Exclusive breastfeeding among Indonesian working mothers: does early initiation of breastfeeding matter?

BACKGROUND: Early initiation of breastfeeding (EIBF) is a starting point that lays the foundation for breastfeeding and bonding between mother and baby. Meanwhile, working mothers are one of the vulnerable groups for the success of exclusive breastfeeding (EBF). The study analyzed the role of EIBF on EBF among Indonesian working mothers. METHODS: The cross-sectional study examined secondary data from the 2021 Indonesian National Nutritional Status Survey. The study analyzed 4,003 respondents. We examined EBF practice as an outcome variable and EIBF as an exposure variable. We included nine control variables (residence, maternal age, marital, education, prenatal classes, wealth, infant age, sex, and birth weight). All variables were assessed by questionnaire. The study employed a binary logistic regression test in the last stage. RESULTS: The result showed that the proportion of EBF among working mothers in Indonesia in 2021 was 51.9%. Based on EIBF, Indonesian working mothers with EIBF were 2.053 times more likely than those without to perform EBF (p < 0.001; AOR 2.053; 95% CI 2.028-2.077). Moreover, the study also found control variables related to EBF in Indonesia: residence, maternal age, marital, education, prenatal classes, wealth, infant age, sex, and birth weight. CONCLUSION: The study concluded that EIBF was related to EBF. Indonesian working mothers with EIBF were two times more likely than those without to perform EBF. The government needs to release policies that strengthen the occurrence of EIBF in working mothers to increase EBF coverage.

Soil-transmitted helminth infections and anemia in children attending government run schools on Samosir Island, Indonesia.

Background: Worldwide, >654 million children live in regions where soil-transmitted helminth (STH) infections are endemic. These parasites cause a variety of symptoms, including anemia. Methods: In May 2023, fecal and blood samples were collected from children aged 6 to 11 years attending government run (public) elementary schools in the Simanindo and Ronggur Nihuta sub-districts of Samosir Island, Indonesia where a twice a year mass drug administration (MDA) program is currently in place. A questionnaire was administered to students' parents or adult family members on possible risk factors for STH infections. Qualitative data were collected through in-depth interviews and focus group discussions. Results: In total, 187 and 221 children in Simanindo and Ronggur Nihuta provided samples, respectively. The STH infection prevalence in Simanindo was 4.8% (9/187) and the infection prevalence in Ronggur Nihuta was 5.9% (13/221). In Simanindo, all infections were caused by Trichuris trichiura (n = 9), and in Ronggur Nihuta infections were caused by Ascaris lumbricoides (n = 6), Trichuris trichiura (n = 5), and A. lumbricoides + T. trichiura (n = 2). Three children had anemia but were negative for STH infections. While the results of the parent/adult questionnaires indicated access to a generally safe water supply and septic system, information from the in-depth interviews and focus groups revealed that the local water supply becomes greatly diminished during the dry season. Conclusions: While MDA has been shown to effectively control roundworms and hookworms, additional measures to control trichuriasis are needed. There is also a need for the government to invest in improving the public water supply infrastructure.

The Role of Travel Time on Hospital Utilization in the Islands Area: A Cross-Sectional Study in the Maluku Region, Indonesia, in 2018.

Background: Maluku region is one of the vulnerable areas in Indonesia, and this region has extreme geographical conditions with thousands of islands. The study aims to analyze the role of travel time to a hospital in the Maluku region in Indonesia. Material and Methods: This cross-sectional study analyzed the 2018 Indonesian Basic Health Survey data. The research included 14,625 respondents by stratification and multistage random sampling. The study used hospital utilization as an outcome variable and the travel time to the hospital as an exposure variable. Moreover, the study employed nine control variables: province, residence, age, gender, marital status, education, employment, wealth, and health insurance. The study performed binary logistic regression to interpret the data in the final analysis. Results: The result shows a relationship between travel time and hospital utilization. Someone with a travel time of 30 min or less to the hospital has a 1.792 (95% CI 1.756-1.828) higher probability than those with a travel time of more than 30 min. The results of this analysis find that shorter travel time to the hospital has a better possibility of hospital utilization. In addition, the study also found eight control variables to have a significant relationship with hospital utilization. Conclusion: Shorter travel time to the hospital is more likely to be utilized in the Maluku region.

Hospital utilization among urban poor in Indonesia in 2018: is government-run insurance effective?

BACKGROUND: An urban poor is a vulnerable group that needs government financing support to access health services. Once they are sick, they will fall deeper into poverty. The study aims to analyze the effectiveness of government-run insurance in hospital utilization in urban poor in Indonesia. METHODS: The research analyzed the 2018 Indonesian Basic Health Survey data. This cross-sectional survey collected 75,970 participants through stratification and multistage random sampling. Meanwhile, the study employed hospital utilization as an outcome variable and health insurance ownership as an exposure variable. Moreover, the study looked at age, gender, marital status, education, and occupation as control factors. The research employed a binary logistic regression to evaluate the data in the final step. RESULTS: The results show that someone with government-run insurance is 4.261 times more likely than the uninsured to utilize the hospital (95% CI 4.238-4.285). Someone with private-run insurance is 4.866 times more likely than the uninsured to use the hospital (95% CI 4.802-4.931). Moreover, someone with government-run and private-run insurance has 11.974 times more likely than the uninsured to utilize the hospital (95% CI 11.752-12.200). CONCLUSION: The study concluded that government-run insurance is more effective than the uninsured in improving hospital utilization among the urban poor in Indonesia. Meanwhile, private-run is more effective than government-run and uninsured in improving hospital utilization among the urban poor in Indonesia. Moreover, the most effective is to combine the kind of health insurance ownership (government-run and private-run).

Factors Associated with the Place of Delivery among Urban Poor Societies in Indonesia.

Background: Pregnant women in urban poor societies are vulnerable groups. Due to low financial capacity, there are obstacles to accessing delivery in an institution for poor women in urban areas. The study analyses factors associated with the delivery place among pregnant women in urban poor society in Indonesia. Materials and Methods: The study analyzed secondary data from the 2017 Indonesian Demographic and Health Survey (IDHS). A total of 1,562 samples were childbearing-age women (15-49 years) who gave birth in an urban poor society in Indonesia in the last 5 years. The study examined some variables, such as delivery place, age, education, employment, marital status, parity, insurance, knowledge of pregnancy danger, antenatal care (ANC), the autonomy of health, and family finance autonomy. The study employed binary logistic regression in the final stage. Results: The results show that age is associated with the place of delivery. The higher the education, the higher the possibility for delivery in an institution. Being employed and having partners are protective factors for women in institution delivery. The likelihood of giving birth in a medical facility decreases as more children are born alive. In addition, having health insurance, thorough ANC visits, knowledge of pregnancy danger symptoms, and health autonomy are protective factors for pregnant women having deliveries in medical facilities. On the contrary, pregnant women who rely solely on family financing have a higher chance of delivering in a medical facility. Conclusion: The study concluded that 10 variables were associated with pregnant women's delivery in Indonesia's urban poor society: age, education, employment, marital, parity, insurance, pregnancy danger knowledge, ANC, health autonomy, and family finance autonomy.

The Role of Government-run Insurance in Primary Health Care Utilization: A Cross-Sectional Study in Papua Region, Indonesia, in 2018.

Health development in the Papua region often lags behind other areas of Indonesia. The study aims to analyze the role of government-run insurance in primary health care utilization in the Papua region, Indonesia. The study examined 17,879 Papuan. The study used primary health care utilization as an outcome variable and health insurance ownership as an exposure variable. The study also employed nine control variables: province, residence, age, gender, marital status, education, employment, wealth, and travel time to primary health care. The research employed data using binary logistic regression in the final analysis. The results show that Papuans with government-run insurance were three times more likely to utilize primary health care than uninsured Papuans (AOR 3.081; 95% CI 3.026-3.137). Meanwhile, Papuan with private-run insurance were 0.133 times less likely to utilize primary health care than uninsured Papuans (AOR 0.133; 95% CI 0.109-0.164). Moreover, Papuans who have two types of health insurances (government-run and private-run) were 1.5 times more likely to utilize the primary health care than uninsured Papuan (AOR 1.513; 95% CI 1.393-1.644). The study concluded that government-run insurance increases the chance of primary health care utilization in the Papua region, Indonesia. Government-run insurance has the most prominent role compared to other health insurance categories.

Sub-national disparities in accessing anti-malarial drug treatment in eastern Indonesia.

BACKGROUND: Poor access to health care providers was among the contributing factors to less prompt and ineffective malaria treatment. This limitation could cause severe diseases in remote areas. This study examined the sub-national disparities and predictors in accessing anti-malarial drug treatment among adults in Eastern Indonesia. METHODS: The study analyzed a subset of the 2018 National Basic Health Survey conducted in all 34 provinces in Indonesia. We extracted socio-demographic data of 4655 adult respondents diagnosed with malaria in the past 12 months in five provinces in Eastern Indonesia. The association between socio-demographic factors and the access to anti-malarial drug treatment was assessed using logistic regression. RESULTS: Over 20% of respondents diagnosed with malaria within last 12 months admitted that they did not receive anti-malarial drug treatment (range 12-29.9%). The proportion of untreated cases was 12.0% in East Nusa Tenggara, 29.9% in Maluku, 23.1% in North Maluku, 12.7% in West Papua, and 15.6% in Papua. The likelihood of receiving anti-malarial drug treatment was statistically lower in Maluku (adjusted OR = 0.258; 95% CI 0.161-0.143) and North Maluku (adjusted OR = 0.473; 95% CI 0.266-0.840) than those in Eastern Nusa Tenggara (reference). Urban respondents were less likely to receive malaria treatment than rural (adjusted OR = 0.545; 95% CI 0.431-0.689). CONCLUSIONS: This study found that there were sub-national disparities in accessing anti-malarial drug treatment in Eastern Indonesia, with a high proportion of untreated malaria cases across the areas. Findings from this study could be used as baseline information to improve access to anti-malarial drug treatment and better target malaria intervention in Eastern Indonesia.

Geographical heterogeneity and socio-ecological risk profiles of dengue in Jakarta, Indonesia.

The aim of this study was to assess the role of climate variability on the incidence of dengue fever (DF), an endemic arboviral infection existing in Jakarta, Indonesia. The work carried out included analysis of the spatial distribution of confirmed DF cases from January 2007 to December 2018 characterising the sociodemographical and ecological factors in DF high-risk areas. Spearman's rank correlation was used to examine the relationship between DF incidence and climatic factors. Spatial clustering and hotspots of DF were examined using global Moran's I statistic and the local indicator for spatial association analysis. Classification and regression tree (CART) analysis was performed to compare and identify demographical and socio-ecological characteristics of the identified hotspots and low-risk clusters. The seasonality of DF incidence was correlated with precipitation (r=0.254, P<0.01), humidity (r=0.340, P<0.01), dipole mode index (r= -0.459, P<0.01) and Tmin (r= -0.181, P<0.05). DF incidence was spatially clustered at the village level (I=0.294, P<0.001) and 22 hotspots were identified with a concentration in the central and eastern parts of Jakarta. CART analysis showed that age and occupation were the most important factors explaining DF clustering. Areaspecific and population-targeted interventions are needed to improve the situation among those living in the identified DF high-risk areas in Jakarta.

Variation of preventive practices and its association with malaria infection in eastern Indonesia: Findings from community-based survey.

BACKGROUND: Geographical variation may likely influence the effectiveness of prevention efforts for malaria across Indonesia, in addition to factors at the individual level, household level, and contextual factors. This study aimed to describe preventive practices at individual and a household levels applied by rural communities in five provinces in eastern Indonesia and its association with the incidence of malaria among adult (≥15 years) populations. METHODS: This study analyzed a subset of data of nationally representative community-based survey 2018 Riset Kesehatan Dasar (Riskesdas). Data for socio-demographic (age, gender, education and occupation) and preventive behaviors (use of mosquito bed nets while slept, insecticide-treated mosquito nets (ITNs), mosquito repellent, mosquito electric rackets, mosquito coil/electric anti-mosquito mats, and mosquito window screen) were collected. Data were analyzed using bivariate and multivariable logistic regression model. RESULTS: Total of 56,159 respondents (n = 23,070 households) living in rural areas in Maluku (n = 8044), North Maluku (n = 7356), East Nusa Tenggara (n = 23,254), West Papua (n = 5759) and Papua (n = 11,746) were included in the study. In the multivariable models, using a bed net while slept likely reduced the odds of self-reported malaria among Maluku participants. Reduced odds ratios of self-reported malaria were identified in those participants who used ITNs (North Maluku, ENT, Papua), repellent (Maluku, West Papua, Papua), anti-mosquito racket (ENT), coil (Maluku, North Maluku, Papua) and window screen (West Papua, Papua). CONCLUSION: Our study concluded that the protective effects of preventive practices were varied among localities, suggesting the need for specific intervention programs.

Paediatric dengue infection in Cirebon, Indonesia: a temporal and spatial analysis of notified dengue incidence to inform surveillance.

BACKGROUND: The recent situation of dengue infection in Cirebon district is concerning due to an upsurge trend since the year 2010. The largest dengue outbreak was reported in 2016 which has affected more than 1600 children. A study was conducted to explore the temporal variability of dengue outbreak in Cirebon's child population in during 2011-2017, and to assess the short-term effects of climatic and environmental factor on dengue incidence. In addition, the spatial pattern of dengue incidence in children and high-risk villages were investigated. METHODS: A total of 4597 confirmed dengue cases in children notified from January 2011 to December 2017 were analysed. Seasonal decomposition analysis was carried out to examine the annual seasonality. A generalized linear model (GLM) was applied to assess the short-term effect of climate and normalized difference vegetation index (NDVI) on dengue incidence. The incidence rate ratio (IRR) of the final model was reported. Spatial analyses were conducted by using Moran's I and local indicator of spatial association (LISA) analyses to explore geographical clustering in incidence and to identify high-risk villages for dengue, respectively. RESULTS: An annual dengue epidemic period was observed with peaks occurring every January/February. Based on the GLM, temperature at a lag 4 months (IRR = 1.27; 95% confidence interval, 95% CI: 1.22-1.31, P < 0.001), rainfall at a lag 2 months (IRR = 0.99, 95% CI: 0.99-0.99, P < 0.001), humidity at lag 0 month (IRR = 1.05, 95% CI: 1.04-1.06, P < 0.001) and NDVI at a lag 1 month (IRR = 3.07, 95% CI: 1.94-4.86, P < 0.001) were associated with dengue incidence in children. The dengue incidence in children was spatially varied and clustered at the village level across Cirebon. During 2011-2017, a total of 38 high-risk villages for dengue were identified, which were mainly located in the northern part of Cirebon. CONCLUSIONS: Seasonal patterns of dengue incidence in children in Cirebon were strongly associated with rainfall, temperature, humidity and NDVI variability, suggesting that climatic and environmental data could be used to help predict dengue outbreaks. Our spatial analysis revealed a clustered pattern in dengue incidence and high-risk villages for dengue across Cirebon, suggesting that effective interventions such as vector surveillance and school-based campaigns should be prioritized around the identified high-risk villages. Temporal and spatial analytical tools could be utilized to support local health authorities to apply timely and targeted public health interventions and help better planning and decision-making in order to minimize the impact of dengue outbreaks.

Individual and contextual factors predicting self-reported malaria among adults in eastern Indonesia: findings from Indonesian community-based survey.

BACKGROUND: Malaria is still an important parasitic infectious disease that affecting poor and vulnerable communities in many developing countries, including Indonesia. During the period of 2010-2017, there have been approximately 2.2 million confirmed malaria cases reported across Indonesia. This study aimed to identify individual, household and village-level factors associated with self-reported malaria among adults more than 15 years of age in Maluku, West Papua and Papua province. METHODS: This study analysed a subset of the data from nationally representative population-based Indonesian National Basic Health Research (Riset Kesehatan Dasar) (N = 1,027,763 in 294,959 households in 33 provinces) in 2013. Total of 41,079 individuals (20,326 males and 20,753 females) aged ≥ 15 years in 19,269 households in Maluku, West Papua and Papua provinces were included. Participants were interviewed if they ever had been diagnosed and laboratory confirmed of having malaria by physician in the past 12 months. A mixed effects multilevel logistic regression models were developed to assess the associations between socio-demographical variables at individual, household and village level and self-reported malaria. RESULTS: Individuals aged ≥ 15 years in 701 villages in Maluku (n = 11,919), West Papua (n = 8003) and Papua (n = 21,157) were analysed. In all provinces, gender distribution was equally-represented. The prevalence of self-reported malaria was 4.1% (Maluku), 12.4% (West Papua) and 18.8% (Papua). At the individual level, primary industry workers (OR 1.29, 95% CI 1.15-1.46 [Maluku]; OR 1.17, 95% CI 1.09-1.25 [Papua]) and having higher education were associated with self-reporting malaria (OR 0.67, 95% CI 0.53-0.83 [Maluku]; OR 1.27, 95% CI 1.15-1.40 [Papua]). Household level factors include having bed net and better off wealth index were associated with increased self-reporting malaria among West Papua (OR 1.21; 95% CI 1.09-1.34 and OR 1.38; 95% CI 1.17-1.65, respectively) and Papuan (OR 1.12; 95% CI 1.02-1.23 and OR 1.33; 95% CI 1.11-1.57, respectively) adults. Increased odds of self-reporting malaria was associated with time required to reach healthcare facility (OR 1.30, 95% CI 1.01-1.67 [Maluku]). Contextual village-level characteristics such as living in rural (OR 1.31, 95% CI 1.12-1.54 [Maluku]; OR 1.56, 95% CI 1.17-2.07 [West Papua]), higher community education level (OR 1.28, 95% CI 1.02-1.63 [West Papua]; OR 1.45, 95% CI 1.23-1.72 [Papua]), higher community bed net ownerships (OR 0.59 95% CI 0.45-0.77 [West Papua]) were associated with self-reported malaria. CONCLUSIONS: Factors associated with self-reported malaria were varied between provinces suggesting locally-specific determinants were exist at individual, household and community-level. This study highlights the need for specific interventions by taking into consideration the contextual factors within the region and involving multi-sectoral collaboration between health authorities and related stakeholders (e.g., bureau of education, bureau of public works and infrastructure) to improve designs in planning and intervention strategies to succesfully eliminate malaria in Maluku and Papua.