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Fresearch , 10 Oct , 7: DOI: Data associated with the article are available under the terms of the Creative Commons Zero "No rights reserved" data waiver CC0 1. Dataset 1. All raw data and demographic information obtained from subjects during the present study.

Background : Diphtheria remains a health problem, especially in developing countries. In November , the Indonesian Ministry of Health stated that there was a diphtheria outbreak in Indonesia. East Kalimantan is one of the provinces that experienced this disease outbreak. This study analyzes the risk factors for diphtheria outbreak in children aged years. Methods: A case-control study was conducted on 37 respondents. Research variables consist of immunization status against diphtheria, pertussis and tetanus DPT , nutritional status, children mobility, source of transmission, physical home environment natural lighting, ventilation area, occupancy density, wall and floor type , knowledge of diphtheria and attitudes towards the diphtheria prevention program.

Results: We found that the most of the children who had diphtheria had been immunized against DPT. It is recommended to limit the mobility of children to travel to areas that are experiencing increased cases of diphtheria, improve the nutritional status, and further research on the effectiveness of diphtheria vaccine.

Although vaccination programs have succeeded in reducing the incidence of diphtheria in the world, diphtheria remains a health problem, especially in the Asian region. The World Health Organization reports that the number of diphtheria in was 4, cases which were widespread and mostly concentrated in the Asian continent, including India 3, cases , Indonesia cases , Iran cases , Pakistan cases , and Nepal cases.

Indonesia has the second highest number of diphtheria cases, with cases 1 , 2. This is based on reports from various provincial health offices, with cases documented between 1 January and 1 November There was a surge in the number of cases.

Previously, there were cases in , cases in and cases in East Kalimantan is one of the provinces that experienced a diphtheria outbreak, with all cases occurring in children aged 1—10 years 3. Diphtheria, taken from Greek "Diphtera", which means leather hide, was first identified by Hippocrates in the 5 th century BC 4. This disease mostly occurs in children under 5 years of age, but currently occurs in children over 5 years 5—19 years and in adults 5.

Several studies have shown that low vaccination coverage, crowding and migration, or a combination of host, agent, and environmental factors, can influence the incidence of diphtheria 6 , 7. Other factors include nutritional status and parental behavior, personal hygiene of children 8 , density of house occupancy, humidity in the house, type of floor of the house and the source of transmission contracting from other people , parents knowledge about diphtheria 9 , parent education level 10 , 11 , child age, home lighting, and house ventilation This study aims to determine the risk factors for diphtheria outbreaks in children aged 1—10 years in the East Kalimantan province of Indonesia, by involving immunization factors, children's factors, home environmental factors and parents' knowledge and attitude factors.

A case control study was conducted on 37 respondents 18 cases, children with diphtheria and 19 controls, healthy children , between April to August , located in six districts in the province of East Kalimantan City of Samarinda, Bontang, Balikpapan and Districts of Kutai Kartanegara, Kutai Timur and Berau.

The population approached for recruitment was all children aged 1—10 years with diphtheria recorded in the East Kalimantan provincial health office from January 1, to March 1, The study began after the researcher obtained the permission and address of the child suffering from diphtheria from the relevant authorities. The case group was formed of children suffering from diphtheria, with inclusion criteria: age 1—10 years, recorded in the East Kalimantan Provincial Health Office register from January —February , residing in the city of Balikpapan, City of Samarinda, City of Bontang, District of Kutai Timur, District of Kutai Kartanegara, and District of Berau, did not move to another area, the house that occupied had not been renovated from 1 week before the child suffering from diphtheria until the data collection, the families of the patients were willing to become respondents and were willing to be interviewed.

All children with diphtheria were used as respondents total sampling , while the control group was obtained using non-random sampling techniques. The control group was recruited by identifying children who met the inclusion criteria that were friends with those in the case group or lived nearby.

Administered structured questionnaire and an observation checklist were used to collect data. The questionnaire and observation checklist used in this study consists of eight sections. Dataset 1 contains all de-identified responses to the questionnaire To reduce interview bias, researchers provide adequate explanations before the interview begins, motivated respondents to give honest answers, questionnaires are arranged in simple language and easily understood and provides sufficient time for interviews.

The determination of DPT immunization status, nutritional status and healthy housing standards are in line with those described by the Indonesian Health Ministry regulations 14 — Data were analyzed using chi square and multiple logistic regression.

Informed written consent was obtained from a parent or guardian of the participants prior to their participation. The sex of the case group was mostly male The sex of the control group were mostly male Multivariate analysis performed on the variables which proved to be significantly associated with the incidence of diphtheria, i.

Table 3. The results of univariate analysis demonstrated that most patients with diptheria had received complete DPT immunization. The result of bivariate analysis revealed no correlation between DPT immunization status and diphtheria infection.

This result is notable, and indicates that further investigation is required on the effectiveness and potential of vaccines. A further example documented by Ningtyas et al. Other studies have documented the variable thermolability of vaccines, caused by breaks in the cold chain, can lead to loss of vaccine potency The results of this study complement the findings of Dhinata et al. Complete immunization status does not guarantee the child is free from the risk of diphtheria.

Sadoh and Sadoh 20 concluded that two out of three children with diphtheria in Nigeria had been completely immunized against DPT, and suggested the use of DT boosters in developing countries. Previously, Gowin et al. Likewise, the results of research by Phadke et al. We found the nutritional status of children was significantly associated with the incidence of diphtheria.

The implications of this finding are, to reduce the risk of the occurrence of diphtheria in children, the improvement of nutrition is absolutely necessary. The results prove that the mobility of respondents travel history to an area that is experiencing a surge in cases of diphtheria is significantly related to the incidence of diphtheria, this result is consistent with other studies by Patil et al.

Population migration increases the risk of transmission of infectious diseases 28 , transmission of measles, rubella, diphtheria, tetanus, polio and Haemophilus influenzae is strongly influenced by population mobility High mobility, poor living conditions, and barriers to accessing healthcare are risk factors to facilitate the spread of infectious diseases such as tuberculosis active and latent , HIV, hepatitis B, hepatitis C, measles, mumps, rubella, diphtheria, tetanus, pertussis, H.

Nutritional status, child mobility and source of transmission were significantly associated with diphtheria. Most children who had diphtheria Mobility of children is the main risk factor of diphtheria. Further research is needed on the effectiveness of diphtheria vaccine in East Kalimantan Province, Indonesia. The author are grateful to all of respondent in this research, Rector of Mulawarman University and Islamic Development Bank. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

This is an interesting, well-structured study analyzing the risk factors for contracting diphtheria in Indonesian children. The article is well written but some improvements are needed before indexing:. What were the criteria for defining cases of diphtheria? Only clinically or after bacteriological confirmation? The results obtained cases better vaccinated than the controls and better nutritional status in the controls than in the cases should lead to discuss more deeply the possibility of a weaker immune response among the cases and suggest a complementary study with dosage of post- vaccine antibodies.

A source of contamination was found among the controls, not among the cases; it is in contradiction with the fact that among diphtheria cases, mobility in a region experiencing a recrudescence of diphtheria proves to be the main risk factor.

Such discrepancy should be analysed in the discussion. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

This research article is very good. The keywords, introduction, methods, results including statistical analysis , discussion, conclusion and references are okay.

The study design is appropriate and the work is technically sound. The method is quite detailed and analysis provided is absolutely perfect to allow replication by other researchers. The statistical analysis is correct and its interpretation is also appropriate.

The conclusions drawn should be: the main risk factors for diphtheria outbreak are children mobility, source of transmission, and nutritional status. It is recommended for further study to analyze the effectiveness of diphtheria vaccines since both study and control group have already got diphtheria vaccination. Read article at publisher's site DOI : This data has been text mined from the article, or deposited into data resources.

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