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All Journal Medical Journal of Indonesia Universa Medicina Paediatrica Indonesiana Jurnal Pendidikan Kedokteran Indonesia: The Indonesian Journal of Medical Education Oto Rhino Laryngologica Indonesiana Majalah Kedokteran Neurosains Review of Primary Care Practice and Education (Kajian Praktik dan Pendidikan Layanan Primer) Journal of the Indonesian Medical Association : Majalah Kedokteran Indonesia JOURNAL OF COMMUNITY MEDICINE AND PUBLIC HEALTH RESEARCH Indonesia Journal of Physical Medicine and Rehabilitation Indonesia Journal Physical Medicine and Rehabilitation Sriwijaya Journal of Neurology Occupational and Environmental Medicine Journal of Indonesia Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education and Research Institute Kesmas: Jurnal Kesehatan Masyarakat Nasional (National Public Health Journal)
Retno Asti Werdhani
Department Of Community Medicine Faculty Of Medicine Universitas Indonesia
Biochemistry, Genetics & Molecular Biology Decision Sciences, Operations Research & Management Dentistry Education Environmental Science Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Physics Public Health

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Application of The JMF 10 Warning Signs for Early Detection of Primary Immunodeficiency among Children with Recurrent Infections in Indonesia Muktiarti, Dina; Hendarto, Aryono; Munasir, Zakiudin; Wulandari, Dewi; Satari, Hindra Irawan; Werdhani, Retno Asti; Wati, Ketut Dewi Kumara
Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education Research Institute Vol. 9 No. - (2025): Proceedings Book of International Conference and Exhibition on The Indonesian M
Publisher : Writing Center IMERI FMUI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69951/proceedingsbookoficeonimeri.v9i-.318

Abstract

Introduction: Limited awareness and diagnostic resources contribute to delayed recognition of primary immunodeficiency (PID). The Jeffrey Modell Foundation (JMF) 10 warning signs have been widely used for screening. However, their diagnostic performance has not been validated in Indonesia. Objective: To evaluate the diagnostic performance of the JMF 10 warning signs for early detection of PID among children with recurrent infections in Indonesia. Methods: This multicentre cross-sectional study was conducted across 10 hospitals in Jakarta involving 254 children aged 0–18 years who met the severe, persistent, unusual, and recurrent (SPUR) infection criteria. The diagnosis of PID was established based on clinical diagnosis by the European Society for Immunodeficiencies (ESID) Registry Working Definitions. Analysis was performed to determine the sensitivity, specificity, predictive values, and accuracy of the JMF 10 warning signs. Results: Diagnostic performance for PID improved with the number of warning signs, with overall accuracy increasing from 15% (1 sign) to 86.2% (≥5 signs). A total score of ≥3 signs was associated with higher occurrence of PID (PR 2.63; 95% CI 1.23–5.60; p = 0.008), providing an optimal balance of 75.7% sensitivity and 48.9% specificity. The two most specific indicators were recurrent severe sinus infections (99.5%) and ear infections (95%). All PID subjects required IV antibiotics. Conclusion: The JMF warning signs remain a valuable clinical screening tool for early detection of PID among Indonesian children. A threshold of three or more warning signs provides reasonable accuracy for screening and referral of PID in resource-limited settings.
Identifying primary immunodeficiency through the evaluation of severe, persistent, unusual, and recurrent infections in Indonesian children Muktiarti, Dina; Hendarto, Aryono; Munasir, Zakiudin; Wulandari, Dewi; Satari, Hindra Irawan; Werdhani, Retno Asti; Kumara Wati, Ketut Dewi
Paediatrica Indonesiana Vol. 66 No. 2 (2026): March 2026
Publisher : Indonesian Pediatric Society

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Abstract

Background Primary immunodeficiency (PID) is widely underdiagnosed in countries with high rates of infection and limited diagnostic facilities, such as Indonesia. It remains challenging to distinguish PID from other conditions predisposing children to severe, persistent, unusual, and recurrent (SPUR) infection. Such conditions include secondary immunodeficiency caused by human immunodeficiency virus (HIV) infection, allergic diseases, and chronic diseases with structural or anatomical abnormalities. Objective To evaluate children with SPUR infections for PID and to compare the clinical characteristics of children with PID to those with other underlying conditions. Methods We conducted a cross-sectional, analytic study of children aged 0-18 years presenting with SPUR infections at 10 hospitals in Jakarta, Indonesia, from July 2024 to September 2025. Clinical assessment and laboratory investigations, including immunological tests, were performed to identify the underlying cause of SPUR infections. Children were classified as healthy, PID, secondary immunodeficiency (HIV), allergy, or chronic disease/anatomical abnormalities. Results Two hundred fifty-four subjects (53% male) with a median age of 26 months were included in our study. Most of them had a history of pneumonia (72.1%), diarrhea (31.1%), and pulmonary tuberculosis (27.9%). Thirty-three (13%) subjects were diagnosed with PID, with the majority being male (60.6%). The most common PID found was antibody deficiency (27.3%), followed by immunodeficiencies combined with associated or syndromic features (24.2%), and immunodeficiencies affecting cellular and humoral immunity (21.2%). Median age of onset in the PID group was 12 (3–24) months. Severe malnutrition was most common in children with HIV. Gender, parental consanguinity, and adverse events following live vaccines did not differ significantly across groups. Conclusion The prevalence of PID among children with SPUR infection in this study was 13%, with the most common classification being antibody deficiency.
Adaptation of Stanford Presenteeism Scale-6 in Indonesia Tanama, Fery Alfaro; Adi, Nuri Purwito; Werdhani, Retno Asti; Herqutanto, Herqutanto
Occupational and Environmental Medicine Journal of Indonesia Vol. 2, No. 2
Publisher : UI Scholars Hub

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Abstract

Background: Presenteeism has been identified to cause productivity loss more than 50% greater than absenteeism. Currently in Indonesia there are no standardized tools to assess presenteeism among workers. Therefore, we intended to adapt and validate SPS-6 in Indonesia. Methods: This is a cross-sectional study with cross-cultural adaptation refers to the ISPOR method, with a validity and reliability statistical test. Total respondents were 112 white-collars workers. Inter-item correlation was used for validity test and Cronbach’s Alpha was used for reliability test. Results: Cross-cultural adaptation of SPS-6 has been successfully done. The most significant change occurred in the explanation of the health problem definition. All item and item’s dimension were statistically significant correlated with total score. Cronbach’s alpha of work focus dimension and psychological dimension was 0.657 and 0.646, respectively. Conclusion: The Indonesian version of the SPS-6 questionnaire was valid and reliable and could be used as an instrument to identify presenteeism for office workers (white collar workers) in Indonesia.
Co-Authors Achmad Fauzi Kamal Agus Rizal Ardy Hariandy Hamid, Agus Rizal Ardy Hariandy Agus Sugiharto Ahmad Aulia Akbar, Resti Rahmadika Akmal Taher Amilya Agustina Anandita, Faizal Ablansah Anang Endaryanto Ance Adriani Andy Ardhana Mamahit Ardi Findyartini, Ardi Ari Prayitno, Ari Aria Kekalih Aryono Hendarto Asmarinah Badriul Hegar Dewanto, Naomi Esthernita Fauzia Dewi Wulandari Dian Kusumadewi Dina Muktiarti, Dina Elsa P. Setiawati Fajriani, Rosalina Fatima Safira Alatas, Fatima Safira Fedri R. Rinawan Ferry Safriadi Fiastuti Witjaksono Harahap, Alida Roswita Hartono Gunadi Hasan Mihardja Herqutanto - Hindra Irawan Satari Isman Firdaus Ivo Novita Sah Bandar Jenny Bashiruddin Jeo, Wifanto Saditya Juandy Jo Ketut Dewi Kumara Wati Khoe, Levina Chandra Koloi, Vican Sefiany Kusuma Dewi, Dian Luh Karunia Wahyuni, Luh Karunia Mahardika, Abiyyu Ghiyats Malau, Bintang Leonard Mardiastuti H Wahid Maria Melania Muda Michelle, Michelle Muchtaruddin Mansyur Muhammad Arvianda Kevin Kurnia Nareswari, Irma Nove Maria Nur Indah Lestari Lestari Nur Rasyid Nuri Purwito Adi Pambudi, Wiyarni Ponco Birowo Pukovisa Prawiroharjo Ramdhani, Aris Ramlan, Andi Ade Retno Wibawanti Reyhan Eddy Yunus Rini Sekartini Rino Alvani Gani Rukmindar, Dion Rusli, Noer Triyanto Salim Harris Savira, Missy Selfi Handayani Setyawati Budiningsih Sri Rezeki S. Hadinegoro, Sri Rezeki S. Suharto, Wuryantoro Sulistomo, Astrid Tamin, Susyana Tanama, Fery Alfaro Tanoto, Rodri Tantri, Julietta Theresia Santi, Theresia Tiffany, Tiffany Umi Fahmida Widayat Alviandi Widi Atmoko Widjaja, Lydia Rosalina Widjajalaksmi Kusumaningsih Widjajalaksmi Kusumaningsih Winnugroho Wiratman Wistara, Sevita Sathya Yefta Moenadjat Yusra, Yusra Zakiudin Munasir