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Prevalence of Scabies in Indonesian Islamic Boarding Schools: a Systematic Review
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Pejuang Waras PublishingLiterature to Read Journal (2024), Vol. 1, No. 1:28-39 E-ISSN: 2988-5892
Homepage: https://pejuangwaras.weebly.com/
Prevalence of Scabies in Indonesian Islamic Boarding Schools: a Systematic Review
Azza Fithra Alhanifa
11Faculty of Medicine, Udayana University, Bali, Indonesia Abstract
Background: Scabies is a highly contagious skin disease with a significant global burden, particularly in crowded settings like Islamic boarding schools. Indonesia, with its large Muslim population and numerous Islamic boarding schools, is a potential high-risk environment. However, prevalence estimates for scabies in these settings vary widely. This systematic review aims to determine the prevalence of scabies in Indonesian Islamic boarding schools and explore factors that might contribute to the variability in reported data. This understanding will help inform targeted interventions and guide future research within this context.
Methods: PubMed and Google Scholar were systematically searched (published 2010-2024). An independent reviewer was involved to ensure consistency. Data were analyzed and presented in narrative form, summarizing the overall scabies prevalence range within Indonesian Islamic boarding schools.
Results: 35 studies examining scabies prevalence within Indonesian Islamic boarding schools were identified. A wide range of prevalence was observed (4.4% to 88.46%). Prevalence was consistently higher in male students and exhibited an inverse correlation with educational level and age.
Implementation of stricter quality assessment criteria yielded a slightly narrower prevalence range.
These findings indicate a significant scabies burden within this setting and suggest the need for targeted interventions addressing identified high-risk populations.
Discussion: This systematic review highlights current prevalence of scabies within Indonesian Islamic boarding schools, showing many factors involving its spread and prevalence. To improve research and reduce scabies, standardized diagnosis, follow-up studies, and targeted interventions focusing on hygiene, sanitation, and early treatment are essential.
Keywords: scabies, prevalence, schools, Islamic boarding schools, students
Prevalensi Skabies di Pondok Pesantren Indonesia: Tinjauan Sistematis
Abstrak
Latar Belakang: Skabies adalah penyakit kulit yang menular dan menjadi beban global yang signifikan, khususnya di lingkungan padat penduduk seperti pesantren. Indonesia, dengan populasi Muslim yang besar dan banyaknya pesantren, merupakan lingkungan yang berpotensi berisiko tinggi. Namun, perkiraan prevalensi skabies di wilayah ini sangat bervariasi. Tinjauan sistematis ini bertujuan untuk mengetahui prevalensi skabies di pesantren di Indonesia dan mengeksplorasi faktor-faktor yang mungkin berkontribusi terhadap variabilitas data yang dilaporkan. Pemahaman ini akan membantu menginformasikan intervensi yang ditargetkan dan memandu penelitian di masa depan dalam konteks ini.
Metode: PubMed dan Google Scholar dicari secara sistematis (diterbitkan 2010-2024). Peninjau independen dilibatkan untuk memastikan konsistensi. Data dianalisis dan disajikan dalam bentuk narasi, merangkum rentang prevalensi skabies secara keseluruhan di pesantren di Indonesia.
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Hasil: Teridentifikasi 35 penelitian yang meneliti prevalensi skabies di pesantren di Indonesia. Berbagai macam prevalensi diamati (4,4% hingga 88,46%). Prevalensi secara konsisten lebih tinggi pada siswa laki-laki dan menunjukkan korelasi terbalik dengan tingkat pendidikan dan usia. Penerapan kriteria penilaian kualitas yang lebih ketat menghasilkan kisaran prevalensi yang sedikit lebih sempit. Temuan ini menunjukkan beban skabies yang signifikan dalam situasi ini dan menyarankan perlunya intervensi yang ditargetkan untuk mengatasi populasi berisiko tinggi yang teridentifikasi.Pembahasan: Tinjauan sistematis ini menyoroti prevalensi skabies saat ini di pesantren Indonesia, menunjukkan banyak faktor yang mempengaruhi penyebaran dan prevalensinya. Untuk meningkatkan penelitian dan mengurangi skabies, diagnosis standar, penelitian lanjutan, dan intervensi tertarget yang berfokus pada kebersihan, sanitasi, dan pengobatan dini sangatlah penting.
Kata Kunci: santri sekolah, skabies, pesantren, prevalensi,
INTRODUCTION
Scabies is an infectious skin disease caused by the Sarcoptes scabiei var. hominis mite which causes a very itchy condition [1]. People of all ages worldwide, including children and the elderly, are susceptible to scabies. Low- resource areas are especially vulnerable to scabies, which is most common in tropical countries [2]. The World Health Organization (WHO) estimates that scabies infects over 200 million people at any given point, with over 400 million new cases annually. This widespread impact led to its recent inclusion on the WHO's Neglected Tropical Diseases (NTDs) 2021-2030 roadmap. Scabies meets the WHO's criteria for NTDs as it heavily affects poor populations and results in significant illness and mortality. This high prevalence is particularly concerning in crowded settings like Islamic boarding schools.
Scabies often appears in densely populated residential populations who live together, especially with exposure to close and prolonged skin contact such as in Islamic boarding schools [3]. As a country with a majority Muslim population, Indonesia has many Islamic boarding schools. In 2023, the Indonesian Ministry of Religion recorded that there were 39,167 Islamic boarding schools spread throughout the province [4].
Scabies worldwide prevalence varies greatly, with systematic studies reporting rates between 0.18% and 76.9% with Indonesia exhibits a particularly concerning prevalence, finding 81 out of 105 randomly selected children infected at an Islamic boarding school, making it the highest [5]. This raises the question: Is the prevalence of scabies truly this high across all Indonesian Islamic boarding schools, or could other factors be influencing this data?
Accordingly, this study aims to determine the prevalence of scabies in Indonesian Islamic boarding schools using a systematic review of available studies. Through a comprehensive search strategy, quality assessment of studies, and synthesis of data, a systematic review will provide a clearer picture of scabies prevalence within this unique setting.
Additionally, it can point towards the reasons for data variability and help direct future research efforts.
METHODS
Study identification and selection This systematic review adheres to the updated PRISMA 2020 ‘Preferred Reporting Items for Systematic Reviews and Meta- Analyses’ guidelines. We searched PubMed and Google Scholar databases for studies on scabies epidemiology, with a focus on Islamic boarding schools in Indonesia. Publication date range is also set to past the year 2010 (2010-2024).
Keywords used to search were: ‘scabies’,
‘prevalence’, ‘Islamic boarding schools’,
‘(region/province name)’. Synonyms of the word are also searched to broaden the search.
Searches were carried out in English and Indonesian. The majority of articles are taken from the Google Scholar database with some articles limited to certain university/institution repositories. Articles that are locked to certain university/institution repositories are read for abstracts and requested access through colleagues within the institution.
Study eligibility and quality assessment Titles and abstracts were initially screened independently by AFA. Full-texts were then reviewed for eligibility, and KMKT, an
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independent third party, was consulted toresolve any disagreements.
Only studies that reported the prevalence of scabies in Islamic boarding schools were included in the systematic review.
Thus, studies showing the prevalence of scabies in orphanages or nursing homes, for example, were not included. Quality and risk of bias assessment were conducted by AFA. To assess the quality of the studies retrieved, the Quality of Scabies Assessment was carefully assessed.
The Three-Point Scale approach is carried out by ensuring the presence or absence of clinical examination and microscopic confirmation in the studies taken (These criteria were assessed on a three-point numerical scale 0, 1, or 2).
Apart from systematic assessment, discussions were also carried out by contacting third party reviewer KMKT.
Data extraction
Using a dedicated extraction form, AFA independently collected the following information from each study (when accessible):
study location, boarding school name, data collection method, sample size and prevalences.
In addition, data from the Indonesian Badan Pusat Statistik (BPS)/Central Bureau of Statistics is used to look at the Human Development Index (HDI) by Province which assesses long and healthy life (life expectancy), knowledge (literacy, expected years of schooling, average years of schooling), and living standards (per capita income), was used to classify regions of province from low to high.
Data extracted from the included studies will be presented in a narrative form.
We will first provide a general overview of the prevalence of scabies in Indonesian Islamic boarding schools, summarizing the range and central tendencies (e.g., median) reported across studies. We will then explore potential sources of heterogeneity in prevalence estimates. By systematically examining these factors, we can identify potential reasons for discrepancies in prevalence figures and provide a more nuanced understanding of scabies prevalence within the Indonesian boarding school context.
RESULTS
We've included a PRISMA 2020 flow diagram to ensure transparency in our systematic review (see Figure 1). Our initial literature search yielded 2668 records. After removing duplicates and publication criterias, we screened 1751 titles and abstracts for relevance. We then assessed 71 full-text articles for eligibility against our inclusion and exclusion criteria, ultimately selecting 44 studies.
Quality and risk of bias assessment were presented in table (see attachment Table 1.). Author(s), location, boarding school name, study design, sample, clinical examination and microscopic confirmation, prevalences, and Quality of Assessment (QoA) were included within the table.
Figure 1. PRISMA ‘Preferred Reporting Items for Systematic Reviews and Meta-Analyses’ 2020 flow diagram.
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Thirty-five studies examining scabiesprevalence within Indonesian Islamic boarding schools were identified [6–40]. The quality assessment revealed that 24 studies obtained at least one point [6–16,20,22,23,27–29,32–
34,36–39], whereas the remaining studies still had zero points (see attachment Table 1.) [17–
19,21,24–26,30,31,35,40]. The issue was that many studies described prevalence without specifying clinical examination methods (n = 11). It is possible that the study carried out a clinical examination based on a questionnaire checklist, but the lack of specific mention of clinical examination makes the accuracy of the study results questionable in interpreting the prevalence of scabies in certain Islamic boarding schools. Overall, the quality of the studies was poor. Studies with total sample, clinical examination, and microscopic
confirmation combined only left eight studies [6,7,12,13,28,34,37,38].
The completeness of reported prevalence data varies across studies, likely due to differences in the target populations examined. Twenty-five studies reported only overall sample prevalence [6,7,10,12,14–
20,22,24,26,29–32,34–40]. Three studies focused exclusively on female populations [29,30,32], while eight provided the comprehensive prevalence data required for this systematic review (including breakdowns by education level or age group, sex, and overall prevalence) [8,9,11,13,21,23,25,28]. It's important to note that some figures presented in attachment Table 1 may not be explicitly stated in the original studies, as two studies provided raw data that required pre-processing to generate these values [21,28].
Figure 2. Contribution of scabies prevalence in Indonesian Islamic boarding schools between 2012 and 2024 [6–33,39,40].
As can be seen in (Figure 2.), 33 studies were conducted in the Kawasan Barat Indonesia (KIB)/Western Indonesia Region, Indonesian western region include Sumatera, Java, and Kalimantan [6–38], and two other studies were conducted in the Kawasan Timur Indonesia (KTI)/Eastern Indonesia Region, including Sulawesi, the Nusa Tenggara Islands, the Maluku Islands and Papua [39,40]. This is in line with the fact that the further east you go, the smaller the Muslim population, thus the fewer Islamic boarding schools [41].
The majority of studies (n=18) were conducted on Sumatera Island and its surrounding islands [6,14–17,20,23–25,28–
34,37,38]. Ten studies focused on Java Island and its surroundings [7–13,18,19,36], and five studies examined the island of Kalimantan [21,22,26,27,35]. Two studies were conducted
in Eastern Indonesia (Lombok and Sulawesi Islands) [39,40]. Prevalence within Sumatera Island studies ranged from 4.40% (112/2544) to 69.90% (58/83), with a median prevalence of (x ~ 43.29%). Java Island studies showed a prevalence range of 13.48% (151/1120) to 88.46% (sample number not stated), with a median of (x ~ 53.15%). The limited number of studies (n = 2) from Eastern Indonesia restricts conclusions; observed prevalence ranged from 21% (11/52) to 38% (27/71), with a median of (x ~ 29.50%).
The overall prevalence of scabies ranged from 4.4% to 88.46% in the included studies. The highest prevalence was found in Yogyakarta [7], although the total number of individuals sampled was not stated. The lowest prevalence was found at the Al-Ittifaqiah Islamic Boarding School, Ogan Ilir, South Sumatra with
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112 out of 2544 students diagnosed withscabies [6] (see Figure 3.), with the median of (x
~ 47.30%). The study with the largest sample was conducted at Al-Ittifaqiah Islamic Boarding School, Ogan Ilir, South Sumatera, with a prevalence of 4.4% (112/2544). In contrast, the study with the smallest sample was conducted at the Madarijul Ulum Islamic Boarding School, Lampung, with a prevalence of 60% (21/35).
Based on 2023 data from the Indonesian Central Bureau of Statistics, HDI in Indonesia ranges from 62.25-82.46 [42]. The highest prevalence, 88.46%, was found in Yogyakarta with the second highest Indonesian HDI at 81.42 [7]. Meanwhile, the lowest prevalence, 4.4%, was found in South Sumatra with an HDI of 71.52 [6].
Figure 3. Prevalence of scabies, highlighting the Yogyakarta region as the highest prevalence and South Sumatera as the lowest prevalence.
When quality assessment was required to be (≥ 1) and the total number of samples must be present, the results of 23 studies present the highest prevalence rate at 82% (41/50), while the lowest prevalence was still at 4.4%
(112/2544) (see Figure 4.), with the median of (x ~ 37.69%) [6,8–16,20,22,23,27–29,32–
34,36–39].
Figure 4. Prevalence of scabies after the adjusted criteria, highlighting the West Java region as the highest prevalence and South Sumatera as the lowest prevalence.
When the quality of assessment was further increased becomes must be (≥ 2) and the total number of samples must be present, then the study was reduced to only seven [6,12,13,28,34,37,38]. The highest prevalence was 71.43% (115/161) and the lowest prevalence was still 4.4% (112/2544) (see Figure 5.), with the median of (x ~ 35.70%).
Figure 5. Prevalence of scabies after adjusting the criteria further.
When prevalence was examined in terms of education level and age (given the correlation between educational attainment
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and age), eight studies provided evidence ofdifferences [8,9,11,13,21,23,28,33]. These studies demonstrated that prevalence consistently decreased with increasing educational attainment and age (see Figure 6.).
Figure 6. Studies with education level and age scabies prevalence data.
Nine studies were analyzed to compare scabies prevalence in Islamic boarding schools by sex. Of which, eight studies demonstrated a significantly higher prevalence among males [8,11,13,21,23,25,27,28], while one study reported a contrasting finding [9], with females exhibiting a prevalence of 96.20% compared to 66.70% in males. The addition of three studies focused on female prevalence yielded a median of 12 studies (x ~ 25.06%) [29,30,32].
Meanwhile, a median male prevalence of (x ~ 48.50%) was determined across nine studies (see Figure 7).
Figure 7. Prevalence comparison between sex (male and female).
DISCUSSION
This systematic review identified a wide range of scabies prevalence in Indonesian Islamic boarding schools, highlighting the need for improved prevention and control measures.
In this systematic review, 35 studies based on cross-sectional study designs were included and reported that the prevalence of scabies in Indonesian Islamic Boarding Schools was between 4.4% in South Sumatra, and 88.46% in
Yogyakarta. Studies also show that prevalence tends to be higher in younger groups of population than older groups of population, the same goes to education level, the higher education population got less scabies accident prevalence. Sex related accidents also show a correlation that males are more susceptible to scabies with a higher prevalence than females.
This systematic review also concluded that the more stringent the inspection method used, the smaller the prevalence of scabies found. The majority of studies were conducted on Sumatra Island and its offshore islands, followed by Java Island and its offshore islands, and finally there were only two studies examining the prevalence of scabies in Eastern Indonesia. This study also shows that a high HDI does not mean a low prevalence of scabies. In Yogyakarta, even though the HDI is one of the highest in Indonesia, the prevalence of scabies in Islamic boarding schools is the highest.
Additionally, two previous systematic reviews by Romani et al. and Schneider et. al.
which analyzed the global prevalence of scabies reported a large discrepancy in the global scabies prevalence in population-based settings [5,43], last updated by Schneider et. al. with prevalence varying between 0.18% and 76.9%.
This is comparable with the findings in this systematic review. Two previous systematic reviews concluded that one reason for this wide range was the lack of standardized diagnostics algorithms. They therefore recommended that this problem be addressed by the development of a consensus and evidence-based diagnostic criteria for scabies under the leadership of the IACS [44]. However, with a stricter setting, by only limiting research to Indonesian Islamic Boarding Schools, it makes it increasingly difficult to find studies that follow standardization. We suggest that future studies on scabies prevalence should follow the same criteria of diagnosis, such as those published by the IACS [44].
Apart from that, there have been no studies to check the consistency of data from Islamic boarding schools. We recommend that future updates to the same Islamic boarding school location also need to be carried out to see the development of scabies in the location in line with developments over time. This is to find out whether in certain places the handling of scabies is improving or worsening and to provide a reflection on whether the prevention
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and handling of scabies at the national level,especially in Islamic boarding schools, has been fulfilled or not. Two previous studies also recommended further studies on age-specific causes [5,43]. Although this systematic review study has shown a correlation between age and education level. The calculated data set is still very limited. Further studies are needed regarding age factors and educational levels and are also standardized across future studies.
All and all, there are some study limitations. The approaches and designs of the studies vary widely. The criteria used in each study differ since there are no globally accepted standards for diagnosing scabies. Certain studies rely solely on symptom surveys, while others employ scabies feature verification and even perform microscopic examination.
Furthermore, there is a wide range in the sample size. Comparably, a lot of studies merely report the prevalence of scabies as a whole rather than breaking it down by demographics like age or gender.
We conclude that this systematic review highlights current prevalence of scabies within Indonesian Islamic Boarding Schools in the range of 4.4% to 88.46%. Younger students and those with lower education levels experience higher prevalence rates, with males being more susceptible than females, a high Human Development Index (HDI) doesn't guarantee lower scabies rates, and a stricter inspection methodology correlates with lower prevalence. To address inconsistencies and improve future research, it is recommended that studies adopt standardized diagnostic criteria (such as those from IACS), conduct follow-up studies at the same locations to track progress, and further investigate age-specific causes. These findings underscore the urgent need for targeted interventions within Indonesian Islamic boarding schools to reduce scabies prevalence. Improving hygiene practices, sanitation facilities, and instituting protocols for early identification and treatment are crucial.
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37
ATTACHMENT
Table 1. Appendix.
Author(s) Location Boarding
School Name Design Level of
education Sample Clinical
Examination Microscopic Confirmatio
n
Education Level AND/OR Age Prevalence (*) Total
Prevalence QoA Sex Prevalence
SMP SMA Younger
group Older
group Male Female
[8] Jakarta
Timur, Jakarta
Pondok
Pesantren X cross-
sectional SMP, SMA 192 Yes
-58,1% 41,3%
- -51,6% 1 57,4% 42,9%
[9] Depok, Jawa
Barat Pondok Pesantren Qotrun Nada
Kota Depok
cross-
sectional SMP, SMA 50 Yes
-96,8% 57,8%
- -82% 1 66,7% 96,2%
[10] Sleman,
Yogyakarta Pondok Pesantren
Mlangi Nogotirto
Gamping
cross-
sectional
-53 Yes
- - - - -54,7% 1
- -[11] Jember, Jawa
Timur Pesantren
Nurul Qarnain cross-
sectional SMP, SMA 1120 Yes
-15,61% 11,17%
- -13,48% 1 24,89% 5,82%
[12] Semarang,
Jawa Tengah Pondok
Pesantren X cross-
sectional
-42 Yes Yes
- - - -14% 2
- -[6] Ogan Ilir, Sumatera Selatan
Pondok Pesantren Al
Ittifaqiah
cross-
sectional
-2544 Yes Yes
- - - -4,4% 2
- -[13] Purworejo,
Jawa Tengah Pesantren An Nawawi
Berjan
cross- sectional
case control
-
161 Yes Yes
- -70,17% 25,53% 71,43% 2 83,48% 16,52%
[7] Bantul,
Yogyakarta Pondok Pesantren Al-
Fataa
cross-
sectional
- -Yes Yes
- - - -88,46% 2
- -[14] Palembang, Sumatera
Selatan
Pondok
Pesantren X cross-
sectional
-70 Yes
- - -38,57% 1
- -[15] Palembang, Sumatera
Selatan
Pesantren Al-
Amalul Khair cross-
sectional
-182 Yes
- - -48,4% 1
- -[16] Aceh
Tengah, Aceh
Pesantren Ulumul
Qur’an
cross-
sectional
-69 Yes
- - -62,3% 1
- -[17] Aceh Utara,
Aceh Pesantren
Jabalnur cross-
sectional
-89
- - -58,4% 0
- -[18] Bangkalan, Madura, Jawa Timur
Pesantren Al- Hikam Bangkalan
cross-
sectional
-84
- - - - - -66,7% 0
- -38
[19] Serang,
Banten Al-Rahmah
Walantaka cross-
sectional
-167
- - - - - -47,3% 0
- -[20] Jambi Pesantren
Sa’adatuddar en
cross-
sectional
-85 Yes
- - - - -57,7% 1
- -[21] Kalimantan
Tengah Pesantren
Darul Ulum cross-
sectional SMP, SMA 181
- -65,52% 45,74% 65,38% 48% 55,2% 0 70,45% 40,86%
[22] Kalimantan
Timur Pesanten Hidayatullah
Samarinda
cross- sectional
case control
SMP, SMA 110 Yes
- - - - -42,7% 1
- -[23] Kepulauan
Riau Pesantren Madani Unggulan
cross-
sectional SMP, SMA 106 Yes
-26,2% 8,9% 24,6% 8,1% 18,9% 1 41,5% 4,6%
[40] Sulawesi
Tenggara Pesantren Darul Muklisin
cross-
sectional SMP, SMA 71
- - - - - -38% 0
- -[24] Lampung Pesantren
Busnatul Falah
cross-
sectional SD, SMP,
SMA 50
- - - - - -48% 0
- -[25] Lampung Pesantren
Madarijul Ulum
cross-
sectional SMP 35
- -60%
-60%
-60% 0 48,5% 11,4%
[26] Kalimantan
Selatan Pesantren Nurul Musthofa
cross-
sectional
-91
- - - - - -5,5% 0
- -[27] Kalimantan
Selatan Pesantren
Darul Hijrah case
control
-226 Yes Yes
- - - -23,01% 1 45,28% 3,33%
[28] Sumatera
Utara Pesantren Modern Darul
Hikmah
cross-
sectional SMP, SMA 220 Yes Yes 47,86% 24,27% 53,08% 27,33% 36,81% 2 46,95% 25,71%
[29] Sumatera
Utara Pesantren
Darul Falah cross-
sectional SMP 79 Yes
-69,6%
- - -69,6% 1
-69,6%
[30] Riau Pesantren Al-
Ikhwan cross-
sectional SMP 83
- -69,9%
- - -69,9% 0
-69,9%
[31] Riau Pesantren Al-
Kautsar cross-
sectional SMP, SMA 100
- - - - - -18% 0
- -[39] Nusa
Tenggara Barat
Pesantren Nurul Islam
Sekarbela
cross-
sectional SMA 52 Yes
- -21%
- -21% 1
- -[32] Sumatera
Barat Pondok
Pesantren Nurul Yaqin
cross-
sectional
-131 Yes Yes
- - - -24,4% 1
-24,4%
39
[33] Sumatera
Barat Pesantren Dar
El Iman cross-
sectional
-51 Yes
-- - 33,33% 5,55% 13,7% 1 - -
[38] Sumatera
Selatan Pesantren
Khazanah cross-
sectional
-115 Yes Yes - - - - 35,7% 2 - -
[37] Lampung Pesantren Bahrul’ulum Muyassaroh Al
cross-
sectional
-55 Yes Yes - - - - 63,6% 2 - -
[36] Jember, Jawa
Timur Pondok
Pesantren X cross-
sectional SMP, SMA,
College 67 Yes
-- - - - 25,37% 1 - -
[34] Medan, Sumatera
Utara
Pesantren Modern Ta’dib Al
Syarikin
cross-
sectional
-60 Yes Yes - - - - 15% 2 - -
[35] Samarinda, Kalimantan
Timur
Pondok Pesantren Al –
Aziziyah
cross-
sectional SMP, SMA 92
- -- - - - 55,43% 0 - -
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