Epidemiology and Society Health Review (ESHR)

Physical Activity, Sedentary Behavior, and Fitness Levels in University Students

Mega Amanda — 2026-07-17

Background: Physical fitness is crucial for university students as it supports productivity and helps prevent disease. It largely depends on levels of physical activity and sedentary behavior. However, the current student lifestyle relies heavily on technology, resulting in reduced physical activity and increased sedentary behavior. This study aims to investigate the physical activity, sedentary behavior, lifestyle, and physical fitness of university students.

Method: This cross-sectional study was conducted using purposive sampling on active students of UIN Syarif Hidayatullah Jakarta from the 2020-2022 batch.

Results: The findings showed that half of the students (51.6%) had low (normal) sedentary behavior, while a substantial proportion (45.1%) had moderate sedentary levels. Additionally, 32.9% of students were classified as having poor physical fitness, and most students (57.3%) reported low levels of physical activity.

Conclusion: A higher proportion of students demonstrated poor physical fitness, moderate levels of sedentary behavior, and low levels of physical activity. These findings highlight the importance of improving physical fitness through regular exercise and reducing sedentary behavior, particularly non-essential smartphone use. In addition, the university should consider developing and implementing policies that encourage greater physical activity among students, helping them achieve optimal fitness to better support their daily activities.

Epidemiological Characteristics and Temporal Trends of Dengue Fever in the Mlati 2 Primary Health Care, Sleman, Indonesia, 2021–2024

Retno Widyaningrum — 2026-07-17

Background: Dengue is a mosquito-borne viral disease transmitted mainly by Aedes aegypti and Aedes albopictus. A rapid increase in cases may indicate a potential outbreak and requires timely surveillance. This study aimed to describe dengue cases by person, place, and time in the Mlati 2 Public Health Center area from 2021 to 2024 and identify potential outbreak patterns.

Method: This quantitative descriptive study used secondary data from epidemiological investigation records at Mlati 2 PHC. “Dengue cases” included all cases classified as DF, DHF, DSS, and DD. A total of 82 cases recorded from 2021 to 2024 were included. Data were analyzed descriptively and presented by person, place, time, laboratory diagnosis, and House Larvae-Free Index.

Results: Most cases occurred among adults aged 19–59 years, with more females than males. Sumberadi Village recorded the highest number of cases, followed by Tlogoadi and Tirtoadi. DHF was the most frequent classification, while cases in 2024 showed more varied diagnoses, including DF, DHF, DD, and DSS. The three-year minimum–maximum pattern showed that cases in February, March, April, May, and August 2024 exceeded the historical maximum from 2021 to 2023, indicating potential outbreak signals. The House Larvae-Free Index remained below the national standard of 95% during the study period.

Conclusion: Dengue cases occurred annually in the Mlati 2 Public Health Center area, with a marked increase in 2024. Cases were mainly found among productive-age adults and concentrated in Sumberadi Village. The potential outbreak signals and low House Larvae-Free Index highlight the need to strengthen surveillance, timely reporting, epidemiological investigation, and community-based vector control.

Health-Related Quality of Life Among Adolescent Girls with Idiopathic Scoliosis Using Spinal Orthoses: A Systematic Review

Ellysa Okky Gusma — 2026-07-17

Background: Adolescent idiopathic scoliosis (AIS) affects 2–4% of adolescents and is predominantly diagnosed in girls during pubertal growth. Bracing is the primary conservative intervention to prevent curve progression; however, adolescence is a critical period of psychosocial development, making brace wear particularly burdensome. As evidence-based guidance for holistic management remains limited, this study aimed to review the QoL of adolescent girls with AIS undergoing brace treatment.

Method: A literature review was conducted using PubMed and Google Scholar for articles published between 2019 and 2026. Inclusion criteria were adolescents aged 10–18 years with AIS, treated with bracing, and assessed using validated QoL instruments (SRS-22, BrQ, BSSQ). From 1,245 identified records, 15 studies were included following PRISMA-based screening and JBI quality assessment.

Results: Brace treatment negatively affects QoL across physical, psychological, and social domains. Patients reported discomfort, limited mobility, body image concerns, emotional distress, and reduced social participation. QoL outcomes were influenced by brace duration, curve severity, and family support. Improved brace design and multidisciplinary care were shown to mitigate these impacts.

Conclusion: Bracing significantly affects QoL in adolescent girls with AIS. A patient-centered approach that integrates psychosocial support and improved brace design is essential for enhancing treatment adherence and overall well-being.

Sleep Quality and Nutritional Status Among Indonesian Children and Adolescents: A Systematic Review

Ulil Albab Habibah — 2026-07-17

Background: Nutritional status is the result of an individual’s nutrient intake and requirements. In Indonesia, issues related to children’s nutritional status remain a major problem. The relationship between these two variables is mediated by two important hormones involved in appetite regulation: leptin and ghrelin. In a cohort study, results showed a relationship between leptin levels and sleep quality. Although global studies have demonstrated a relationship between these two variables, studies in Indonesia have yielded mixed results. Therefore, this systematic review aims to systematically synthesize the evidence regarding the relationship between sleep quality and nutritional status in children in Indonesia.

Method: This literature review was conducted in March 2026. The databases used for the literature review were Google Scholar, PubMed, ScienceDirect, and Garuda, with periode 2021-2026 publication year. The search strategy used the keywords: ("sleep quality") AND ("nutritional status") AND ("children") AND ("Indonesia"), including equivalent Indonesian terms. Article selection was conducted in accordance with the PRISMA guidelines.

Results: Eleven studies were included in the literature review. The sample size for each study ranged from 52 to 221 participants. Eight studies showed a significant association between sleep quality and nutritional status, while three studies showed no significant association.

Conclusion: The findings of this review confirm that sleep quality is not the sole factor determining nutritional status. Therefore, intervention efforts to improve the nutritional status of children and adolescents must be comprehensive, focusing not only on improving sleep quality but also on improving dietary habits, increasing physical activity, and regulating social media use.

Infodemiology of Rabies in Indonesia and Neighboring Countries: Insights from Google Trends (2020–2024)

Agil Wahyu Wicaksono — 2026-07-17

Background: As Asian countries struggle to meet the global "Zero by 30" rabies target due to delayed and underreported conventional surveillance, digital infodemiology offers a complementary solution. This study analyzes rabies-related Google Trends search interest in Indonesia, Malaysia, the Philippines, Thailand, and Vietnam from 2020 to 2024 to evaluate its utility for public health monitoring and elimination strategies.

Method: Google Trends was queried for the term "rabies" across the five countries from January 2020 to December 2024. Monthly normalized scores (0–100) were collected and analyzed descriptively. Trends were examined at monthly and annual levels, including seasonal fluctuations and exceptional peaks. Relative growth between 2020 and 2024 was calculated to identify shifts in long-term public awareness.

Results: Thailand consistently demonstrated the highest baseline search interest, while Indonesia remained the lowest despite a dramatic spike in June 2023 (score 100). Seasonal increases were observed in Thailand and Vietnam during the second half of the year, coinciding with agricultural cycles and awareness campaigns. Annual mean scores rose in all countries, with the Philippines showing the largest relative increase (+164%), followed by Indonesia (+110%). Malaysia and Vietnam exhibited moderate growth, while Thailand's increase was more modest (+86%).

Conclusion: Rabies awareness in Southeast Asia is highly variable and largely event-driven, highlighting the need for integrated, sustained communication strategies tailored to each country's epidemiological and sociocultural context to support the achievement of the "Zero by 30" elimination goal.

Association Between Maternal Height and Childhood Stunting in Indonesia: A Systematic Review

Yanasta Yudo Pratama — 2026-07-17

Background: Stunting is one of Indonesia's most complex health problems with the incidence of stunting reaches almost 30%. Maternal factors are known to play a significant role in the risk of stunting. However, further analysis of the influence of maternal height is needed to identify the influence of maternal height on child growth and development for future intervention. This study aims to evaluate maternal height as risk factor for stunting in Indonesia based on previous published article.

Method: This systematic review was prepared in accordance with the PRISMA guidelines. The literature search was conducted in PubMed and Google using keywords in English including "maternal height", "maternal stature", "stunting" and "Indonesia", while keyword in Bahasa Indonesia using "tinggi badan ibu" and "stunting." The search was limited to English and Indonesian language studies with included studies published after 2020.

Results: Of the 581 studies identified from two electronic search engines, seven studies met our inclusion criteria. A total of 703 population samples from seven included studies were analyzed regarding the relationship between maternal height and stunting. Five of the seven included studies showed that maternal height influenced the risk of stunting Although maternal height is correlated with the risk of stunting, analysis of the causes of low maternal height is necessary for planning further interventions.

Conclusion: Maternal height influences the risk of stunting. However, maternal influences can also influence prenatal growth and development. Long-term studies and interventions are needed to analyze the maternal role in stunting risk.

Community-Based Digital Mental Health Modules and Mental Health Literacy Among Generation Z Students in Islamic Boarding Schools

Nahdiyatus Nur Fitriyah — 2026-07-17

Background: Mental health is a growing issue in educational settings. Islamic boarding schools (pesantren) are educational environments based on a dormitory system. This creates mental health issues. Low mental health literacy among Islamic boarding school students (santri) is a significant issue in Islamic boarding schools (pesantren).

Method: The study used a quasi-experimental, two-group pretest-posttest design with a sample of 78 students divided into intervention 38 studens and control groups 40 studens. The instrument used was the Mental Health Knowledge Questionnaire (MHKQ), Data analysis using paired t-tests and independent t-tests.

Results: The results showed a significant increase in knowledge in the intervention group (p<0.05). There were significant differences between the intervention and control groups in indicators of basic concepts, causes, and treatment and management (p=0.000), but not in prevention (p=0.287).

Conclusion: Digital modules are more effective than leaflets in improving mental health literacy among Islamic boarding school students, although they are not optimal for prevention.

Fear of Missing Out (FoMO), Social Media Addiction, and Academic Stress: A Quantitative Study among High School Students in Sukoharjo Regency

Bangkit Ary Pratama — 2026-07-17

Background: The rapid development of the internet and social media has driven the emergence of the Fear of Missing Out (FoMO) phenomenon among adolescents, which can evolve into social media addiction and trigger academic stress. This study aims to examine the effect of FoMO and social media addiction on academic stress among high school students in Sukoharjo Regency.

Method: This research used a quantitative analytic design with a cross-sectional approach. The sample consisted of 110 high school students aged 15–19 years in Sukoharjo Regency, selected through accidental sampling. Data were collected using validated questionnaires, including the FoMO Scale, BSMAS, and ESSA. A multiple linear regression model was applied to analyze the collected data.

Results: The results showed that FoMO partially had a significant positive effect on academic stress (t = 3.611, p < 0.001). Social media addiction also partially had a significant positive effect on academic stress (t = 3.422, p = 0.001). Simultaneously, FoMO and social media addiction significantly affected academic stress (F = 22.284, p < 0.001), contributing 29% to the variance in academic stress.

Conclusion: FoMO and social media addiction significantly escalate academic stress among high school students in Sukoharjo Regency, acting as both partial and simultaneous contributors.

Nutritional Status of Primary School Children in Kintamani, Bangli, Bali Based on School Screening Program

Cintya Riska Prathiwi Ni Ketut — 2026-07-17

Background: Bangli regency has the highest prevalence of stunting in Bali with 43.2% children under 5 years old is stunting. However, nutritional status among school age children here has not been reported in any studies. The aim of this study is to determine the nutritional status of primary school children in Kintamani, Bangli.

Method: This study was a descriptive cross-sectional study which conducted alongside school screening programs in 9 primary schools. Nutritional status of children aged 6-13 years was assessed based on body mass index, weight and height for age and gender according to the references from WHO.

Results: Out of 1,158 children participated, 602 (52.0%) were male and 556 (48.0%) were female. The prevalence of severe thinness, thinness, overweight, and obesity are 0.3%, 1.2%, 71.6%, 15.9%, 11.0%, respectively. The prevalence of stunting among primary school age children (HAZ<2) was 9.3%. The proportion of children with nutritional problems (both under and overnutrition) were higher in male than female. This study showed that other than undernutrition, overnutrition such as overweight and obesity in older children is increasing and the trend were also found in other countries, possibly due to lack of physical activity, micronutrient deficiencies, and unhealthy diet. Therefore, evidence-based interventions are needed for all children with nutritional problems.

Conclusion: Double burden of malnutrition was found in Kintamani, Bangli, Bali. The higher prevalence of overnutrition among school aged children should be highlighted and concerned as important as undernutrition mattered.

Post-operative Carcinoembryonic Antigen (CEA) Increase as an Indicator of Recurrence After Resection in Colorectal Cancer Patients at Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar

Cokorda Bagus Nurparma Putra — 2026-07-17

Background: Carcinoembryonic Antigen (CEA) is a glycoprotein utilised as a serological marker for postoperative surveillance of colorectal cancer. Its role in predicting recurrence after curative resection remains a subject of debate.This study aimed to evaluate post-operative CEA as an indicator and predictor of recurrence after resection in colorectal cancer patients, and to determine the disease-free survival (DFS) over 24 months.

Methods: A retrospective cohort study was conducted at the Digestive Surgery Outpatient Clinic of Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, from December 2024 to February 2025. A total of 66 patients with stage II–III colorectal cancer who had undergone curative resection (R0) between 2018 and 2022 were enrolled. Post-operative CEA was measured at a minimum of four months after resection. Patients were followed for recurrence and disease-free survival over a 2-year period.

Results: Of 66 patients, 43 (65.2%) experienced recurrence. Post-operative CEA >5 ng/mL was significantly associated with recurrence (RR = 1.82; 95% CI: 1.357–2.444; p = 0.001). ROC curve analysis identified an optimal CEA fluctuation cut-off of 1.01 ng/mL as a “surveillance threshold” for predicting recurrence (AUC = 0.821; sensitivity 72.1%; specificity 95.7%). The optimal post-operative CEA cut-off was 4.11 ng/mL (AUC = 0.696; p = 0.009). Two-year DFS was significantly lower in patients with post-operative CEA >4.11 ng/mL versus those with CEA ≤4.11 ng/mL (40% vs. 63%; p = 0.001).

Conclusion: Elevated post-operative CEA was significantly associated with recurrence after resection in colorectal cancer patients. A CEA increase of 1.01 ng/mL can serve as a “surveillance threshold” to indicate possible recurrence. CEA should be combined with radiological imaging for optimal surveillance.

Comparison of Interleukin-6 Levels After Rectal Irrigation With Metronidazole and Normal Saline Versus Normal Saline Alone in Male Wistar Rats With a Hirschsprung-Associated Enterocolitis Model

Agung Aditya Arnaya — 2026-07-17

Background: Hirschsprung-Associated Enterocolitis (HAEC) is a serious complication of Hirschsprung disease characterized by intestinal inflammation. Rectal irrigation with systemic antibiotics is the standard management, but efficacy remains limited. Metronidazole, an effective anaerobic antibiotic, has immunomodulatory properties that may reduce inflammation. This study evaluates whether topical metronidazole combined with normal saline irrigation reduces IL-6 levels more effectively than saline alone.

Method: An experimental study using 20 male Wistar rats (2-3 months, 250-300g) was conducted. HAEC model was induced using benzalkonium chloride (BAC) 0.1% applied topically to the sigmoid colon. Rats were randomized into two groups: Control group (K) receiving rectal irrigation with normal saline 0.9% (10 mL/kg/day, once daily), and Treatment group (P) receiving combination irrigation with metronidazole 7.5 mg/kg/day plus normal saline 10 mL/kg/day (twice daily). Both interventions began on day 7 post-induction and continued until day 14. Serum IL-6 levels were measured by ELISA on day 14. Data were analyzed using independent samples t-test.

Results: The combination group demonstrated a mean IL-6 level of 4.47 ± 1.54 pg/mL versus 5.63 ± 2.04 pg/mL in the saline-only group (mean difference -1.15 pg/mL, 95% CI: -2.85 to 0.54; t = -1.430, df = 18, p = 0.170). Normal distribution was confirmed in both groups (Shapiro-Wilk: W = 0.904, p = 0.243 and W = 0.879, p = 0.126, respectively), and homogeneity of variance was confirmed by Levene’s test (F = 0.043, p = 0.837).

Conclusion: Combination irrigation with metronidazole demonstrated a numerically lower mean IL-6 level compared with saline alone (4.47 ± 1.54 vs. 5.63 ± 2.04 pg/mL; Cohen’s d = 0.64); however, this difference was not statistically significant under the current experimental conditions (p = 0.170). Given the unequal irrigation frequency between groups and the limited statistical power of this pilot study, these findings should be regarded as hypothesis-generating rather than evidence of therapeutic efficacy, warranting larger, adequately powered trials with equal irrigation frequency and longer intervention duration.

Prevalence, Correlates, and Public Health Implications of Mental Disorders in Uzbekistan and Indonesia: A Systematic Review

Sardorbek Ibragimov — 2026-07-22

Background: Mental disorders represent a growing public health challenge in low- and middle-income countries. This study aimed to comparatively investigate the prevalence, sociodemographic correlates, and public health implications of mental disorders in Uzbekistan and Indonesia, two lower-middle-income nations sharing structural mental health system challenges despite differing geographic and cultural contexts.

Methods: A comparative epidemiological study was conducted using secondary data from publicly available sources, including the World Health Organization, Global Burden of Disease database, Indonesian national health surveys, the Uzbekistan Ministry of Health, and Scopus-indexed literature (2013–2024). No primary data were collected.

Results: Indonesia reports that 14.7% of adults experience anxiety and depression symptoms, yet most remain untreated despite an annual economic burden of USD 29.22 billion. Uzbekistan lacks national prevalence data, with mental health services heavily reliant on inpatient care and a limited psychiatric workforce. Both countries face substantial treatment gaps, workforce shortages, and slow progress in deinstitutionalization.

Conclusion: Both countries face substantial unmet mental health burdens requiring urgent investment in community-based care, workforce expansion, primary care integration, and evidence-based policy implementation to reduce treatment gaps and improve population mental health outcomes.

Healthcare Access and Regional Inequalities as Determinants of Childhood Stunting in East Nusa Tenggara, Indonesia: A Systematic Review

Arif Andriyanto — 2026-07-22

Background: Stunting remains a major public health problem in Indonesia, particularly in East Nusa Tenggara (NTT) Province, which has the highest prevalence of stunting nationally. The high incidence of stunting in NTT is influenced not only by inadequate nutrition but also by limited access to health services, clean water, and sanitation, as well as socioeconomic and development disparities between regions.

Method: This study employed a systematic review method following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic literature search was conducted through Google Scholar, PubMed, and Garuda databases using the keywords "stunting," "access to health services," "regional inequality," and "East Nusa Tenggara." A total of 1,653 articles were found in the initial search phase, and 12 met the criteria for further analysis.

Results: The study results show that stunting in East Nusa Tenggara is closely related to various multidimensional factors, including limited access to sanitation and clean water, minimal health care facilities, geographic isolation, poverty, and inequality between rural and urban areas.

Conclusion: Stunting in East Nusa Tenggara is a multidimensional problem. Therefore, efforts to address stunting in NTT require an integrated, cross-sectoral approach that emphasizes equitable access to health services, improved sanitation, clean water provision, poverty alleviation, and region-based development.