Oktaria V, Lee K J, Bines J E, Watts E, Satria C D, Atthobari J, Nirwati H, Kirkwood C D, Soenarto Y, Danchin M H
Pediatrics Research Office, Child Health Department, Faculty of Medicine, Universitas Gadjah Mada/ DR Sardjito Hospital, Yogyakarta, Indonesia.
Department of Pediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.
BMC Pediatr. 2017 Dec 21;17(1):211. doi: 10.1186/s12887-017-0966-x.
Infant morbidity and mortality rates remain high in Indonesia, with acute respiratory illnesses (ARI) and diarrhea the leading two health problems in children under 5 years. We aimed to describe the nutritional status, feeding practice and case management of ARI and diarrhea of infants from two regions of Indonesia during the first 6 months of life.
This study was an observational study conducted in parallel to an immunogenicity and efficacy trial of an oral rotavirus vaccine (RV3-BB) in the Klaten and Yogyakarta regions, Indonesia. Mothers were interviewed at 3 time points: within the first 6 days of their infant's life, and at 8-10 and 22-24 weeks of age. Questions asked included pregnancy history, infant nutritional status, feeding status and health of infants within up to 2 weeks prior to the assessment.
Between February 2013 and January 2014, 233 mother-infant pairs were recruited. 60% (136/223) of infants were exclusively breastfed (EBF) until 6 months of age with the strongest support for EBF reported by mothers themselves 70% (101/223) and 25% (36/223) from their partners. At 6 months, 6% (14/223) of infants were underweight and severely underweight; 4% (8/ 223) wasted and severely wasted; and 12% (28/223) were stunted and severely stunted. Non-recommended medication use was high, with 54% (21/39) of infants with reported cough within 2 weeks of an assessment receiving cough medication, 70% (27 /39) an antihistamine, 26% (10/39) a mucolytic and 15% (6 /39) an oral bronchodilator. At age 22-24 week, infants with reported diarrhea within 2 weeks of an assessment had low use of oral rehydration solutions (ORS) (3/21;14%) and zinc therapy (2/ 21;10%).
In this unique observational study, breastfeeding rates of 60% at 6 months were below the Indonesian national target of >75%. Adherence to WHO guidelines for management of ARI and diarrhea was poor, with high use of non-recommended cough medications and oral bronchodilators in the first 6 months of life and low use of ORS and zinc therapy. Ongoing education of primary health care workers and parents regarding management of common illness is needed in Indonesia.
印度尼西亚婴儿的发病率和死亡率仍然很高，急性呼吸道疾病（ARI）和腹泻是5岁以下儿童的两大主要健康问题。我们旨在描述印度尼西亚两个地区6个月大婴儿的营养状况、喂养方式以及ARI和腹泻的病例管理情况。
本研究是一项观察性研究，与印度尼西亚克拉登和日惹地区口服轮状病毒疫苗（RV3-BB）的免疫原性和疗效试验同时进行。在3个时间点对母亲进行访谈：婴儿出生后的前6天内，以及8至10周龄和22至24周龄时。所问问题包括怀孕史、婴儿营养状况、喂养状况以及评估前2周内婴儿的健康状况。
2013年2月至2014年1月期间，招募了233对母婴。60%（136/223）的婴儿在6个月大之前纯母乳喂养（EBF），母亲本人对EBF的支持率最高，为70%（101/223），伴侣的支持率为25%（36/223）。6个月时，6%（14/223）的婴儿体重不足和严重体重不足；4%（8/223）消瘦和严重消瘦；12%（28/223）发育迟缓并严重发育迟缓。不推荐的药物使用率很高，在评估前2周内报告有咳嗽的婴儿中，54%（21/39）服用了止咳药，70%（27/39）服用了抗组胺药，26%（10/39）服用了黏液溶解剂，15%（6/39）服用了口服支气管扩张剂。在22至24周龄时，评估前2周内报告有腹泻的婴儿口服补液盐（ORS）的使用率较低（3/21；14%），锌疗法的使用率也较低（2/21；10%）。
在这项独特的观察性研究中，6个月时60%的母乳喂养率低于印度尼西亚国家设定的>75%的目标。对ARI和腹泻的管理遵循世界卫生组织指南的情况较差，在生命的前6个月中，不推荐的止咳药和口服支气管扩张剂的使用率很高，而ORS和锌疗法的使用率较低。印度尼西亚需要对初级卫生保健工作者和家长持续开展关于常见疾病管理的教育。
