarta area. Methods: An ecological time-trend study was implemented. The data of PM2.5 ambient concentration obtained from Nafas Indonesia and the National Institute for Aeronautics and Space (LAPAN)/National Research and Innovation Agency (BRIN). The daily COVID-19 death data obtained from the City's Health Office. Findings: Our study unveiled an intriguing pattern: while short-term exposure to PM2.5 showed a negative correlation with COVID-19 mortality, suggesting it might not be the sole factor in causing fatalities, long-term exposure demonstrated a positive correlation. This suggests that COVID-19 mortality is more strongly influenced by prolonged PM2.5 exposure rather than short-term exposure alone. Specifically, our regression analysis estimate that a 50 µg/m3 increase in long-term average PM2.5 could lead to an 11.9% rise in the COVID-19 mortality rate. Conclusion: Our research, conducted in one of the most polluted areas worldwide, offers compelling evidence regarding the influence of PM2.5 exposure on COVID-19 mortality rates. It emphasizes the importance of recognizing air pollution as a critical risk factor for the severity of viral respiratory infections.

Overview of Child Violence in the Family in Padang Indonesia.

BACKGROUND: Violence against children within the family context is a global issue that has serious implications for children's well-being. In Indonesia, like the tip of an iceberg, this violence is often underreported. However, this issue is prevalent in many countries worldwide. It is estimated that up to 1 billion children aged 2-17 years experienced physical, sexual, and emotional violence in the past year. Most of this violence occurs within the family, and this trend is also apparent in Indonesia. OBJECTIVES: This research aims to describe the types, forms, and perpetrators of violence against children in Padang, Indonesia. MATERIALS AND METHODS: This study utilizes a descriptive design with a population of elementary school-age children in Padang City. The population consists of 16,747 individuals, with a margin of error of 3%. The sample size was determined using the Slovin formula, resulting in a sample of approximately 1000 individuals. Data were collected from October to December 2022 through two types of questionnaires, one describing respondent demographics and the other containing questions about the forms of violence perpetrated by parents. Data collection was facilitated by enumerators from elementary school teachers who had undergone training. RESULTS: The study involved 1200 participants, with 1000 providing complete data. The results showed that 95.1% of children had experienced violence within the family, including physical violence (94.60%), psychological violence (95.10%), sexual violence (22.10%), and social violence (31.60%). Mothers were the most common perpetrators (80%), followed by fathers (61.3%), grandfathers (14.8%), brothers (35.4%), and uncles (13.1%). CONCLUSION: This research underscores the alarming prevalence of violence against children within the family context in Padang. Addressing and preventing violence against children should be a priority to protect their rights and create a safe environment for their development.

When the smoke gets in your lungs: short-term effects of Indonesia's 2015 forest fires on health care use.

BACKGROUND: The forest fires that ravaged parts of Indonesia in 2015 were the most severely polluting of this century but little is known about their effects on health care utilization of the affected population. We estimate their short-term impact on visit rates to primary and hospital care with particular focus on visits for specific smoke-related conditions (respiratory disease, acute respiratory tract infection (ARTI) and common cold). METHOD: We estimate the short-term impact of the 2015 forest fire on visit rates to primary and hospital care by combining satellite data on Aerosol Optical Depth (AOD) with administrative records from Indonesian National Health Insurance Agency (BPJS Kesehatan) from January 2015-April  2016. The 16 months of panel data cover 203 districts in the islands of Sumatra and Kalimantan before, during and after the forest fires. We use the (more efficient) ANCOVA version adaptation of a fixed effects model to compare the trends in healthcare use of affected districts (with AOD value above 0.75) with control districts (AOD value below 0.75). Considering the higher vulnerability of children's lungs, we do this separately for children under 5 and the rest of the population adults (> 5), and for both urban and rural areas, and for both the period during and after the forest fires. RESULTS: We find little effects for adults. For young children we estimate positive effects for care related to respiratory problems in primary health care facilities in urban areas. Hospital care visits in general, on the other hand, are negatively affected in rural areas. We argue that these patterns arise because accessibility of care during fires is more restricted for rural than for urban areas. CONCLUSION: The severity of the fires and the absence of positive impact on health care utilization for adults and children in rural areas indicate large missed opportunities for receiving necessary care. This is particularly worrisome for children, whose lungs are most vulnerable to the effects. Our findings underscore the need to ensure ongoing access to medical services during forest fires and emphasize the necessity of catching up with essential care for children after the fires, particularly in rural areas.

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.

Correlation of risk factors with systemic inflammatory response syndrome in burn patients at the Burn Center of Dr Soetomo General Hospital, Surabaya, Indonesia.

INTRODUCTION: Systemic inflammatory response syndrome (SIRS) is the main cause of death in burns and is associated with high burn mortality rates. SIRS occurs when burns are in the subacute phase and is affected by several factors, such as host, trauma and management. The research was conducted at the Burn Center of Dr Soetomo General Hospital, Surabaya, Indonesia, using retrospective observational analytic research design. The aim of the study was to assess the correlation of risk factors which include age, extent of burns, cause of burns, inhalation trauma, history of hyperglycaemia, anaemia, hypoalbuminemia and ESBL infection with the incidence of SIRS. MATERIALS AND METHODS: The study is observational analytic research using a retrospective design and secondary data of all burn patients treated at the Burn Center of Dr Soetomo General Hospital, Surabaya, Indonesia from January 2018 to December 2019. RESULTS: A total of 163 burn patients were included. Among comorbidities found were inhalation trauma (39.3%), diabetes mellitus (2.5%), anaemia (14.7%), hypoalbuminemia (40.5%) and ESBL infection (1.2%). A total of 11 patients (6.7%) suffered from SIRS. The statistical analysis showed that anaemia (p=0.012), hypoalbuminemia (p=0.030) and the percentage of burns (p=0.001) were significantly correlated to the incidence of SIRS while age, sex, cause of burn injury, inhalation trauma, diabetes mellitus and ESBL infection have no significant correlation with SIRS. CONCLUSION: Burn surface area is the most influencing factor of SIRS incident. It is important to meticulously monitor patients with extensive burn areas for indications of SIRS. However, the sample size of this study was relatively small, and it used a retrospective approach, so a larger sample size and a prospective or cohort design method were recommended for further study.

Pleiotrophin serum level and metastasis occurrence in breast cancer patients.

BACKGROUND: Breast cancer (BC) cases in Makassar, Indonesia, are on the rise, with 2723 cases recorded in 2018. Tumor cells in the blood indicate metastasis, emphasizing the need for early diagnosis and monitoring. Pleiotrophin (PTN) is associated with various human malignancies, and recent studies suggest a correlation between PTN expression and advanced BC stages; therefore, PTN could serve as an independent predictor of metastasis. This study aimed to determine the correlation between serum PTN level, histopathological grading, and metastasis occurrence in BC patients in Makassar, Indonesia. METHODS: This study used an observational cross-sectional design. Pleiotrophin serum levels were examined using enzyme-linked immunosorbent assays. This study used a t-test and ROC curve analysis for the statistical tests. RESULTS: Of the 64 samples used in this study, metastasis was present in 26 cases and absent in 38 samples. The mean PTN serum levels in metastatic and non-metastatic breast cancer patients were 4.311 and 1.253, respectively. The PTN receiver operating characteristic curve showed an area under the curve of 2.47 ng/dL, which was statistically significant (p < 0.001). A significant relationship was found between PTN level and metastasis (p < 0.001). The correlation coefficient was 0.791, indicating a positive correlation. CONCLUSION: This study revealed that the serum PTN level among breast cancer patients had a cut-off value of 2.47 ng/dL. The research established a clear correlation between PTN level and metastasis occurrence in breast cancer patients, indicating a higher likelihood of distant metastasis with elevated PTN concentration.

Differences in knowledge, attitude, and practice regarding hypertension by access to a community-based screening program (POSBINDU): A cross-sectional study from four districts in Indonesia.

BACKGROUND: A high prevalence of hypertension is found in Low- and Middle-income Countries (LMICs) including in Indonesia. However, hypertension awareness, treatment, and control are relativity poor. A community-based program to screen and educate people on non-communicable disease prevention (POSBINDU) was launched by the Indonesian government. However, the association between participation in the POSBINDU program with increasing knowledge, attitude, and practice of hypertension has not been widely assessed. In this study, we compared the knowledge, attitudes, and practices among people who accessed the POSBINDU and those who did not access the POSBINDU program. Subsequently, factors associated with the knowledge, attitudes, and practices among people who accessed the POSBINDU and those who did not access the POSBINDU were explored. METHODS: This was an observational study with a cross-sectional design measuring the knowledge, attitudes, and practices for hypertension control in four districts in Indonesia from October 2019 to January 2020. A total of 1,988 respondents were included in this study. A questionnaire was used to assess the knowledge, attitudes, and practices of hypertension. Simple logistic regression was used to investigate the correlation between the characteristics of respondents and knowledge, attitudes, and practice status. Multiple logistic regression tests were conducted to investigate factors associated with knowledge, attitudes, and practice status. RESULTS: We found that people who accessed POSBINDU had higher odds of having better knowledge (aOR:1.4; 95%CI:1.2-1.8), however, accessed to POSBINDU was associated with lower attitudes (aOR:0.6; 85%CI: 0.5-0.7) and had no association with hypertension-related practice. CONCLUSION: People who accessed POSBINDU have an association with good knowledge, but the association with good attitude and practice was less clear. Therefore, an improvement in the POSBINDU program is needed to increase the attitudes and practices of hypertension.

"I pity the TB patient": a mixed methods study assessing the impact of the COVID-19 pandemic on TB services in two major Indonesian cities and distilling lessons for the future.

INTRODUCTION: In Indonesia, a country with around 280 million people and the second-highest tuberculosis (TB) incidence rate in the world, the impact of the COVID-19 pandemic on TB care needs careful assessment so that future response strategies can be strengthened. We conducted a study comparing TB testing and treatment rates before and during the first 2 years of the COVID-19 pandemic in Indonesia, and the reasons for any disruptions to care. METHODS: We conducted retrospective secondary data analysis and qualitative interviews in Yogyakarta and Bandung, Indonesia. Routine data on TB testing and treatment were sourced from the national TB information system operated by the Indonesian Ministry of Health. TB testing and treatment outcomes were compared between two time periods: pre-COVID (2018-19); and during COVID-19 (2020-21). In-depth interviews were conducted with patients and health workers to explore their experiences in accessing and providing TB services during the pandemic. RESULTS: There was a 45% (21 937/39 962) reduction in the number of patients tested for TB during the pandemic compared with pre-COVID-19, while the proportion of TB tests returning a positive result increased from 12% (4733/39 962) to 50% (10 945/21 937). The proportion of TB patients completing treatment increased by 2.6% during the pandemic, yet the proportion cured and the number of patients successfully treated both decreased (by 7% and 4.4%, respectively). Our qualitative interviews highlighted several factors influencing TB service access and delivery, including fear of being diagnosed with COVID-19 during TB-related clinic visits, fear of COVID-19 exposure among patients and health workers, healthcare facilities prioritising COVID-19 over other services, and mandatory mobility restrictions affecting both patients and health workers. CONCLUSION: The COVID-19 pandemic impacted TB testing and treatment outcomes in Bandung and Yogyakarta. Policymakers should consider these findings in designing strategies to ensure TB services are maintained and supported during future health crises.

Contraceptive use with breast cancer incidence in Indonesia.

INTRODUCTION: Breast cancer is the most common cancer in women worldwide and is a significant threat to public health. This study aims to conduct a systematic review of the relationship between hormonal contraceptive use and breast cancer incidence. METHODS: The search was conducted using Google Scholar, Proquest, Pubmed and one Indonesian database, Garuda, using English and Indonesian keywords. The inclusion criteria in this study were the publication year of the last five years, namely 2019-2023, English and Indonesian language, case-control observational research, using the Indonesian population, and full-text access. RESULTS: A total of 165 studies were obtained from the Google Scholar database, including 104 studies. The overall multivariate analysis revealed that there was a statistically significant association of hormonal contraception with the incidence of breast cancer with OR values in the range of 2-6. CONCLUSIONS: The findings of this systematic study suggest that the use of hormones can contribute to hormonal imbalances that further increase breast cell proliferation and disrupt gene expression, resulting in uncontrolled cell development/cancer. In addition, the findings recommend increasing the number of studies on this topic to obtain more adequate and possibly more diverse information.

Monitoring and evaluation of childhood stunting reduction program based on fish supplement product in North Sumatera, Indonesia.

The government of Serdang Bedagai Regency initiated a supplementation program to reduce the high prevalence of stunting in the area by delivering extra supplementation, which were nutritious biscuits from national government and fish-based supplement produced from local resources. A 6-month study from April 2022 to September 2022 was conducted to monitor and evaluate the government program that involved 219 under-5-year-old children with height-for-age Z-score (HAZ-score) below - 2. We observed the stunting prevalence reduction by 37.00%, where 81 children recovered from stunting (HAZ-score ≥ - 2). Furthermore, the mean HAZ-score and WHZ-score (Weight-for-Height Z-score) were monitored to significantly improve by 0.97 ± 1.45 (P-value = 1.74e-14) and 1.00 ± 2.18 (P-value = and 2.40e-8), subsequently. The most significant improvement in HAZ-score was monitored among children receiving fish-based supplements with 1.04 ± 1.44 improvement (P-value = 6.59e-17). Then, a significant WHZ-score improvement was reported from children consuming fish-based supplements and a combination of fish-based supplements with nutritious biscuits (P-value = 2.32e-8 and 5.48e-5) by 1.04 ± 2.29 and 0.83 ± 1.84, respectively. The results of the observation become evidence that the program could effectively reduce the prevalence of stunting in children below five years old, especially among children who received locally produced fish-based supplements.

Examining determinants of stunting in Urban and Rural Indonesian: a multilevel analysis using the population-based Indonesian family life survey (IFLS).

BACKGROUND: In Indonesia, chronic malnutrition leading to stunted growth in children represents a significant issue within the public health domain. The prevalence of stunting varies between urban and rural areas, reflecting disparities in access to nutrition, healthcare, and other socioeconomic factors. Understanding these disparities is crucial for developing targeted interventions to address the issue. METHODS: The study used data from the fifth wave of the Indonesian Family Life Survey (IFLS), which is a national cross-sectional population-based survey conducted across approximately 13 provinces in Indonesia in 2014-2015. Multivariate and Multilevel logistic regression models were utilized in the analysis to determine the factors associated with the prevalence of stunting in Indonesian children. RESULTS: The multivariate logistic regression analysis indicated that among children aged 24-59 months in Indonesia, stunting was associated with the age of the child, birth weight, maternal nutritional status, and residence. Subsequently, the multilevel logistic regression analysis revealed that in rural areas, the age of the child and birth weight exhibited significant associations with stunting. Conversely, in urban areas, stunted children were influenced by 7 factors, including the child's age (months), age of weaning, birth weight (kg), mother and father's age, place of birth, and maternal nutritional status. CONCLUSIONS: Variations in childhood stunting between urban and rural regions in Indonesia were observed, indicating a differential prevalence. The study's findings suggests the importance of age-appropriate nutritional support, healthcare interventions, and growth monitoring. Focused interventions are vital, potentially encompassing initiatives such as improving access to maternal and child healthcare services, promoting adequate nutrition during pregnancy and infancy, and facilitate greater parental engagement in childcare responsibilities.

Exclusive breastfeeding practice during COVID-19 pandemic in West Java Indonesia: A cross-sectional study.

BACKGROUND: The achievement towards 100% exclusive breastfeeding still a challenge in many countries despite adverse impacts due to the absence of exclusive breastfeeding. One consequence from the low practice of exclusive breastfeeding is malnutrition, including stunting that can be prevented by providing optimal food to infants, starting with providing exclusive breastfeeding from birth to 6 months of age. However, the practice of exclusive breastfeeding still low and it is suspected that this practice also decreased during the COVID- 19 pandemic. This study aims to analyze the determinants of exclusive breastfeeding in sub-urban areas during the COVID-19 pandemic. METHODS: This study using cross sectional design conducted from interviewing 206 mothers in 2022 who meet the inclusion criteria, consisted of breastfeeding their babies in the last 1 year and live in Sub-urban area in Depok City, West Java. Multiple binary logistic regression used to measure the association and strength between independent variables with the outcome variable. Independent variables with a p-value < 0.25 during the Chi-square test were included in the logistic regression model. RESULTS: Prevalence of exclusive breastfeeding and early initiation of breastfeeding (EIB) was 58.3% and 57.8% respectively. Factors associated with exclusive breastfeeding practices are education, employment status, knowledge and attitude about exclusive breastfeeding, self-efficacy in providing exclusive breastfeeding, EIB practice, and eating pattern. From multivariate analysis, it was found that the dominant factors to exclusive breastfeeding are EIB. CONCLUSIONS: The study highlights the importance of improving exclusive breastfeeding practice through early initiation of breastfeeding, mother's knowledge, education and self-efficacy. Therefore, health promotion and education should emphasize the importance of those factors, supported by the health policy and massive campaign as a key success in exclusive breastfeeding.

Dynamic Evolution of SARS-CoV-2 in West Sumatra: Analyzing S Gene Mutations Across Variants and Their Impact on Public Health and Vaccine Strategies.

<b>Background and Objective:</b> The global SARS-CoV-2 pandemic highlights the importance of tracking virus evolution through genomic surveillance, especially concerning mutations in the SARS-CoV-2 spike protein, crucial for vaccine development. Despite global concern over variants, regions like West Sumatra, Indonesia, lack thorough genomic analysis, prompting this study to analyze S gene mutations across three pandemic waves in West Sumatra. <b>Materials and Methods:</b> Next-generation sequencing was conducted through the Illumina MiSeq instrument to leverage a dataset of 352 anonymized samples collected between March, 2020 and November, 2022 and rigorous analysis of S gene mutation using CLC Genomics Workbench^® 21 version 21.0.3 were employed. Statistical analyses assessed mutation prevalence over time, exploring associations with clinical outcomes. <b>Results:</b> The findings revealed significant variability in mutation profiles across different variants. Notably, the Omicron variant (21K) exhibited a high mutation rate, suggesting enhanced immune evasion capabilities. Comparative analysis highlighted evolutionary trends, from early variants with fewer mutations to highly adapted forms like Delta (21I) and Omicron. The dynamic nature of SARS-CoV-2 evolution underscores the importance of continuous surveillance, rapid public health response and vaccine adaptation. <b>Conclusion:</b> This study contributes valuable insights into the virus's evolving landscape, emphasizing the need for ongoing research, global collaboration and adaptable vaccine strategies to manage the evolving threat of COVID-19 effectively.

Behind the Hospital Ward: In-Hospital Mortality of Type 2 Diabetes Mellitus Patients in Indonesia (Analysis of National Health Insurance Claim Sample Data).

The rising global prevalence of diabetes mellitus, a chronic metabolic disorder, poses significant challenges to healthcare systems worldwide. This study examined in-hospital mortality among patients diagnosed with non-insulin-dependent diabetes mellitus (NIDDM) of ICD-10, or Type 2 Diabetes Mellitus (T2DM), in Indonesia, utilizing hospital claims data spanning from 2017 to 2022 obtained from the Indonesia Health Social Security Agency or Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan. The analysis, which included 610,809 hospitalized T2DM patients, revealed an in-hospital mortality rate of 6.6%. Factors contributing to an elevated risk of mortality included advanced age, the presence of comorbidities, and severe complications. Additionally, patients receiving health subsidies and those treated in government hospitals were found to have higher mortality risks. Geographic disparities were observed, highlighting variations in healthcare outcomes across different regions. Notably, the complication of ketoacidosis emerged as the most significant risk factor for in-hospital mortality, with an odds ratio (OR) of 10.86, underscoring the critical need for prompt intervention and thorough management of complications to improve patient outcomes.

Spatial-temporal transmission dynamics of HIV-1 CRF01_AE in Indonesia.

Human immunodeficiency virus type 1 (HIV-1) remains a serious health threat in Indonesia. In particular, the CRF01_AE viruses were the predominant HIV-1 strains in various cities in Indonesia. However, information on the dynamic transmission characteristics and spatial-temporal transmission of HIV-1 CRF01_AE in Indonesia is limited. Therefore, the present study examined the spatial-temporal transmission networks and evolutionary characteristics of HIV-1 CRF01_AE in Indonesia. To clarify the epidemiological connection between CRF01_AE outbreaks in Indonesia and the rest of the world, we performed phylogenetic studies on nearly full genomes of CRF01_AE viruses isolated in Indonesia. Our results showed that five epidemic clades, namely, IDN clades 1-5, of CRF01_AE were found in Indonesia. To determine the potential source and mode of transmission of CRF01_AE, we performed Bayesian analysis and built maximum clade credibility trees for each clade. Our study revealed that CRF01_AE viruses were commonly introduced into Indonesia from Southeast Asia, particularly Thailand. The CRF01_AE viruses might have spread through major pandemics in Asian countries, such as China, Vietnam, and Laos, rather than being introduced directly from Africa in the early 1980s. This study has major implications for public health practice and policy development in Indonesia. The contributions of this study include understanding the dynamics of HIV-1 transmission that is important for the implementation of HIV disease control and prevention strategies in Indonesia.

Anemia in Breastfeeding Women and Its Impact on Offspring's Health in Indonesia: A Narrative Review.

Anemia in breastfeeding women is a neglected global health issue with significant implications for maternal and child health. Despite its widespread occurrence and adverse effects, this problem remains largely unknown and overlooked on the global health agenda. Despite efforts to improve health access coverage and provide iron and folic acid supplementation, anemia persists. This underscores the need for a comprehensive approach to address the problem. Urgent action must be taken to prioritize education and awareness campaigns, ensure access to nutritious food, and enhance healthcare services. Education programs should focus on promoting iron-rich diets, dispelling cultural myths, and providing practical guidance. Improving healthcare services requires increasing availability, ensuring a consistent supply of iron supplements, and providing adequate training for healthcare providers. A successful implementation relies on a strong collaboration between the government, healthcare providers, and community. It is crucial that we acknowledge that high coverage alone is insufficient for solving the issue, emphasizing the importance of targeted interventions and a strategic implementation. By adopting a comprehensive approach and addressing the underlying causes of anemia, Indonesia can make significant progress in reducing its prevalence and improving the overall health of its population, particularly among breastfeeding women.

Relationship between interleukin-6 (IL-6) levels and chest X-ray severity scoring in COVID-19 patients.

The severity of coronavirus disease 2019 (COVID-19) may be measured by interleukin-6 (IL-6) and chest X-rays. Brixia score of the chest radiographs is usually used to monitor COVID-19 patients' lung problems. The aim of this study was to demonstrate the relationship between IL-6 levels and chest radiographs (Brixia score) that represent COVID-19 severity. A retrospective cohort study was conducted among COVID-19 patients who had a chest X-ray and examination of IL-6 levels at H. Adam Malik General Hospital, Medan, Indonesia. A multinomial logistic regression analysis was conducted to evaluate the association between IL-6 levels and the severity of the chest radiograph. A total of 76 COVID-19 patients were included in the study and 39.5% of them were 60-69 years old, with more than half were female (52.6%). A total of 17.1%, 48.7%, and 34.2% had IL-6 level of <7 pg/mL, 7-50 pg/mL and >50 pg/mL, respectively. There were 39.5%, 36.8% and 23.7% of the patients had mild, moderate and severe chest X-rays based on Brixia score, respectively. Statistics analysis revealed that moderate (OR: 1.77; 95% CI: 1.05- 3.32) and severe (OR: 1.33; 95% CI: 1.03-3.35) lung conditions in the chest X-rays were significantly associated with IL-6 levels of 7-50 pg/mL. IL-6 more than 50 pg/mL was associated with severe chest X-ray condition (OR: 1.97; 95% CI: 1.15-3.34). In conclusion, high IL-6 levels significantly reflected COVID-19 severity through chest X-rays in COVID-19 patients.