Singgih, Adrian Himawan
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PROFILE OF IMMUNIZATION PRACTICE BY GENERAL PRACTITIONERS AND PEDIATRICIANS IN PRIVATE SETTING Soedjatmiko, Soedjatmiko; Gunardi, Hartono; Satari, Hindra Irawan; Singgih, Adrian Himawan; Yolanda, Natharina
Majalah Kedokteran Bandung Vol 49, No 4 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (66.572 KB) | DOI: 10.15395/mkb.v49n4.1153

Abstract

Basic immunization coverage in Indonesia in 2013 was still low (59.2%) (IBHS, 2013). Physicians? attitude and practice were among the determinant factors of a successful immunization program. This survey aimed to describe general practitioner?s (GP) and pediatrician?s attitude towards immunization and its coverage  in private practices. This cross-sectional study was performed by distributing questionnaires consisting of 5 items on opinion and 10 items on immunization practices to 100 respondents in November 2014. Completed questionnaires were obtained from 29 GPs and 65 pediatricians. Most respondents considered that the Expanded Program in Immunization vaccine should be given. First dose of hepatitis B vaccine was mostly given in the first 12 hours after birth (90% GPs and 74% pediatricians). Oral polio vaccine was mostly given shortly before hospital discharge (65% of GPs and 81% pediatricians) while the DTwP-HB-Hib vaccine were given by 27% of GPs and 21% of pediatricians to >75% patients. Pneumococcal, rotavirus, hepatitis A, typhoid, and influenza vaccines were provided by less than 25% GPs and pediatricians, except for the influenza vaccine which was provided by 31% pediatricians. MMR vaccine was given to >75% patients by 16% of GPs and 29% of pediatricians. This pilot survey of immunization practice in private setting might be the first study in Indonesia that this can be considered as a preliminary report of immunization in private setting. Further studies need to be done, especially regarding problems in immunization in private practices. Key words: Attitude, general practitioners, immunization practice, private setting, pediatriciansGambaran Praktek Imunisasi Dokter Umum dan Dokter Spesialis Anak di Praktek SwastaRiset Kesehatan Dasar 2013 melaporkan bahwa cakupan imunisasi Indonesia masih rendah (59,2%). Sikap dan praktik imunisasi dokter merupakan salah satu faktor penentu keberhasilan. Tujuan penelitian ini mengetahui sikap dokter dan cakupan imunisasi di praktik swasta. Penelitian potong lintang dilakukan dengan menyebarkan kuesioner tentang sikap dan praktik imunisasi kepada responden, yaitu 29 dokter umum (DU) dan 65 dokter spesialis anak (DA) pada bulan November 2014. Mayoritas responden berpendapat bahwa vaksin program pengembangan imunisasi harus diberikan. Vaksin hepatitis B dosis I mayoritas diberikan dalam 12 jam setelah lahir (90% oleh DU dan 74% oleh DA). Vaksin polio oral mayoritas diberikan sebelum pulang perawatan (65% oleh DU dan 81% oleh DA), Vaksin DTwP-HB-Hib diberikan oleh 27% DU dan 21% DA kepada ?75% pasien. Penggunaan vaksin pneumokokus, rotavirus, hepatitis A, tifoid dan influenza pada >75% pasien adalah kurang dari 25%, kecuali vaksin influenza, yaitu 31% digunakan oleh DA. Pemberian vaksin MMR pada >75% pasien dilakukan oleh 16% DU dan 29% DA.  Penelitian imunisasi pada praktik swasta ini mungkin  merupakan laporan yang pertama dipublikasi di Indonesia. Penelitian lebih lanjut diperlukan untuk mengetahui hambatan imunisasi di praktik swasta.Kata kunci: Cakupan imunisasi, dokter,  imunisasi, praktik, spesialis
Nutritional Formula Selection in Pediatric High-Output Stoma with Acute Kidney Injury: A Review Article Anggitha, Gisheila Ruth; Widodo, Ariani Dewi; Singgih, Adrian Himawan
Archives of Pediatric Gastroenterology, Hepatology, and Nutrition Vol. 4 No. 4 (2025): APGHN Vol. 4 No. 4 November 2025
Publisher : The Indonesian Society of Pediatric Gastroenterology, Hepatology, and Nutrition

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58427/apghn.4.4.2025.208-218

Abstract

Background: High-output stoma (HOS) is a common complication in pediatric patients with ileostomy, often leading to dehydration, electrolyte imbalance, and malnutrition. These complications increase the risk of acute kidney injury (AKI), which is associated with high morbidity and mortality. Nutritional management in children with HOS and AKI is challenging, requiring careful formula selection to maintain adequate energy and protein intake, fluid and electrolyte balance, and optimize gastrointestinal tolerance. Discussion: In children with HOS and AKI, the selection of an appropriate enteral formula represents a critical component of nutritional management, aiming to mitigate dehydration, electrolyte disturbances, and protein-energy malnutrition. Isotonic or mildly hypotonic solutions are preferred to minimize osmotic losses. Electrolyte composition must be adjusted to account for impaired renal handling in AKI. Semi-elemental formulas are generally recommended as first-line therapy due to their enhanced absorptive properties and relatively lower potassium and phosphate content compared with polymeric preparations. Transition to polymeric formulas may be considered once stoma output stabilizes and renal function improves. Elemental formulas are reserved for severe malabsorption, intolerance, or when strict electrolyte restriction is required. Continuous enteral infusion is preferred during the acute phase to reduce stoma output volume and nutrient loss, with a gradual transition to intermittent bolus feeding to promote intestinal adaptation and stimulate gut hormone. Conclusion: Individualized nutritional management is essential in pediatric patients with HOS and AKI. Semi-elemental formulas, electrolyte adjustments based on renal function, and tailored feeding strategies help maintain fluid–electrolyte balance, prevent malnutrition, and support recovery and growth.