Kaleidoscoph #28

kaleido scoph.

HEALTH ISSUE

FATHIYAH ZAHRA MUHAMMAD

Extraordinary Event! Polio Emerge Back After Eradicated

I GEDE PAKSHA YUSTIANA

The Threat Behind The Sweetness

VIONA MARESKA

Salt Shakers: Shaking Off The Habit of Excessive Salt Consumption

FERIZAL AL RASYID

Realize The Impacts of Bullying on Mental Health

LOCALS

CIMSA FK UIN SH CIMSA UNEJ

PEOPLE

dr. Eta Auria L.

Child Malutrition in Indonesia: An Iceberg of Triple Burden

KaleidoSCOPH #28

National Leadership Summit

image by jcomp on freepik

SCOPH NEWS

documentation from: Ariella Ramadhini Hakim – Hari Gizi Nasional 2023

PHOTO BY MATT C ON UNSPLASH

The World Health Organization (WHO) defines diabetes mellitus (DM) as a chronic disease with various causes characterized by high blood sugar levels accompanied by metabolic disorders due to insufficiency of the function of the hormone insulin, either reduced production or decreased responsiveness of body cells to insulin. In 2019, the Ministry of Health (Kemenkes RI) stated that the prevalence of diabetes in Indonesia is estimated at 10.9% of the population aged 15 years above and is 2% based on a doctor's diagnosis. When calculated from all ages, the prevalence of diabetes in Indonesia based on a doctor's diagnosis reaches a percentage of 1.5%. It places Indonesia in seventh place with the highest numberofdiabeticsworldwide.

According to the Ministry of Health (2017), 80% of non-communicable diseases are caused by unhealthy lifestyles. Among them, 26.1% of the population lacks physical activity; 93.5% of the population over the age of 10 consumes less fruit and vegetables; 36.3% of the population over the age of15smokes;and4.6%ofthepopulation

over the age of 10 consumes alcohol. This is a concern of the Ministry of Health in reducing the number of noncommunicable diseases, one of which is through a lifestyle, namely a healthy diet. A healthy diet is a diet that is followed by adopting a healthy diet with balanced nutrition so that the nutrients thebodyneedsareadequatelymet. WHO stated that 420 million people with diabetes require proper diabetes management. An estimated nine million people with type 1 diabetes need insulin to survive, and around 60 million people with type 2 diabetes need insulin to manage their condition. It further noted that the need for insulin to treat type 2 diabetes is expected to increasebymorethan20%by2030.

In connection with the high rate of diabetes in Indonesia, insulin is still an urgent need. Therefore, it is necessary to study the availability of insulin in Indonesia and the access and facilities provided by the government for the distribution of insulin to people with diabetesinIndonesia.

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HEALTH ISSUES

documentation from: POLISI (2022) – CIMSA UGM

Extraordinary Event! Polio Emerge Back After Eradicated

Fathiyah Zahra Muhammad from CIMSA FK UIN SH

Polio, a highly infectious disease caused bythepoliovirus,hasbeenconfirmedto have resurfaced unexpectedly in Pidie, Aceh. This amazing case was reported by Indonesia's Ministry of Health and declaredanextraordinaryeventbecause polio was declared completely eradicated seven years ago. At the Meeting of the South-East Asia Regional Certification Commission for Polio Eradication (SEA-RCCPE) in New Delhi, India, in 2014, Indonesia became one of eleven countries in South-East Asia to eradicate polio and achieve polio-free certification. It is not at all a piece of cake to receive the polio-free predicate, it is complicated since it is a vicious cycle. If someone is infected with the poliovirus, the virus will spread through contaminated water, foods, or even something as simple as droplets. The droplet then infects people of all ages (mainly children) and develops many symptoms, such as flu-like syndrome, paralysis,andevendeath.

We are probably wondering how this virus can be so durable and last so long. Among other viruses, poliovirus hasmoreconcisegeneticmaterial,positive

single-stranded RNA, which eases the replication and translation processes after it invades a single human cell. Single-stranded RNA can be directly translated into protein, and its genome replicates using its own RNA-dependent RNA polymerase. New particles are assembled. They kill the infected cells and release many viral particles. This is also why poliovirus tends to mutate easily. Due to its unembellished, simple RNA, each nitrogen base is vulnerable and unstable. This strain is prone to changing and becoming a different variety of virus. Other than that, strong free viruses scattered in the air adapt swiftly to survive. They mutate and become a new strain of poliovirus that hasn'tbeenrecognizedbyourbodyyet. Thiswillbetroublesomelater.

People have been protected by their immune-induced vaccine for an estimated7years.Itwasbecauseofherd immunity and personal immunity. Most mothers follow the government's advice and take their child to get vaccinated.Until two years ago, COVID-19 attacked the world. Everybodywasworkingfromhome,

minimizing mobilization by staying in their own homes; hospitals were full. Adherence to vaccines also loosened. Newborn babies didn’t receive adequate vaccines and immunity. This can make babies more susceptible to a varietyofillnesses.

Until now, there have been three serotypes of wild poliovirus. It is poliovirus 1, 2, and 3. Type 1 poliovirus was the main cause of most cases of paralyticpoliointheworlduntilvaccines became widespread. Type 2 and 3 were considered eradicated in 2015. When a baby or a person is infected with a new or existing strain of poliovirus, he becomes an "agent" of the virus. The virus lives in the throat or nasopharynx, then travels down into the stomach and intestine and infects several epithelial cells, developing and producing uncountable offspring there. Together with the food that is absorbed simultaneously, the virus can enter and circulate in the nearest lymphatic system, then end up in the blood circulation. Here is one of the points where immunity determines the body’s response.Iftheimmunesystemisnotas strong as the virus, the virus can cause viremia.Viremiaisaconditionwherethe virus spreads all over the blood. Then, inflammation occurred, which was detected by the hypothalamus, and it raised the body’s temperature. The infected host has developed a fever. After viremia, viruses can find a way into some axons of motor neurons and do the replication, which damages the neuron.Thisprocessiscalledretrograde axonal transport. Every axon will eventually stop in the spinal cord and causemoredamage.

Poliovirus causes several symptoms, but most of the patients have asymptomatic poliovirus. Some experience flu-likesyndrome,nausea,headache,vomiting,

PHOTO BY KRISTINE WOOK ON UNSPLASH

that condition, so the importance of vaccines, especially the polio vaccine, should have been known by everyone. The polio vaccine is available in two forms.Oralpoliovirusvaccine(OPV)and inactivated poliovirus vaccine (IPV) OPV contains an attenuated virus that is givenbymouthanddirectlytravelsinto the digestive tract. Then, the vaccine will stimulate the immune system, and the body will form antibodies to fight polio. An attenuated virus will be directly bound and shut down by the child's immunity formed after vaccination.OPV,ontheotherhand,has more side effects than IPV. For the first dose,shortlyafterbirth,OPVisgivento the baby. At the ages of 2 months, 3 months, and 4 months, IPV is injected into the muscle or under the skin. Booster vaccines are given when the child is 18 months old. IPV contains a deadvirusthatisformedinthebloodto stimulate direct immunity. In this condition, the virus will still be able to multiplyinsidetheintestinebutwillnot cause symptoms because polio immunity has been formed. Patients with bleeding disorders, such as thrombocytopenia, require special care because hematomas can occur during intramuscular IPV injection. Normal babies without immunodeficiency should be vaccinated well to prevent anotherextraordinarycase.

Garg N, Park SB, Vucic S, Yiannikas C, Spies J, Howells J, et al. Differentiating lower motor neuron syndromes. J Neurol Neurosurg Psychiatry.2017;88(6):474–83

Kementerian Kesehatan RI. Buletin Surveilans dan Imunisasi - Polio Belum Berakhir. Bul Surveilans Imunisasi.2020;1–2

Mehndiratta MM, Mehndiratta P, Pande R. Poliomyelitis: historical facts, epidemiology, and current challenges in eradication. Neurohospitalist. 2014 Oct;4(4):223-9. doi: 10.1177/1941874414533352. PMID: 25360208;PMCID:PMC4212416

Infeksi emerging Kementerian Kesehatan RI. Available at: https:// infeksiemerging.kemkes.go.id/ penyakit-virus/poliomyelitis-penyakitvirus-polio/ (Accessed: January 20, 2023).

Wolbert JG, Higginbotham K. Poliomyelitis. 2022 Jun 21. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–.PMID:32644370

Minor PD. An Introduction to Poliovirus: Pathogenesis, Vaccination, and the Endgame for Global Eradication. Methods Mol Biol. 2016;1387:1-10. doi: 10.1007/978-1-4939-3292-4_1. PMID:26983727.

REFERENCES

Poliomyelitis - chapter 4 - 2020 yellow book (no date) Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. Available at: https:// wwwnc.cdc.gov/travel/ yellowbook/2020/travel-relatedinfectious-diseases/poliomyelitis (Accessed:January20,2023).

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freepik.com

The Threat Behind The Sweetness

I Gede Paskha Yustiana from CIMSA UWKS

The frequency of type 2 diabetes mellitus (DM), a chronic metabolic conditionasaresultofinsulinresistance, decreased insulin production, and eventually failing pancreatic beta cells, type 2 diabetes is characterized by insulin insensitivity that lead to less glucose is transported into the liver, muscle, and fat cells with hyperglycemia, there is an increase in the breakdown of fat, has been continuously rising worldwide. Due of this pattern, it is quickly turning into an epidemicinsomeplaces.

According to the WHO, each year, 1.5 million deaths are directly related to diabetes.  Nearly 422 million people worldwide suffer from diabetes. The number of affected nations is anticipated to double in the following ten years due to an aging population, adding to the stress currently placed on healthcare providers, particularly in less developednations.

Genetics and lifestyle choices are the main causes of type 2 diabetes. It is well recognized that a variety of lifestyle factorsplayasignificantroleinthe

emergence of type 2 DM. These include a sedentary lifestyle, smoking, excessive alcohol consumption, and physical inactivity.

It has been discovered that obesity has a role in about 55% of type 2 DM cases. Type 2 DM in children and adolescents is thought to have increased as a result of the rise in juvenile obesity between the 1960s and 2000s. Toxins from the environmentcouldbepartofthereason why type 2 DM rates have recently increased. Bisphenol A, a component of various plastics, has been discovered to have a sluggishly positive connectionwithtype2diabetesincidence.

Diabetes can damage the heart, blood vessels, eyes, kidneys, and nerves these are why we have to prevent it. Type 2 diabetes is largely preventable by following a few simple steps: losing weight, increasing physical activity, eating a healthy diet, and not smoking. However, it is clear that individuals cannot bear the entire burden of behavior change. Families, schools, workplaces, healthcare providers,communities,themedia,thefood

industry, and the government must all collaborate to make healthy choices easy.

As for the individuals that have been already diagnosed with type 2 diabetes such following things can be done to manage the disease and prevent the complications. First of all  is the food diet, the importance of regular eating in terms of meal schedule, type and amount of food.  The recommended standard is food with a balanced composition in terms of carbohydrates 60-70%, fat 20-25% and protein 10-15%.  Second is physical activity, diabetics are advised to do physical exercise regularly (3-4 times a week) for approximately 30 minutes.  And avoid laziness and lack of physical activity. If diet and increased physical activity cannot control blood sugar levels.  It is necessary to use antidiabetic drugs, as well as use insulin regularly and accordingtodoctor'srecommendations.

In conclusion, it is important to have knowledge about how to maintain our healthy lifestyle and practice it in our daily lives in order to prevent the threat of type 2 diabetes as well to keep the bodyhealth in general.

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Salt Shakers: Shaking Off The Habit of Excessive Salt Consumption

Viona Mareska from CIMSA UNUD

As seen from the increasing production of processed food and rapid changes in lifestyle, it is as clear as day that we are continuously falling into the trap of slothfulness and its dangerous aftermath to our body. As world leaders aim to reduce health problems, in the midst of all the turmoil, debates and different world views on how to create the ideal healthy world, some of the tiniest of factors become camouflaged and unaddressed, most especially, food. Take, a simple grain of salt – a timeless ingredient dating back to 6050 BC, thousands of people died in search of salt and wars have taken place for its trading rights in the past. For something to be a commonplace part on our kitchen top, people wouldneversuspectitslethalproperties.

The efforts of lowering cardiovascular diseases such as stroke, hypertension and heart failure are clearly stated in the Sustainable Development agenda, however the distance towards said goal has ironically become wider each year, with excessive salt consumption being a prime suspect of suchsetbacks.Duetosaltbeingthemost

ubiquitous and accessible food seasoning and preservative, salt has reached an international stage and become utilized even to the poorest of countries. In fact, in 2021, 290 metric tons of salt were produced. The World Health Organization (WHO) has found that salt, provokes water retention in blood vessels, resulting in increased pressure within itself, to further aggravate, excessive salt in the body will also cause microvascular inflammation and functional abnormalities. Seeing such dire conditions, the dream of reducing salt consumption has become something that feels a miles away from reality.

Indonesia is no stranger to this issue; Indonesia is the top fourth country with the highest increase of cardiovascular diseases in the last decade. As of today, a quarter of the entire population has hypertension and is causing 5 million deaths per year. Despite the mass educative effort that the Indonesian government of health has implemented, concrete and significant changes in the population’s lifestyle are still subjectedtoself-persistenceandawareness.

Therefore, further individual and specialized efforts in educating the population through the media and uncomplicated acronyms have been written within the mandate of the ministryofhealth.

The Indonesian Ministry of health has issued a guideline recommendation regarding sodium consumption in which states that the healthy daily intake of an adult is five grams or is equivocal to 1 teaspoon. A key note to remember is not just the quantity of salt to consume, but the quality of salt. All salt consumed should be fortified with iodine to stimulate brain development and maintain the population’s general mental function. Aside from the change of sodium intake, exercising, regular evaluation and maintenance of overall body health is essential to upkeep, considering its role of being our starting point to be in a tip top condition of health.

While salt may be one of the most timeless ingredient, our cardiovascular health will always be our most priceless asset to have. Let us all walk hand in handpursuingabetterus.

RAISE: Realize The Impacts of Bullying on Mental Health

Ferizal Al Rasyid from CIMSA FK YARSI

School is one of the places for a child to gain knowledge, develop and form a character. Seeing the importance of school for a child, school must be a safe and comfortable place that is useful for making a foundation for children in sorting out right and wrong. However, it is sometimes hindered by some deviant behaviors that make the school a less comfortable place or become a scary place, one example of behaviorisbullying.

Bullying is aggressive behavior that is carried out intentionally by an individual or group of people, repeatedly and continuously towards victims who cannot fight themselves easily. Some of the triggering factors that can cause a child to want to bully seniority, racism, differences in economic level, less harmonious family conditions, and group/individual character, which have envious, spiteful, andvindictivequalities.

Bullying is divided into four categories: physical violence, verbal abuse, social and cyberbullying. Physical violence occurswhenapersonisphysically

harmed through an action. Verbal abuse is bullying that is carried out through threats, sexually suggestive calls, and spreading false or dangerous rumors (hoaxes). Mental or psychic bullying means ignoring others and making or inviting others to dislike someone. While cyberbullying is bullying that occurs with the help of information technology that aimstoharmandharmsomeone.

The act of bullying can affect the level of social intelligence of the victim because it is shaped by the environment and the people with whom we interact. Then an unkind environment can be seen as negative behavior and always be considered despicable. These actions are carried out by bullies, based on theories presented by experts regarding the dangers and impacts of bullying behavior in the educational environment. Bullies are usually aggressive both verbally and physically, want to be popular, often make trouble, find fault with others, are vindictive, envious, live-in groups and master social life in the school environment. Usually, the perpetrators have a lack of empathy towardothers.

Based on data from the 2018 national survey of child and adolescent life experiences, it is explained that 2 out of 3 girls or boys have experienced at least one type of violence during their lifetime The 2018 PISA study at least 41% of students have experienced bullying at least several times in one month. The influence of bullying activities on emotional intelligence and mental health can change a person's personality to be moody, pessimistic, apathetic to their environment, decreased academic aspects, and traumatized.

Indonesia has a law regulating child protection within an educational unit contained in Law of the Republic of Indonesia Number 35 of 2014 concerning amendments to Law number 23 of 2002 concerning child protection, in article 54 paragraph (1) that: "Children in and within the education unit must receive protection from acts of physical, psychological, sexual violence, and other crimes committed by educators, education personnel, fellow learners, and or other parties".

The problem of bullying will continue to increase if it is not followed up immediately and can have a very bad impactonthevictim.

Counseling about bullying in schools is one way to prevent the spread of bullying cases in Indonesia. By providing information and knowledge about bullying so that students can know the impact of their actions. So that it can minimize bullying in Indonesia, especially in schools and teenagers. Not only for students, counseling about bullying can also be donetoparentsandschooleducators.

Bullying behavior can have a very bad impact on mental and physical health in the future. By conducting counseling on bullying in schools, it is hoped that it can have a positive impact on the teaching and learning process in

REFERENCES

Setiawan, J, A., et.al., 2022., Edukasi pencegahan buliying pada murid sekolah dasar. Jurnal pengabdian perawat, Volume 1, pp. 1-7

Yunitasari, P., 2021., Dampak Bulliying terhadap kesahtan mental remaja.

Jurnal Keperawatan, Volume 13, pp.

Kamil, Y, N., Bayu Adi L., Lilis K, 2022. Peningkatan Kepekaan Pada Korban

Bullying di  Lingkungan Pendidikan.

Jurnal pendidikan modern, Volume 7,

Kurniawan, H, E., Aini, L., Susanto T., 2022., Fungsi Afektif Keluarga Dan Temper Tantrum Pada Anak

Prasekolah: Studi Cross-Sectional., Volume 2., pp 1 – 3.

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SCOPH LOCALS

documentation from: SONATA (2022) – CIMSA UNILA

Mental health is a picture of a person's emotional, psychological, and social relationship where it reflects how a person feels, thinks, and acts towards himself and others. Emotional mental changes are conditions where a person experiences emotional and psychosocial changes and this is normal to happen, but if it is left unchecked, grows as time passes, and is disturbing, then it can lead to a pathological state.

The prevalence of depression in the population grouped by age was found that elderly is the highest amount, followed by the adolescent and young adult age group. These results are higher than those of productive age (25-34 years, including college students). This condition can affect the student’s life, both in academic, physical, and social functions. If this happens persistently, the individual may experience relationship disturbances and develop several physical ailments. In addition, students who experience mental emotional disorders are reported to have unsatisfactory academic scores. Mental emotional disorders in college students are also related to dropout rates.

In 2020, SCOPH CIMSA FK UIN SH held a community development called LESI with the theme "Depression" on the strength of distributed online assessments using the Google Form platform and filled by 220 college students. Based on the LESI primary assessment using the Self Reporting Questionnaire (SRQ-20) which contains questions about mental health problems, it shows that 111 people (50.45%) had an SRQ Test score above 6, the Riskesdas border to indicate a person has mental health problems. This proves that there are still many preclinical students of the medical faculty at UIN Syarif Hidayatullah Jakarta who have mental health problems.

Therefore, in the third year of Community Development LESI, SCOPH CIMSA FK

UIN SH held LESI (Let's Erase Sadness and Insecurities) to increase the knowledge of preclinical students of the medical faculty UIN Syarif Hidayatullah Jakarta regarding stress management, coping with stress, as well as the benefits of sharing, exchanging ideas and providing a forum for coping stress in the form of Art Therapy. LESI has 2 interventions in it.

Prior to the intervention, SCOPH CIMSA FK UIN SH held pre-intervention activities to get to know each other and bonding with the target community, 15 preclinical students of the medical faculty of UIN Syarif Hidayatullah Jakarta. The first intervention was carried out on Sunday, 23rd of October 2022 with an online seminar and consultation. In the intervention, participants and the target community received material about stress management and how to deal with it presented by Sophie Dwiyanti S.Psi. Hereafter, this event was continued with a sharing session from a survivor of mental health problems by Adinda Nurul Istiqomah. Each material was delivered within 1 hour and followed by an interactive Question and Answer session with the speakers. After the presentations from speaker and survivor, the question and answer session ended, the target community then underwent a private online consultation session with the UIN SHpsychologistteam.

The second intervention was carried out on Tuesday, 10th of January 2023 with the concept of art therapy. In this second intervention, the target community is facilitated to do art therapy. This art therapy aims to provide an activity to manage and cope with stress. Prior to art therapy, the target community was given exposure to material related to therapyforstressmanagement,arttherapy,and

various types of art therapy. The material was delivered by Anisah Chairani, M.Psi, Psychologist. After that, a question and answer session was held. Next, the target community undergoes art therapy guided by LESI Buddies (members of SCOPH CIMSA FK UIN SH)  and accompanied by them during this community development.

From this event, SCOPH CIMSA FK UIN SH hopes that preclinical students of the medical faculty at UIN Syarif Hidayatullah Jakarta, especially the target community, can understand stress, stress management, and coping stress technique.SCOPHCIMSAFKUINSHalso hoped that this event can raise awareness and be able to deal with mental health problems. Because a healthy mind will make it positive so that the body will work properly emotionally, psychologically, socially. It will affect the way we think, feel and behave. Mental health will also have an impact on physical health and good social life, according to the saying "Al-'aqlu Salim Fil Jismi Salim" A healthy mindliesinahealthybody.

DRAGONBALL

DIABETES RISK REDUCTION PROGRAM BY APPLICATING OF HEALTH LIFESTYLE

Diabetes mellitus (DM) is a chronic metabolic disorder characterized by persistent hyperglycemia. It may be due toimpairedinsulinsecretion,resistanceto peripheral actions of insulin, or both. Chronic hyperglycemia in synergy with the other metabolic aberrations in patients with diabetes mellitus can cause damage to various organ systems, leading to the development of disabling and life-threatening health complications, most prominent of which are microvascular (retinopathy, nephropathy, and neuropathy) and macrovascular complications that increased risk of cardiovasculardiseases.

There are two main types of diabetes: Type 1 diabetes, which is a result of damage to the pancreas that leaves it producingeitherverylittleinsulinornone at all, and an increase of blood glucose level. This type usually develops in childhood or the teenage years. Things are different in type 2 diabetes, whereinsulinismadebythepancreasbutthe

body’s cells gradually lose the ability to absorb and use the insulin, which also occurs with the increasing blood glucose level. In the past, type 2 diabeteswasoftenreferredtoas“adultonset” diabetes because it is commonly diagnosedlaterinlife.

In Indonesia, the incidence number of the non-communicable disease continues to increase. Based on data from Kementerian Kesehatan RI (2019), the percentage of non-communicable diseases reached 69,91%. Riskesdas, 2018 (Riset Kesehatan Dasar) shows that compared with Riskesdas 2013, the prevalence of non-communicable diseases increased. One of them is Diabetes Mellitus, which increased from 6,9% to 8,5%. Of the top ten countries with Diabetes Mellitus, Indonesia is in the big 4, with a prevalence of 8,6% of the total population against Diabetes Mellitus type 2. From 2000 until 2030 it is estimated that there will be an increaseof8,5to21,3millionsouls.

If type 2 diabetes goes untreated, blood sugar levels stay high all the time. Type 2 diabetes can develop gradually over several years without any noticeable symptoms, so the diagnosis often comes asasurprise.ThetreatmentsforDiabetes Mellitus that commonly do are lifestyle changing, medication, and surgery. A lot of people who have type 2 diabetes also have other health problems, such as high blood pressure or high cholesterol. Treating those problems helps to reducetheriskofcardiovasculardiseasetoo.

diabetes, changing their diet and getting more exercise can help delay the onset of diabetes for several years. But it's not clear whether eating the "right" foods and getting more physical exercise can help you to prevent type 2 diabetescompletely.

As medical students, things that could contributetotheDiabetesMellitusissue are education and health promotion. Therefore,SCOPHCIMSAUNEJpresent a community development called DRAGONBALL:DiabetesRiskReduction Program By Application of Healthy Lifestyle at Kelurahan Patrang, Jember that we aim at decreasing the prevalence of DM in the future by educate people how to prevent this disease.

There’s a lot of advice out there about how to prevent type 2 diabetes. It mainly concerns lifestyle factors such as eating a balanced diet, getting enough exercise, and keep their weight normal. In peoplewhoareatagreaterriskofdeveloping

We have 3 interventions held in 3 consecutive months, September, October, and November. The first intervention is welcoming volunteers and introducing the community all about Dragonball as community development including what we will do in every intervention. The community was accepting us very well and welcomedus,theparticipantswerealso

excited. We also did a blood glucose check on the community and we were extremely happy to help the participants and answer their questions about Diabetes. We gave monitoring cards to the participants and asked them to bring the card to the next intervention.

For the second intervention, we invite our Alumni, dr. Ajeng Eka Putri Widianti to educate the community about what Diabetes Mellitus is, the signs and symptoms of DM, the complication of it, what should we do if our blood glucose level is more than normal, and how to prevent Diabetes Mellitus. The participants were really excited and interacting along with dr. Ajeng Eka. In the second intervention, we also did a blood glucose check and wrote the result on the monitoring card. So, we could compare their blood glucose level in the first and second intervention to see if there any changes on that.

In the final intervention, we invite our external partner, Ms. Nurul Baro’ah as the representative of Nutrinote.id. Ms. Nurul Baro’ah to give education and knowledge about Diet and Nutrition for Diabetes Mellitus. We started the day by checking the blood glucose level  and writing on the card as usual. So, we could compare the glucose level of participants among the last 3 interventions. Most of them have decreased scores and we were really glad knowing that they have normal blood glucose levels. Then, the participants sat and listen to the presentation  from Ms. Nurul Baro’ah. The last agenda of this final intervention is a cooking demo by Ms. Nurul Baro’ah and continued with a food plating competition for Karang Taruna. We have talked to the community and Karang Taruna that we will hold a food plating competition before, and the participants must bring their own stuff for this competition . It was a really  good event because the participants could  know what

is the best food for patients with Diabetes Mellitus and how to cook that. The food plating competition was also exciting and full of laughter.

Overall, Dragonball has done very well despite it being really tiring to prepare 3 interventions every month, and of course, there were mistakes along the way. But, it was so fantastic and surely gave us amazing experiences, such as checking people’s blood glucose level, communicating with them, answering their questions and their worries, seeing their reaction if their glucose level is normal, and also got  a lot of  knowledge about Diabetes Mellitus. We even got a special thanks from the community for holding this event. Big applause and a million  thank you to all of the amazing committee of Dragonball 2022!

SCOPH PEOPLE

documentation from: Ditia - Hari Gizi Nasional 2023

Child Malnutrition in Indonesia: An Iceberg of Triple Burden

by dr. Eta Auria Latiefa Liaison Officer to Student Organizations CIMSA

Recently, the public was shocked by a fact presented by the Indonesian Pediatrician Association (IDAI) that in 2023, cases of diabetes in children aged 0-18 years have increased by 700% over a 10-year period. Yes, you read that precisely: a 70-fold increase. Many people are wondering, how is it possible the disease that mostly affects adults and the elderly actually occurs in children?

Basically, diabetes mellitus (DM), or what is known as “kencing manis” does have several types. Type 1 DM is a disease that often occurs in children and adolescents due to pancreatic cells being unable to produce insulin, usually caused by an autoimmune process. However, along with lifestyle changes and unhealthy eating patterns of children and their families, there is a tendency for an increase in cases of type 2 DM as well, whose pathophysiology is insulin resistance. The risk factors are related to obesity, genetics, ethnicity, and family history of type 2 DM. From the data presented by IDAI in 2023, more than 59% of children with diabetes are girls. The age of 10-14 years dominates the

2015/2016

epidemiological distribution with 46% of the total reported, followed by the age group of 5-9 years with 31.5%. In addition, as stated by the Head of the IDAI Endocrinology Coordination Work Unit, Muhammad Faizi, the incidence of diabetes in children could be even higher than what has been recorded at this time.

This data might be a new thing for most people, considering that the issue which has been intensified so far is about how to overcome stunting in Indonesia. However, as it turns out, malnutrition in Indonesia is not merely talking about stunting. This country has an overnutrition problem and micronutrient deficiency at the same time as well. The triple burden of malnutrition, the term that represents this condition, is the coexistence of overnutrition (overweight and obesity), undernutrition (stunting and wasting), and micronutrient deficiency at all levels of the population— country, city, community, home, and individual. Even before the COVID-19 epidemic, Indonesian children faced a triple burden of malnutrition. This condition has a direct influence on a kid's physical and mental development and

puts them at risk of future diseases. Diverse nutritional intake is critical to a child's growth, hence children in Indonesiarequireimmediatesupport.

How could the triple burden of malnutrition happen? The era of globalization has made almost all activities easier to do. Accessing food easily and following the food trends lead to bad habits in choosing a diet: high fat, low fiber, and lack of nutrients. This is compounded by a sedentary lifestyle. Certainly, inattention to the adequacy of micronutrients, especially in pregnant women and adolescents, can lead to nutritional problems such as anemia. This condition may also affect the next generation which results in stunting and othernutritionalproblems.

Stunting itself is a condition where the zscoreforheightperage(TB/U)islessthan -2 WHO standard. Stunting in toddlers can be known by measuring their length or height, then compared with a standard chart. However, diagnosing stunting is not only concluded by this measurement. Thereareseveralothercharacteristicsthat can be found, such as growth and development delay, poor focus and learning performance, and susceptibility to various infectious diseases. In Indonesia, national initiatives to combat stuntinghavebeennoticeablesince2020, as part of the National Mid-Term DevelopmentPlan2020-2024.

Concomitantly, there is a piece of good news coming from the issue of stunting in Indonesia. Data obtained from the results of the Indonesian Nutrition Status Survey (SSGI) 2022, the stunting rate in 2022 has decreased by 2.8% compared to 2021, from 24.4% to 21.6%. Congratulation! But wait, is that enough? Unfortunately, not yet. The target for the stunting rate in Indonesiais14%.Currently,thereisonly1 provincethatcanachieveastuntingrate

below 14%, Bali, with a rate of 10.9% in 2021 and down to 8% in 2022. The three provinces with the largest reduction in stunting are South Kalimantan, North Kalimantan, and South Sumatra. However, even though the stunting rate has generally decreased, there has been an increase in stunting rates in several provinces in Indonesia, such as West Sulawesi, Papua, and West Nusa Tenggara.

On the other hand, according to the 2018 national Basic Health Research Survey (RISKESDAS), about 20% of primary school-aged children and 14% of Indonesian adolescents are obese or overweight. Overnutrition is a kind of malnutrition caused by an overabundance ofnutrients,resultinginabuildupofbody fatthatcompromiseshealth.Forchildren

under the age of 5, overweight is defined as weight-for-height (TB/BB) greater than 2 standard deviations above the WHO Child Growth Standards median, while obesity is defined as weight-for-height (TB/BB) greater than 3. Meanwhile, for children aged 5 to 19, overweight is defined as BMI-for-age (BMI/U) greater than 1 standard deviation, and obesity is defined as BMI-for-age (BMI/U) larger than 2 standard deviations over the WHO GrowthReferencemedian.

The third issue is micronutrient deficiencies. Globally, data from WHO estimated 42% of children under 5 years of age and 40% of pregnant women worldwide are anemic. This condition can be caused by a lack of iron, folate, and vitamin B12. Micronutrients, vitamins and minerals that the body needs in minute quantities, have much influence on a body's health. Micronutrients are crucial, and deficiencies in any of them can result in serious and even life-threatening illnesses. Lack of Iron, vitamin A, and iodine deficiencies are the most frequent allovertheworld,especiallyinyoungsters andpregnantwomen.

a healthy lifestyle, such as paying attention to nutritional intake that is consumed with balanced nutrition guidelines, limiting consumption of sugar, salt, and fat, and doing regular physical activity (150 minutes per week). Health workers also need to provide comprehensive education to the community in creating government programs successful. Various government efforts have been intensified to address thisnutritionalproblem,suchaseducation on exclusive breastfeeding, provision of protein-rich complementary foods, management of toddlers with nutritional problems, and increasing coverage of mandatory immunization. For pregnant women and teenagers, the blood supplement program is also an effort to prevent nutritional problems from occurringinthefuture.

Some other parties also give response to malnutrition in Indonesia. UNICEF offers technical support to the government of Indonesia in order to improve food security and reduce child wasting and stunting by 14% by 2024. In addition, Indonesia joined the SUN Business Network(SBN)in2015,whichbillsitselfas the world's biggest business sector nutrition program. The corporate sector mobilizes within this network to meet national nutrition targets through educationandfortifiedfooditems.

Well,themostimportantquestionis:what should we do to overcome this triple burdenofmalnutrition?Theeasiestwayis tostartwithourselves.Wecanimplement

In conclusion, the triple burden of malnutrition is an iceberg of a serious problemthatneedsmoreconcernfromall parties. Malnutrition in its many manifestations was traditionally regarded and treated as a separate public health concern, but the new emerging truth is that undernutrition and overnutrition are interrelated, necessitating double-duty interventions that concurrently address morethanonedimension.

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WHO. Obesity and overweight. [Internet]. 2021. [Cited 9 February 2023] Available from: https:// www.who.int/news-room/fact-sheets/ detail/obesity-and-overweigh WHO.Micronutrients.[Internet].[Cited 9 February 2023] Available from: https://www.who.int/health-topics/ micronutrients#tab=tab_

Kemenkes RI. 2018. Hasil Utama RISKESDAS 2018. Kementerian

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Youngwook Chun. Double Burden of Child Malnutrition in Indonesia. [Internet] [Cited 7 February 2023]

Available from: https:// borgenproject.org/child-malnutritionin-indonesia

Mathur, P., & Pillai, R. (2019). Overnutrition: Current scenario & combat strategies. The Indian journal ofmedicalresearch,149(6),695–705

Rah, J.H., Melse-Boonstra, et al. The Triple Burden of Malnutrition Among Adolescents in Indonesia. Food and NutritionBulletin.2021,42(1):S4-S8.

SCOPH GALLERY

documentation from: REMEDY (2022) - CIMSA FK Unpad

STANDING COMMITTEE ON PUBLIC HEALTH CENTER FOR INDONESIAN MEDICAL STUDENTS’ ACTIVITIES