Abstrak: According to several studies, infants whose mothers had a malaria-infected placenta (MIP) at delivery are at increased risk of a first malaria infection. Immune tolerance caused by intrauterine contact with the parasite could explain this phenomenon, but it is also known that infants who are highly exposed to Anopheles mosquitoes infected with Plasmodium are at greater risk of contracting malaria. Consequently, local malaria transmission must be taken into account to demonstrate the immune tolerance hypothesis. From data collected between 2007 and 2010 on 545 infants followed from birth to age 18 months in southern Benin, we compared estimates of the effect of MIP on time to first malaria infection obtained through different Cox models. In these models, MIP was adjusted for either 1) "village-like" time-independent exposure variables or 2) spatiotemporal exposure prediction derived from local climatic, environmental, and behavioral factors. Only the use of exposure prediction improved the model's goodness of fit (Bayesian Information Criterion) and led to clear conclusions regarding the effect of placental infection, whereas the models using the village-like variables were less successful than the univariate model. This demonstrated clearly the benefit of adequately taking transmission into account in cohort studies of malaria.

Abstrak: Penyakit HIV/AIDS yang merupakan salah satu dari 10 penyakit terbesar didunia yang memiliki angka mortalitas dan morbiditas tinggi. Pada tahun 2016 menurut Infodatin AIDS bahwa DKI Jakarta adalah yang tertinggi untuk penderita HIV. Salah satu cara penularannya adalah penularan secara vertikal dari ibu ke anak, saat kehamilan, persalinan dan menyusui. Penelitian ini ingin mengetahui apakah faktor sosidemografi ibu, faktor Ibu, faktor obstetri dan faktor anak berhubungan dengan penularan HIV/AIDS pada anak. Penelitian ini dilakukan pada bulan Mei sampai dengan bulan Juli 2017 di RSUP Fatmawati. Pada penelitian ini menggunakan desain Kasus Kontrol dengan sample anak usia 2-5 tahun, sebesar 33 anak sebagai kasus (anak dengan HIV positif)dan 33 anak sebagai kontrol (anak denganHIV negatif) dari ibu yang menderita HIV positif. Dari hasil analisis dengan menggunakan SPSS 20.0 didapatkan bahwa untuk variabel yang dinyatakan adanya hubungan adalah faktor sosioekonomi( OR=4,7; CI=1,45-15,07), stadium klinis HIV (OR=26,7; CI=3,25-218,86), jumlah CD4 ibu (OR=19,3; CI=5,29-70,66), lama ibu minum ARV(OR=7,4; CI=1,87-29,84), cara persalinan (OR=6,7; CI=1,35-33,75) dan prematuritas anak saat kelahiran (OR=16,5; CI=3,37-80,31).Sedangkan variabel yang tidak ada hubungan adalah dari faktor sosiodemograi yaitu usia, pendidikan , pekerjaan dan paritas ibu menunjukan tidak adanya hubungan dengan penularan HIV/AIDS pada anak. Kata kunci: Penularan, HIV/AIDS, anak HIV / AIDS disease is one of the top 10 diseases in the world that have high mortality and morbidity. In 2016 according to Infodatin AIDS that DKI Jakarta is the highest for people with HIV. One way of transmission is vertical transmission from mother to child, during pregnancy, delivery and breastfeeding. This research wanted to know whether mother's sosidemography factor, mother factor, obstetric factor and child factor related to HIV / AIDS transmission in child. This research was conducted from May until July 2017 at Fatmawati General Hospital. In this study used a control case design with a sample of 2-5 year olds, 33 children as a case (HIV positive children) and 33 children as control (HIV negative children) from HIV positive mothers. From the result of the analysis by using SPSS 20.0 it is found that for the variable which stated the existence of the relation is socioeconomic factor (OR = 4,7; CI = 1,45-15,07), clinical stage HIV (OR = 26,7; CI = 3, 25-218,86), mother's CD4 cell count (OR = 19.3, CI = 5.29-70.66), duration of mother taking ARV (OR = 7,4; CI = 1.87-29,84), (OR = 6,7; CI = 1.35-33,75) and prematurity of the child at birth (OR = 16.5; CI = 3.37-80,31). While the variables that have no correlation are from sosiodemograi factor that is age, education, work and parity of mother showed no relation with HIV / AIDS transmission in child. Keywords: Transmission, HIV / AIDS, child

Abstrak:

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Abstrak: Latar Belakang: Program nasional Deteksi Dini Hepatitis B (DDHB) untuk ibu hamil merupakan strategi utama untuk mencegah penularan hepatitis B dari ibu ke anak/ mother-to-child transmission (MTCT). Sekitar 90% bayi yang tertular dari ibu dengan HBsAg reaktif akan berkembang mengalami hepatitis B kronik. Imunisasi merupakan salah satu upaya pencegahan, namun belum bisa sepenuhnya mencegah penularan Hepatitis B pada anak. Penelitian ini bertujuan untuk menganalisis faktor risiko yang berhubungan terhadap hepatitis B pada anak, membuat model probabilitas kejadian hepatitis B pada anak, dan menelaah penerapan program DDHB sebagai tindakan pencegahan dan pengendalian MTCT. Metode: Penelitian ini menggunakan pendekatan concurrent mixed method, penelitian kuantitatif dengan desain studi kohort retrospektif dilakukan dengan melibatkan 166 pasangan ibu-anak, ibu dipastikan memiliki infeksi hepatitis B (HBsAg-positif) berdasarkan skrining saat melakukan ANC. Sedangkan penelitian kualitatif menggunakan desain studi kasus melalui indepth-interview kepada 23 informan. Penelitian ini dilaksanakan di Kota Makassar dan Kabupaten Gowa, Provinsi Sulawesi Selatan. Hasil: Analisis multivariat menggunakan GLM binomial link log dilakukan untuk menghitung risk rasio (aRR) dari faktor risiko yang berhubungan dengan hepatitis B pada anak. Hasil penelitian menunjukkan bahwa ibu dengan kadar HBV-DNA tinggi (>106 copies/mL) memiliki risiko lebih tinggi untuk menularkan HBV kepada anaknya (aRR=2,9; 95%CI=1,37-6,20). Anak yang tidak mendapat HBIg (aRR=5,6; 95%CI=2,28-13,76), tidak vaksin HB-0 (aRR=2,9; 95%CI=1,37-6,20), tidak vaksin HB-1 (aRR=10,4; 95%CI=5,23-20,87), dan tidak vaksin HB-2 (aRR=12,1; 95%CI=5,21-28,35) memiliki risiko infeksi HBV yang lebih tinggi. Adapun anak dengan kadar HBV-DNA ibunya yang tinggi (>106 copies/mL), tidak mendapat HBIg, tidak vaksin HB-0, tidak vaksin HB-1, dan tidak vaksin HB-2 memiliki probabilitas kejadian hepatitis B sebesar 94%. Kesimpulan: Temuan ini menekankan pentingnya program DDHB bagi ibu hamil dalam mengidentifikasi kadar HBV-DNA untuk memfasilitasi terapi antivirus sesuai kebutuhan. Begitupun pemberian HBIg dan vaksin hepatitis B (HB-0, HB-1, dan HB-2) kepada anak sangat efektif dalam mengurangi risiko penularan hepatitis B pada anak, menjadikannya sebagai strategi penting dalam mencegah infeksi hepatitis B pada anak. Saran: Program DDHB perlu dioptimalkan secara komprehensif, sejak tindakan skrining pada ibu hamil, melaksanakan pemeriksaan HBV-DNA pada ibu hamil yang HBsAg reaktif, serta meningkatkan cakupan pemberian HBIg dan vaksinasi hepatitis B (HB-0, HB-1, dan HB-2) pada anak.

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Background: The national Early Detection of Hepatitis B (DDHB) program for pregnant women is a key strategy to prevent mother-to-child transmission (MTCT) of hepatitis B. With approximately 90% of infants born to HBsAg-positive mothers developing chronic hepatitis B, immunization remains crucial but does not fully eliminate the risk of transmission. This study aimed to analyze risk factors contributing to hepatitis B in children, develop a probability model for its occurrence, and evaluate the implementation of the DDHB program as a preventive and control measure for MTCT. Methods: This study employed an explanatory mixed-methods approach. The quantitative component used a retrospective cohort design involving 166 mother-child pairs, where mothers were confirmed to have hepatitis B infection (HBsAg-positive) through antenatal care (ANC) screening. The qualitative component utilized a case study design with in-depth interviews conducted with 23 informants. The research was carried out in Makassar City and Gowa Regency, South Sulawesi Province. Result: A multivariate analysis using a binomial GLM with a log link was conducted to calculate the adjusted risk ratio (aRR) for factors associated with hepatitis B in children. The results indicated that mothers with high HBV-DNA levels (>106 copies/mL) had a significantly increased risk of transmitting HBV to their children (aRR=2.9, 95%CI=1,37-6,20). Children who did not receive hepatitis B immunoglobulin (HBIg) (aRR = 5.6, 95%CI=2,28-13,76), did not vaccinate HB-0 (aRR = 2.9, 95%CI=1,37-6,20), did not vaccinate HB-1 (aRR = 10.44, 95%CI=5,23-20,87), or did not vaccinate HB-2 (aRR = 12.11, 95%CI=5,21-28,35) were at significantly higher risk of HBV infection. Additionally, children born to mothers with high HBV-DNA levels (>106 copies/mL) who did not receive HBIg, HB-0, HB-1, and HB-2 vaccines had a 94% probability of hepatitis B occurrence. Conclusion: These findings emphasize the importance of the DDHB program for pregnant women in identifying HBV-DNA levels to facilitate antiviral therapy as needed. Furthermore, the administration of HBIg and hepatitis B vaccines (HB-0, HB-1, and HB-2) to infants is highly effective in reducing the risk of MTCT, making it a vital strategy in preventing hepatitis B infections in children. Recommendation: The DDHB program should be comprehensively optimized, starting with screening for pregnant women, conducting HBV-DNA testing on pregnant women who are HBsAg reactive, and enhancing the coverage of HBIg administration and implementation of the hepatitis B vaccination (HB-0, HB-1, and HB-2) for children.

Abstrak: Polio eradication is on the cusp of success, with only a few regions still maintaining transmission. Improving our understanding of why some regions have been successful and others have not will help with both global eradication of polio and development of more effective vaccination strategies for other pathogens. To examine the past 25 years of eradication efforts, we constructed a transmission model for wild poliovirus that incorporates waning immunity (which affects both infection risk and transmissibility of any resulting infection), age-mediated vaccination rates, and transmission of oral polio vaccine. The model produces results consistent with the 4 country categories defined by the Global Polio Eradication Program: elimination with no subsequent outbreaks; elimination with subsequent transient outbreaks; elimination with subsequent outbreaks and transmission detected for more than 12 months; and endemic polio transmission. Analysis of waning immunity rates and oral polio vaccine transmissibility reveals that higher waning immunity rates make eradication more difficult because of increasing numbers of infectious adults, and that higher oral polio vaccine transmission rates make eradication easier as adults become reimmunized. Given these dynamic properties, attention should be given to intervention strategies that complement childhood vaccination. For example, improvement in sanitation can reduce the reproduction number in problematic regions, and adult vaccination can lower adult transmission.

Abstrak: Tuberkulosis masih menjadi salah satu penyakit menular yang paling mematikan di dunia. Saat ini diperkirakan 9,6 juta orang memiliki masalah terkait TB pada tahun 2014 (5,4 juta laki-laki; 3,2 juta perempuan; dan 1 juta anak-anak). Kasus tertinggi terdapat di India, Indonesia dan China dengan julah kasus masing-masing: 23%, 10% dan 10%. WHO telah memperkenalkan the End TB Strategy dalam upaya menurunkan prevalensi TB, yang berlaku sejak tahun 2016. Sehubungan dengan strategi tersebut, telah ditetapkan target terkait dengan SDGs yaitu menurunkan jumlah kematian TB sebesar 90% dan jumlah kasus TB baru sebesar 80% dari target tahun 2015 untuk tahun 2030 serta memastikan bahwa tidak ada keluarga dibebani dengan bencana biaya karena TB. Prinsip dasar perawatan kasus tuberkulosis adalah sama di seluruh dunia. Diagnosis harus ditetapkan secara akurat dan sedini mungkin, dan rejimen pengobatan harus sesuai standar. Skrining foto toraks menunjukkan sensitivitas yang baik dalam mengidentifikasi individu dengan risiko tertinggi mengalami TB, terutama ketika kriteria abnormal pada paru-paru dan pleura digunakan. Banyak negara menggunakan skrining foto toraks untuk TB peningkatan deteksi kasus TB.Tujuan utama penelitian ini adalah: menganalisis positivitas skrining TB dengan memanfaatkan pemeriksaan foto toraks serta potensi kerugian ekonomi yang dapat dicegah. Tujuan khusus adalah menganalisis peningkatan positivitas bakteriologi positif pada skrining TB dengan penambahan foto toraks; menganalisis akurasi dengan penambahan pemeriksaan skrining foto toraks dan implikasinya terhadap biaya pemeriksaan.Penelitian ini menggunakan data sekunder SPTB yang dilaksanakan tahun 2013-2014 untuk tingkat nasional dan 3 wilayah. Disain SPTB 2013-2014 adalah potong lintang dengan stratified multi-stage cluster sampling. Semua partisipan diwawancarai tentang gejala TB dan dilakukan skrining foto toraks kecuali wanita hamil dan partisipan yang menolak. Suspek adalah partisipan dengan gejala TB atau abnormal foto toraks, pemeriksaan sputum mikroskopik, kultur dan Xpert MTB/Rif dilakukan oleh tujuh laboratorium rujukan TB. Hasil penelitian ini membuktikan bahwa skrining foto toraks dapat mendeteksi sebesar 97% smear positif, 94% smear negatif, serta 95% dari konfirmasi bakteriologis TB. Sebanyak 30% smear positif dan 51% smear negatif serta 43% konfirmasi bakteriologis TB hanya terdeteksi dari skrining foto toraks tanpa skrining gejala TB. Berarti terdapat kasus TB yang tidak terdeteksi jika tanpa skrining foto toraks dan jika hanya mengandalkan skrining gejala TB di Indonesia tahun 2013-2014, sebanyak 602.717 untuk umur ≥15 tahun, dan 421.250 untuk kelompok umur 18-60 tahun diantaranya, laki-laki 273.810 dan perempuan 147.440.Penambahan skrining foto toraks minimal meningkatkan empat kali konfirmasi bakteriologis TB dibanding dengan hanya skrining gejala TB dan sembilan kali jika bersama-sama skrining gejala dan skrining foto toraks. Sensitivitas dan spesifitas abnomal foto toraks pada skrining gejala positif masing-masing terhadap konfirmasi bakteriologis TB adalah 91,3% dan 47,2%. Hasil lainnya apabila hasil uji diagnostik penambahan skrining foto toraks normal pada skrining gejala positif, maka probabilitas pasien tidak TB adalah sebesar 99,4 %(NPV). Hal ini berarti adanya efisiensi dari sekitar 45% pasien dengan skrining gejala TB positif tetapi skrining foto toraks normal, bukan suspek TB sehingga tidak memerlukan biaya untuk pemeriksaan laboratorium smear dan Xpert MTB/RIF. Umumnya (96%) hasil pemeriksaan Xpert MTB/RIF positif adalah kultur positif yang diacu sebagai gold standard, sedangkan hanya 49% hasil BTA positif diantara kultur positif.Penambahan skrining foto toraks untuk mendeteksi TB dapat menghemat biaya pengeluaran dalam deteksi kasus TB terutama pada laki-laki umur produktif. Sebesar 38% biaya yang dapat dihemat berasal dari biaya tidak langsung yaitu kehilangan tahun produktifitas karena kematian dini dan selama sakit. Biaya yang dapat dihemat ini tinggi terutama pada laki (50%) Penambahan pemeriksaan foto toraks juga dapat menurunkan kematian dan transmisi sebesar 75% pada smear positif dan 30% pada smear negatif. Oleh karena itu rekomendasi utama penelitian ini adalah memasukkan skrining foto toraks selain skrining gejala TB pada alur diagnosis TB dewasa bersama pemeriksaan Xpert MTB/RIF dalam deteksi dini kasus TB untuk menurunkan prevalensi, kematian akibat TB dan transmisi di masyarakat.

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Tuberculosis remains one of the world?s deadliest communicable diseases. Worldwide, 9.6 million people was estimated to have TB?s related problems in 2014; i.e 5.4 million in men; 3.2 million women and 1 million children. Globally, India, Indonesia and China had the largest number of TB cases: 23, 10 and 10 of total percentage. WHO has launched the End TB Strategy in the effort of reducing TB?s prevalence that has been implemented since 2016. With regard to the target of the strategy which is linked to the SDGs, 90% of mortality and 80% of the new TB cases (year 2015) should be achieved in 2030. In addition, there should be taken for granted there would not any family be financially burden because of TB. The basic principle to cure TB cases is the same all over the world. Diagnose has to be done accurately and as early as possible. In addition, treatment regiments have to be standardized. Thorax screening has shown as a good sensitivity in identifying a high risk TB suspect, especially when abnormality criterion at lung and pleura is implemented. Many countries has adopting screening of thorax photo to escalate for TB case detection.The purpose of this study is to analyze the positivity of TB screening through thorax photo identification and its economics potential losses that can be prevented. The specific purposes are: to analyze the positivity of bacteriologically TB confirmed in TB screening with chest X-ray; to analyze accuracy of adding chest X-ray screening in a bacteriologicallyTB confirmed and its financial implication on TB diagnose.This study utilized a secondary data of SPTB that has been collected in 2013-2014 for national level and 3 regions representative. The design of the study is a cross-sectional, implementing stratified multi-stages cluster sampling. Participants were interviewed on TB?s symptoms and screened for direct digital chest radiography (DDR) except for pregnant women and those refused to participate. Suspect are those who having symptoms of TB or abnormal thorax photo, assessed for microscopic sputum for acid-fast bacillus (AFB),, culture and Xpert MTB/RIF done by seven referal TB?s laboratory.Study results showed, screening for thorax photo can detect as much as 97% of positive smear, 94% of negative smear and 95% of bacteriologically TB confirmed. Without symptoms of TB, thorax photo can detect 30% positive smear, 51% negative smear and 43% bacteriologically TB confirmed. It can be said that there are TB cases that can?t be detected without taking thorax photo. By doing screening of symptoms only, there are 602,717 cases of age ≥15 years old, 421,250 cases of age 18-60 years among others 273,810 cases are men and 147,440 cases are women were may loss detected. By adding thorax screening we can increase four-fold TB bacteria confirmation and nine-fold when both (symptoms and thorax) are done simultaneously.Sensitivity and specificity of abnormal thorax photo for positive symptom towards TB bacterilogically TB cofirmed was 91.3% and 47.2% respectively. Other results was when the results of thorax photo screening normal, but having positive symptoms, the probability of non TB cases was 99.4% (NPV). Thus, there would be about 45% efficiency can be done for cases of symptom positive ? thorax normal, or non TB suspect which can save finance for laboratory smear assessment and Xpert MTB/RIF. Generally 96% of Xpert MTB/RIF positive was culture positive that used as a gold standard comparing to 49% of BTA positive among culture positive.Using chest X-Ray screening to detect TB could save budget in detecting TB cases, especially at men of productive age. As much as 38% finance reveal as indirect cost that is productivity losses due to premature death and temporary disability. This cost saving is relatively high (50%). By adding thorax photo assessment, it can reduce 75% mortality and TB?s transmission of positive smear and 30% of negative smear.The main recommendation of this study is to implement thorax photo screening in spite of TB?s symptom screening at the diagnoses pathways for adult TB cases, simultaneously with early detection of Xpert MTB/RIF to reduce TB prevalence, mortality as well as transmission in the community.