Child tuberculosis in Respira Lung Hospital, Yogyakarta: demographic and clinical profiles

Tuberculosis (TB) remains a significant source of morbidity and mortality among children in endemic settings. Demografic and clinical profiles of children with TB in Yogyakarta have not been well documented. A total of 80 children with TB were diagnosed with TB during the study period. There were 41 (51.2%) females and 39 (48.8%) males. The case findings of child TB cases has been increasing from 20 cases in 2014, 28 cases in 2015, and 32 cases in 2016. The majority of the children (89.3%) aged less than 5 years. The most common symptoms were cough 50 (62.5%), followed by weight loss 45 (56.3%), and fever 28 (35%). Contact with a TB case was identified in 46 (57.5%) children. Mantoux test was  done  in  76  (95%)  children  with  positive  result  documented  in  61(76.3%) children. Chest X-ray was done in 54 (67.5%) children, of which 52 (65%) chest X- rays showed suggestive of TB. Confirmed diagnosis (bacteriology) was only documented in one child (1.25%)

Efektivitas Pembelajaran Teaching Factory untuk Pengembangan Karakter Entrepreneurship Siswa Sekolah Menengah Kejuruan.

Penelitian ini dilakukan dengan tujuan mengetahui pelaksanaan pembelajaran Teaching Factory (TeFa), dan efektivitas pembelajaran TeFa untuk pengembangan karakter entrepreneurship siswa SMK Kompetensi Keahlian Teknik Instalasi Tenaga Listrik dan Kompetensi Keahlian Mekatronika. Penelitian ini dilakukan dengan pendekatan evaluasi dengan model context, input, process, product. Subjek penelitian ini yaitu: koordinator TeFa, guru, dan siswa yang mengikuti pembelajaran TeFa di SMK Muhammadiyah 3 Surakarta dan SMK N 1 Bawang. Pengambilan data dilakukan melalaui angket, observasi, studi dokumen, dan wawancara. Uji validitas angket dilakukan dengan teknik korelasi Product Moment dengan nilai koefisien korelasi antara 0,408 dan 0,792. Uji reliabilitas instrumen angket dilakukan dengan teknik Alpha Cronbach dengan perolehan koefisien Alpha 0, 817 dan 0,833. Hasil penelitian ini dapat diketahui pelaksanaan pembelajaran TeFa secara keseluruhan komponen CIPP dalam kategori baik, yang mencakup: komponen context dalam kategori “cukup”, komponen input dalam kategori “baik”, komponen process dalam kategori “baik, dan komponen product dalam kategori “baik”. Selanjutnya, pembelajaran TeFa efektif digunakan untuk pengembangan karakter entrepreneurship siswa melalui uji beda Mann Whitney dengan nilai 0,228 untuk komponen input dan 0,237 untuk komponen product

EVALUASI KEPATUHAN PETUGAS DALAM TATALAKSANA PNEUMONIA DI KABUPATEN TOLITOLI

EVALUASI KEPATUHAN PETUGAS DALAM TATALAKSANA PNEUMONIA DI KABUPATEN TOLITOLIAbd Rahman1, Mohammad Hakimi2, Rina Triasih3ABSTRACTBackground: The infant mortality rate in Central Sulawesi Province is 52 per 1000 live births, which isthe fifth highest in Indonesia. The high rate of morbidity and mortality of acute respiratory infection andpneumonia in children under five in Tolitoli District in past year related to the implented efforts triandsARI eradication program. This is indeed related to how officers comply with pneumonia managementcorrectly.Objective: To evaluate officers’ compliance in implementing pneumonia manager Tolitoli Distric.Method: This was an observational study with cross-sectional study design, using quantitative approach,Data were collected through observation and interview using standardized questionnaire by tramednurses. Officer who handled pneumonia program in Tolitoli District and those in Publich Health Centreswere recruited as subjects.Result and Discussion: One hundred and nineteen subjects were recruited to this study. The percentaseof officers who complied with pneumonia management was 69%. The result of multivariate analysis thatwas training increased officers’ compliance in pneumonia management which was adjusted to education,knowledge and length of work had a significant relationship (PR: 1.79; 95% CI: 1,38 – 2,33) and theincreased value R2 of 6.3%, it mean.Conclusion: Trained officers were more compliant than untrained officers with the prevalence risk of1.79 times. Education, knowledge, and length of working service were related to officers’ compliance inpneumonia management.Keywords: training, officers’ compliance in pneumonia managementABSTRAKLatar belakang: Angka kematian bayi di Propinsi Sulawesi Tengah sebesar 52 per 1000 kelahiran hidupdan menempati urutan kelima tertinggi di Indonesia. Tingginya angka kesakitan dan angka kematian balitaakibat pneumonia di Kabupaten Tolitoli dalam beberapa tahun terakhir tidak terlepas dari seberapa jauhupaya program pemberantasan penyakit ISPA telah dilaksanakan. Hal ini sangat terkait dengan bagaimanakepatuhan petugas dalam melakukan tata laksana pneumonia secara tepat.Tujuan: Diketahuinya kepatuhan petugas dalam melakukan tatalaksana pneumonia di Kabupaten Tolitoli.Metode: Penelitian ini merupakan jenis penelitian observasional dengan rancangan cross sectional denganmenggunakan pendekatan kuantitatif. Data dikumpulkan melalui observasi dan wawancara dengan subyekpenelitian dengan menggunakan lembar observasi dan kuesioner.Hasil dan Pembahasan: Sebanyak 119 subyek diikutkan dalam penelitian ini. Rata-rata petugas yang patuhterhadap tata laksana pneumonia sebesar 69%. Hasil analisis multivariat menunjukkan bahwa variabelpelatihan dan kepatuhan petugas dalam tatalaksana pneumonia dengan mengikutsertakan variabel pendidikan, pengetahuan dan masa kerja untuk dianalisis secara bersama mempunyai hubungan yangsignifikan ((RP;1,79, IK 95%; 1,38 – 2,33) dan peningkatan nilai R2 sebesar 6,3%Kesimpulan: Petugas yang telah dilatih lebih patuh dibanding petugas yang belum dilatih dengan risikoprevalensi 1,53 kali. Faktor pendidikan, pengetahuan dan masa kerja berhubungan secara bermaknadengan kepatuhan petugas dalam tataksana pneumonia.Kata kunci: pelatihan, Kepatuhan petugas tatalaksana pneumonia1 Tolitoli Faculty of Medicine and Health Science2 Maternal and Child Health-Reproductive Health Graduate Program, FK-UGM3 Pediatric Department, Dr. Sardjito General Hospital, Yogyakart

Knowledge and Implementation of Integrated Management of Childhood Illness at East Kalimantan

Pneumonia is the most common cause of morbidity and mortality among young children worldwide. Integrated Management of Childhood Illness (IMCI) is a procedural form in the care of childhood illness which aims to minimize morbidity and mortality rate in children, including pneumonia. This was a cross-sectional study at Samarinda and Kutai Kartanegara community health center from July to October 2015. The health workers’ knowledge was assessed through questionnaire. The quality of IMCI implementation was evaluated through direct observation in primary health care. A total of 46 health workers were involved in this study. Observation of IMCI implementation quality was conducted in 104 children. The majority of respondents (73.9) had sufficient knowledge; however, in terms of direct implementation on the field, most of the respondents (87%) were included in incompetent category. It can be concluded that level of knowledge was related to implementation of cough IMCI in community health center, but the correlation was weak

Kadar Bilirubin 24 Jam Pertama Sebagai Faktor Prediksi Hiperbilirubinemia Pada Bayi Cukup Bulan Yang Sehat

Rina Triasih, Ekawaty L Haksari, Achmad Surjono - The first 24 hour bilirubin level as a predictor of hyperbilirubinemia in healthy term newborns. Background: The practice of early discharge in healthy term newborns results in difficulty for recognition, follow-up and early treatment of hyperbilirubinemia, the most common cause of readmission in term newborns. Objectives: The aim of the study was to determine the ability of first 24 hours total and unbound bilirubin levels in predicting hyperbilirubinemia in healthy term newborns in the first week of life. Methods: The first 24 hours and 5th day of total and unbound bilirubin were measured in 84 healthy term newborns. The total bilirubin level was measured spectrophotometrically whereas unbound bilirubin level was determined by peroxidase-oxidation method. Hyperbilirubinemia was defined as serum total bilirubin of a 12.9 mg/dL or serum unbound bilirubin of a 0.5 mg/dL after 24 hours of life. Results: A correlation between first 24 hours and 5th day of total bilirubin was found (r= 0.53) with a regression equation: Y (total bilirubin day 5) = 4.69 + 1.15 X (total bilirubin first 24 hours). In unbound bilirubin (r= 0.31), the regression equation was Y (unbound bilirubin day 5) = 0.13 + 0.95 X (unbound bilirubin first 24 hours). The relative risk of newborns whose first 24 hours total bilirubin of a 4.5 mg/dL and becoming hyperbilirubinemia was 12 (95% CI = 2.9 - 48.4), and newborns whose unbound bilirubin of a 0.09 mg/dL was 9.5 (95% CI = 1.2-77.4). Conclusions: Total bilirubin level a 4.5 mg/dL in the first 24 hours can predict the occurance of hyperbilirubinemia in the first week of life inthe term newborns. Key word: fullterm newborn, hyperbilirubinemia, prediction, total bilirubin, unbound bilirubi

Interferon-g-Inducible Protein 10 for Diagnosis of Tuberculosis in Children

BACKGROUND: The diagnosis of tuberculosis (TB) in children is challenging by the absence of a practical gold standard. Interferon (IFN)-ginducible protein 10 (IP-10) is a chemokine that may serve as the leading candidate marker in child TB diagnosis. The aim of this study is to assess the diagnostic value of IP-10 in the diagnosis of TB in children.METHODS: We recruited eligible symptomatic and asymptomatic children aged <15 years actively by contact investigation and passively from inpatient and outpatient clinics in two hospitals, in Yogyakarta, Indonesia. We conducted clinical examination and chest X-ray in all eligible children. Sputum smear and the rapid molecular TB test were performed in children with TB symptoms. All participants underwent blood sampling for IFN-g Release Assay and IP-10 test.RESULTS: A total of 79 children were recruited to this study. Twelve children were with TB disease, 16 with latent TB infection (LTBI), 40 were TB-exposed only and 11 were non-TB. Children with evidence of TB infection either with TB disease or LTBI had higher levels of antigen-stimulated IP-10 compared to non-infected children, both TB exposed only and non-TB (p=0.000). A cut-off 408.74 pg/mL for antigen-stimulated IP-10 showed high diagnostic accuracy for diagnosis of TB infection (AUC: 0.97, 95% CI: 0.92-1.00, sensitivity: 92.3%, and specificity: 91.9%). However, the stimulated levels of IP-10 between children with TB disease and LTBI were not significantly different (p=0.268).CONCLUSION: IP-10 performed well to diagnose TB infection in children. However, it cannot be used to differentiate TB infection from TB disease.KEYWORDS: IFN-g, IP-10, latent TB, active TB, childre

Contact Investigation of Children Exposed to Tuberculosis in South East Asia: A Systematic Review

Background. Screening of children who are household contacts of tuberculosis (TB) cases is universally recommended but rarely implemented in TB endemic setting. This paper aims to summarise published data of the prevalence of TB infection and disease among child contacts in South East Asia. Methods. Search strategies were developed to identify all published studies from South East Asia of household contact investigation that included children (0–15 years). Results. Eleven studies were eligible for review. There was heterogeneity across the studies. TB infection was common among child contacts under 15 years of age (24.4–69.2%) and was higher than the prevalence of TB disease, which varied from 3.3% to 5.5%. Conclusion. TB infection is common among children that are household contacts of TB cases in South East Asia. Novel approaches to child contact screening and management that improve implementation in South East Asia need to be further evaluated

Computer Aided Classification of X-ray Images from Pediatric Pneumonia Subjects Collected in Developing Countries

Pneumonia is a lower tract respiratory infection due to bacteria or viruses. It is a severe disease in the pediatric population. Pneumonia is the leading cause of mortality in children under five years worldwide. One of the problems with pneumonia is the diagnosis, as the symptoms of pneumonia may overlap with other diseases, such as asthma and bronchiolitis. In this work, we propose to develop a method for classifying pneumonia and non-pneumonia using X-ray images. We collected 60 X-ray images from Dr. Sardjito Hospital, Yogyakarta, Indonesia, and the dataset from Kaggle. We processed these images through pre-processing algorithms to enhance the image quality, segmentation, white pixel computation, and classification. The novelty of our method is using the ratio of the white pixels from edge detection using the Canny algorithm with the white pixels from segmentation for classifying pneumonia/non-pneumonia. In the Kaggle dataset, our proposed method achieved an accuracy of 86.7%, a sensitivity of 100%, and a specificity of 85%. The classification using the dataset from Dr. Sardjito Hospital yields sensitivity, specificity, and accuracy of 80%, 60%, and 66.7%, respectively. Despite the low performance in the results, we proved our novel feature, ratio of white pixels, can be used to classify pneumonia/non-pneumonia. We also identified that the local dataset is essential in the algorithm development as it has a different quality from the dataset from modern countries. Further, our simple method can be developed further to support pneumonia diagnosis in resource-limited settings where the advanced computing devices or cloud connection are not available

Paediatric tuberculosis - new advances to close persistent gaps

Young children are most vulnerable to develop severe forms of tuberculosis (TB) and are over-represented among TB deaths. Almost all children estimated to have died from TB were never diagnosed or offered TB treatment. Improved access to TB preventive treatment (TPT) requires major upscaling of household contact investigation with allocation of adequate resources. Symptom-based screening is often discouraged in adults for fear of generating drug resistance, if TB cases are missed. However, the situation in vulnerable young children is different, as they present minimal risk of drug resistance generation. Further, the perceived need for additional diagnostic evaluation presents a major barrier to TPT access and underlies general reluctance to consider pragmatic decentralised models of care. Widespread roll-out of Xpert MTB/RIF Ultra® represents an opportunity for improved case detection in young children, but attaining full impact will require the use of non-sputum specimens. The new Fujifilm SILVAMP TB LAM® urine assay demonstrated good diagnostic accuracy in HIV-positive and malnourished children, but further validation is required. Given the limited accuracy of all available tests and the excellent tolerance of TB drugs in children, the global community may have to accept some over-treatment if we want to close the persistent case detection gap in young children

Infant BCG vaccination and risk of pulmonary and extrapulmonary tuberculosis throughout the life course: a systematic review and individual participant data meta-analysis.

BACKGROUND: BCG vaccines are given to more than 100 million children every year, but there is considerable debate regarding the effectiveness of BCG vaccination in preventing tuberculosis and death, particularly among older children and adults. We therefore aimed to investigate the age-specific impact of infant BCG vaccination on tuberculosis (pulmonary and extrapulmonary) development and mortality. METHODS: In this systematic review and individual participant data meta-analysis, we searched MEDLINE, Web of Science, BIOSIS, and Embase without language restrictions for case-contact cohort studies of tuberculosis contacts published between Jan 1, 1998, and April 7, 2018. Search terms included "mycobacterium tuberculosis", "TB", "tuberculosis", and "contact". We excluded cohort studies that did not provide information on BCG vaccination or were done in countries that did not recommend BCG vaccination at birth. Individual-level participant data for a prespecified list of variables, including the characteristics of the exposed participant (contact), the index case, and the environment, were requested from authors of all eligible studies. Our primary outcome was a composite of prevalent (diagnosed at or within 90 days of baseline) and incident (diagnosed more than 90 days after baseline) tuberculosis in contacts exposed to tuberculosis. Secondary outcomes were pulmonary tuberculosis, extrapulmonary tuberculosis, and mortality. We derived adjusted odds ratios (aORs) using mixed-effects, binary, multivariable logistic regression analyses with study-level random effects, adjusting for the variable of interest, baseline age, sex, previous tuberculosis, and whether data were collected prospectively or retrospectively. We stratified our results by contact age and Mycobacterium tuberculosis infection status. This study is registered with PROSPERO, CRD42020180512. FINDINGS: We identified 14 927 original records from our database searches. We included participant-level data from 26 cohort studies done in 17 countries in our meta-analysis. Among 68 552 participants, 1782 (2·6%) developed tuberculosis (1309 [2·6%] of 49 686 BCG-vaccinated participants vs 473 [2·5%] of 18 866 unvaccinated participants). The overall effectiveness of BCG vaccination against all tuberculosis was 18% (aOR 0·82, 95% CI 0·74-0·91). When stratified by age, BCG vaccination only significantly protected against all tuberculosis in children younger than 5 years (aOR 0·63, 95% CI 0·49-0·81). Among contacts with a positive tuberculin skin test or IFNγ release assay, BCG vaccination significantly protected against tuberculosis among all participants (aOR 0·81, 95% CI 0·69-0·96), participants younger than 5 years (0·68, 0·47-0·97), and participants aged 5-9 years (0·62, 0·38-0·99). There was no protective effect among those with negative tests, unless they were younger than 5 years (0·54, 0·32-0·90). 14 cohorts reported on whether tuberculosis was pulmonary or extrapulmonary (n=57 421). BCG vaccination significantly protected against pulmonary tuberculosis among all participants (916 [2·2%] in 41 119 vaccinated participants vs 334 [2·1%] in 16 161 unvaccinated participants; aOR 0·81, 0·70-0·94) but not against extrapulmonary tuberculosis (106 [0·3%] in 40 318 vaccinated participants vs 38 [0·2%] in 15 865 unvaccinated participants; 0·96, 0·65-1·41). In the four studies with mortality data, BCG vaccination was significantly protective against death (0·25, 0·13-0·49). INTERPRETATION: Our results suggest that BCG vaccination at birth is effective at preventing tuberculosis in young children but is ineffective in adolescents and adults. Immunoprotection therefore needs to be boosted in older populations. FUNDING: National Institutes of Health