Objectives: The primary objective of this study was to examine the effect of women’s empowerment on the immunization of Indonesian children. The secondary objective was to examine the effect of wealth as a factor modifying this association.Methods: We utilized data from the 2017 Indonesian Demographic and Health Survey (IDHS). The subjects were married women with children aged 12-23 months (n=3532). Complete immunization was defined using the 2017 IDHS definition. Multiple components of women’s empowerment were measured: enabling resources, decision-making involvement, and attitude toward intimate partner violence. The primary analysis was conducted using binomial logistic regression. Model 1 represented only the indicators of women’s empowerment and model 2 controlled for socio-demographic variables. Subgroup analyses were conducted for each wealth group.Results: The primary analysis using model 1 identified several empowerment indicators that facilitated complete immunization. The analysis using model 2 found that maternal education and involvement in decision-making processes facilitated complete immunization in children. Subgroup analyses identified that wealth had a modifying effect. The indicators of women’s empowerment were strong determinants of complete immunization in lower wealth quintiles but insignificant in middle-income and higher-income quintiles.Conclusions: To our knowledge, this study is the first to explore women’s empowerment as a determinant of child immunization in Indonesia. The results indicate that women’s empowerment must be considered in Indonesia’s child immunization program. Women’s empowerment was not found to be a determinant in higher wealth quintiles, which led us to rethink the conceptual framework of the effect of women’s empowerment on health outcomes.

Hydatidiform mole belongs to the spectrum of gestational trophoblastic disorders in which abnormal conception leads to excess placental tissue formation in the absence of fetal development. The incidence of hydatidiform mole is quite rare so that not all experienced clinicians handle this case in clinical experience. Therefore, we present a case of hydatidiform mole in an adolescent patient. A 14-year-old primigravida woman, unemployed, with elementary school education, with a gestational age of 16 weeks went to the ER with complaints of vaginal bleeding for 2 days. Physical examination found the fundal height at umbilicus, abdominal tenderness, accompanied by vaginal bloody discharge. Complete blood count found mild normochromic anemia with increased levels of T3 and decreased TSH. Ultrasound imaging found a typical vesicular pattern of a hydatidiform mole. Treatment of molar evacuation by curettage and drainage was carried out one day after presentation and obtained 600 grams of molar tissue. The patient underwent 24 hours of post-operative observation before being discharged in a stable state. The patient presented with a typical clinical appearance of hydatidiform mole. Ultrasound imaging reveals a typical complete hydatidiform mole accompanied by anemia and hyperthyroxinemic which may accompany hydatidiform mole. Evacuation was carried out according to clinical guidelines and the patient was discharged in a good condition.

Type 1 diabetes mellitus (T1DM) is an endocrine disorder, marked by elevated blood glucose level caused by autoimmune process destroying the β-cells of the pancreas which mostly affects children. It is an often-overlooked condition, with low awareness among clinicians and parents alike which led to late diagnosis and patients often presenting with acute complications. Often triggered by a viral infection, here we presented an interesting case of early onset T1DM presenting with Diabetic ketoacidosis (DKA) during a COVID-19 pandemic. A female infant, aged 1 years and 2 days old, presented with dyspnea and fever. Physical examination was otherwise normal, without any rhonchi or wheezing found during pulmonary auscultation. Nasopharyngeal swab and SARS-CoV-2 antigen test was found negative. Laboratory workup found random blood glucose level of 577 mg/dl accompanied by acidosis and ketonuria. The patient also had elevated white blood cells and platelet counts. She was admitted for treatment in the Pediatric intensive care unit (PICU) with therapeutic regiments consisting of slow intravenous insulin infusion, potassium chloride intravenous fluid, antibiotics, and antipyretics. Close monitoring of blood glucose ensues and the patient was treated for 5 days followed by outpatient therapy with mixed insulin treatment twice per day. This case was interesting as T1DM usually manifested in older children with median age of diagnosis ranging from 8 to 13 years old, depending on population. T1DM diagnosed in children younger than 6 years old are classified early onset and it is especially rare to found in infants. Although the patient tested negative for SARS-CoV-2 antigen, the onset of the case coincides with a recent surge of cases locally. It meant that we cannot rule out possibility of prior unknown exposure or infection which may precipitate the condition.