Identifying risk factors of incomplete immunization among children is crucial to developing relevant policies to improve immunization coverage. In this study, we investigated factors associated with incomplete immunization among children in Indonesia and elucidated differences in risk factors between urban and rural areas. The data came from a national-wide survey, the 2017 Indonesia Demographic Health Surveys. In total, 3264 children aged 12-23 months were included in the study. An incomplete immunization status was defined as a child who did not complete the ten doses of basic vaccinations, consisting of one dose of bacille Calmette-Guérin, one dose of hepatitis B, three doses of pentavalent vaccine (diphtheria, pertussis, tetanus, hemophilus influenza type B, and hepatitis B vaccine), four doses of polio vaccine, and one dose of measles vaccine. Generalized linear mixed models were constructed to examine the effects of different levels of risk factors on the incomplete immunization status. We further conducted stratified analyses by urban and rural areas. About 40% of the 3264 children were incompletely immunized, among whom 45.3% were in urban areas and 54.7% were in rural areas. Eight of the 34 provinces had incomplete immunization rates exceeding 50%, and the Papua and Maluku regions had the highest rates of incomplete child immunization. The multivariate analyses showed that when women attended fewer than four antenatal care sessions and resided outside the Nusa Tenggara region, their children were more likely to have incomplete immunization in both urban and rural areas. On the other hand, having no health insurance was positively associated with incomplete immunization in urban areas, whereas having received a tetanus vaccination during pregnancy was negatively associated with incomplete immunization in rural areas. Results of this study suggest that tailored interventions should be developed to address significant risk factors in rural and urban areas.

Obesity is one of the factors associated with cognitive impairment. However, obesity may differently affect cognitive function in different age groups, and scarce data are available from low- and middle-income countries. This cross-sectional study aimed to identify the association between obesity and cognitive impairment among 143 elderly individuals in Yogyakarta. We recorded the sociodemographic factors and some comorbidities, also measured the body mass index as a parameter of obesity, cognitive function using Montreal Cognitive Assessment—Indonesia, mood condition and depression status using geriatric depression scale-short form, as well as the daily life function using Activity of Daily Living and Instrumental Activity of Daily Living. After adjustment for the sociodemographic and comorbidities, we found that subjects with older age were more likely to have cognitive impairment (odds ratio [OR] 3.544, 95%CI: 1.36–9.22, p < 0.01) and compared with elderly individuals with normal weight, obese elderly individuals were 40% less likely to have cognitive impairment (OR 0.604, 95%CI: 0.39–0.95, p < 0.05). This study suggests that obesity in elderly individuals is less frequently associated with cognitive impairment. These findings support the reverse causation mechanism related to body mass index (BMI) and cognitive impairment in low/middle-income countries.

Background: Global COVID-19 outbreaks in early 2020 have burdened health workers, among them surveillance workers who have the responsibility to undertake routine disease surveillance activities. The aim of this study was to describe the quality of the implementation of Indonesia’s Early Warning and Response Alert System (EWARS) for disease surveillance and to measure the burden of disease surveillance reporting quality before and during the COVID-19 epidemic in Indonesia. Methods: A mixed-method approach was used. A total of 38 informants from regional health offices participated in Focus Group Discussion (FGD) and In-Depth Interview (IDI) for informants from Ministry of Health. The FGD and IDI were conducted using online video communication. Yearly completeness and timeliness of reporting of 34 provinces were collected from the application. Qualitative data were analyzed thematically, and quantitative data were analyzed descriptively. Results: Major implementation gaps were found in poorly distributed human resources and regional infrastructure inequity. National reporting from 2017–2019 showed an increasing trend of completeness (55%, 64%, and 75%, respectively) and timeliness (55%, 64%, and 75%, respectively). However, the quality of the reporting dropped to 53% and 34% in 2020 concomitant with the SARS-CoV2 epidemic. Conclusions: Report completeness and timeliness are likely related to regional infrastructure inequity and the COVID-19 epidemic. It is recommended to increase report capacities with an automatic EWARS application linked systems in hospitals and laboratories.

This study attempted to examine individual- and community-level factors that contribute to pregnancy-related health behaviors among Indonesian women. This study used representative nationwide survey samples from the Indonesian Demographic Health Survey in the years 2007 (N = 15 193), 2012 (N = 14 431), and 2017 (N = 14 797). Generalized linear mixed models were constructed in the multivariate analyses. We found that women’s educational level, household wealth index, insurance status, access to health facilities, geographic location, general health condition, and pregnancy intentions were significantly associated with different outcome behaviors. Regarding community-level influences, women who lived in communities with a high proportion of educated women and high household wealth were more likely to have skilled birth attendance during childbirth compared with their counterparts in 2007. The similar pattern of results was also found in 2012 and 2017. The findings of this study suggest that future policies should focus on both individual- and community-level factors to improve women’s pregnancy-related behaviors.

Background: Public health emergencies require integration between multiple stakeholders in different sectors to monitor the situation and carry out an appropriate response. As a country with a large land area consisting of thousands of islands, Indonesia’s centralized Public Health Emergency Operation Center (PHEOC) system is currently unable to effectively contain diseases. A PHEOC system reform is required to accommodate Indonesia’s circumstances, particularly at the regional level. We have outlined potential models at the sub-national level for PHEOC based on existing evidence.Policy Options and Recommendations: Based on existing evidence of PHEOC models internationally, we have formulated three policy models for regional-level PHEOC. These models (the ad hoc agency model, the independent agency model, and the Province Health Office (PHO)-based model) entail different chains of command, and each has its own benefits.Conclusion: We recommend that the Ministry of Health in Indonesia adopt the third PHEOC policy model, in which the chain of command lies under the PHO. This is the most practical approach, as the PHO has the authority to mobilize units and access resources in response to imminent public health emergencies. Further training and capacity-building are required to support the PHO as the commander of the regional PHEOC.

Background: Global COVID-19 outbreaks in early 2020 have burdened health workers, among them surveillance workers who have the responsibility to undertake routine disease surveillance activities. The aim of this study was to describe the quality of the implementation of Indonesia’s Early...