Background: Globally, in 2020, 45 million children were estimated to be wasted, and 149 million children under five years of age were estimated to be stunted. Undernutrition makes children in particular much more vulnerable to disease and death. Our study aims to examine geographic and socioeconomic disparities in child undernutrition across 514 districts in Indonesia. Methods: Employing both geospatial and quantitative analyses (descriptive statistics and Ordinary Least Squares regressions), we analyzed the disparities in the prevalence of underweight, severe underweight, wasting, severe wasting, stunting, and severe stunting among districts. Child undernutrition data were from Indonesia Basic Health Survey (Riskesdas) 2018, which included a sample of 93,620 children under five years. Socioeconomic data were from the World Bank. Results: We found a relatively large geographic and socioeconomic disparity in child undernutrition in Indonesia. By region, districts in the Papua region (including Maluku and Nusa Tenggara) had a significantly higher prevalence of underweight and wasting than those in the Java region (including Bali). Districts in Papua had 44%, 121%, 38%, and 57% higher prevalence of underweight, severe underweight, wasting, and severe wasting, respectively. Similarly, the poorest districts had a significantly higher prevalence of underweight, wasting, and stunting than the wealthiest districts. The poorest districts had 30%, 83%, 16%, 21%, and 74% higher prevalence of underweight, severe underweight, wasting, stunting, and severe stunting, respectively. These results were similar among rural districts. Conclusion: There is a significant disparity in child undernutrition across districts in Indonesia. The government needs to prioritize the reduction of child undernutrition, especially in rural areas, districts outside of Java and Bali, and the poorest and least educated areas.

Background: Accessing immediate health care during pregnancy is key to preventing and treating pregnancy-related complications, which are the leading cause of maternal morbidity and mortality. As the largest archipelago country in the world, Indonesia faces the challenges of disparity in access to healthcare services across geographical regions and socioeconomic groups. Objective: This study aims to assess the relationship between perceived barriers to accessing health care and the risk of pregnancy-related complications among women of reproductive age in Indonesia. Methods: Data from a nationally representative sample of 15,021 last births within 5 years preceding the 2017 Indonesia Demographic and Health Survey were analyzed to examine barriers in accessing health care and the risk of having complications during pregnancy. The statistical model of logistic regression was used to investigate the effect of barriers on the risk of pregnancy complications, and results were presented as odds ratios (ORs) with 95% confidence intervals (CIs). Results: The majority of women in Sumatra and Maluku–Papua regions encountered physical, cultural, and financial barriers to accessing health care. The results indicate significantly higher odds of having complications in mothers who had distance barriers (OR: 1.46, 95% CI: 1.20– 1.77), relative to mothers who reported no barriers, after adjusting for women’s characteristics. Conclusion: The findings suggest that it is necessary to tackle specific physical barriers by providing more developed health-care systems in rural and geographically isolated areas, to bring health services closer to home.

Octavia L, et al. Pediatr Gastroenterol Hepatol Nutr. 2022 Jul;25(4):347-350. https://doi.org/10.5223/pghn.2022.25.4.347

Excessive alcohol consumption increases the risk of non-communicable diseases. This study aimed to analyze the risk factors for alcohol consumption in Indonesia and present a cluster mapping based on the risk factors. The sample of this study was individuals aged 15 years and over who participated in the Indonesia Basic Health Survey 2018, while pregnancy was the exclusion criterion. The sample size for univariate was 542,682 individuals and 539,905 individuals in the multivariate analysis conducted using logistic regression. The prevalence of alcohol consumption was 3.7 percent. The risk factors for drinking alcohol included work as a farmer/fisherman/laborer or other manual occupations (aOR = 1.10; 95% CI 1.04-1.17), smoking (aOR = 4.93; 95% CI 4.62- 5.25), experiencing common-mental disorders (CMD) (aOR = 2.13; 95% CI 1.99-2.28), centrally obese (aOR = 1.21; 95% CI 1.13-1.3) and being overweight/obese (aOR = 1.07; 95% CI 1.01-1.13). On the other hand, the factors that showed a reduced risk of alcohol consumption were being the head of household (aOR = 0.79; 95% CI 0.74-0.85), low education level (aOR = 0.75; 95% CI 0.68-0.83), not working (aOR = 0.74; 95% CI 0.68-0.80), low socioeconomic status (aOR = 0.82; 95% CI 0.75-0.90), and being married (aOR = 0.56; 95% 0.52-0.61) or divorced (aOR = 0.60; 95% CI 0.53-0.67). Type of work as manual workers, smoking, experiencing CMD, being obese centrally, and overweight or generally obese are the main risk factors for alcohol consumption. Specific interventions are needed based on the risk factor cluster of alcohol drinkers

Background: Malnutrition is common among children under 5 years of age in Indonesia, with the rates varying between urban and rural areas. The minimum acceptable diet (MAD) assesses nutrient quality and quantity. This study aimed to identify the potential variables for MAD in 6–23-month-old children in both urban and rural Indonesia.Methods: We used the data from the 2017 Indonesia Demographic and Health Survey to conduct this nationally representative study. A total of 4,688 children aged 6–23 months were included in the study. MAD was classified using the 2017 World Health Organization global nutrition monitoring framework. The determinants of MAD were analyzed using multiple logistic regression.Results: Overall, 45% of children aged 6–23 months received the required MAD, with 47.4% receiving the MAD in urban areas and 35.7% in rural areas. Children’s age, fathers’ age, parents’ education level, mothers’ employment, and wealth index were strongly linked to MAD in both rural and urban homes. The factor specifically related to MAD in urban areas was mother living with her husband. For rural households, mothers’ involvement in decisionmaking and a minimum of four antenatal care (ANC) visits significantly increased the likelihood of their children’s MAD status.Conclusion: MAD status was determined by increased child age, higher parent education, younger father, working mother, and higher wealth index in children aged 6–23 months in both urban and rural settings. Mothers living with a spouse determined the MAD status only in urban areas. More frequent ANC visits and mother participation in household decisions were other factors related to MAD status in rural areas.

This study aims to assess hemoglobin (Hb) level difference according to characteristics and wheat flour consumption frequency among Indonesian aged ≥10. This study used national health survey (Riskesdas) 2013 data, involving 42,705 subjects in the analysis. Hb level was the dependent variable and the independent variables included sample characteristics and wheat flour consumption frequency. An independent t-test was used to examine the difference between two categories of variables and one-way analysis of variance for variables ≥3 categories. There were significant differences in Hb level within groups according to gender, age, education, working status, residence, region, wealth index quintile, and wheat flour consumption frequency. Hb level was significantly higher among subjects with consumption of ≥3 times/week (13,435 g/dL) than consumption of 3 times/month or never (13,357 g/dL). By having sex stratification, the highest Hb level was significantly found among those who consumed wheat flour ≥3 times/week, both in women (12,701 g/dL) and men (14,115 g/dL). There was no difference in Hb level according to wheat flour frequency consumption after stratifying the place of residence. By having wealth index quintile stratification, the significant difference was only found among subjects in quintile 2, it showed that Hb level was higher among subjects who consumed wheat flour 1-2 times/week (13,458 g/dL) than 3 times/month or never (13,299 g/dL). Hb level was lower among a group of female, younger age, lower education, unemployed, living in a rural area, living in the eastern region, quintile 1, and wheat flour consumption 3 times/month or never. Maintaining sustainable Fe fortification in wheat flour is important to reduce anemia.Keywords: anemia, iron fortification, wheat flour consumption ABSTRAK Studi ini bertujuan untuk mengetahui perbedaan kadar hemoglobin (Hb) darah menurut karakteristik dan konsumsi tepung terigu penduduk ≥10 tahun. Studi ini menggunakan data survei kesehatan nasional (Riskesdas) 2013, dengan total sampel yang dianalisis dalam studi ini yaitu 42.705. Kadar Hb darah adalah variabel dependen dan variabel independen meliputi karakteristik dan frekuensi konsumsi tepung terigu sampel. Uji independent t-test digunakan untuk melihat perbedaan variabel dengan dua kategori dan uji one-way analysis of variance untuk variabel ≥3 kategori. Terdapat perbedaan kadar Hb darah yang signifikan antar kelompok menurut jenis kelamin, umur, pendidikan, status bekerja, tempat tinggal, region, kuintil indeks kepemilikan, dan frekuensi konsumsi tepung terigu. Penduduk yang mengonsumsi tepung terigu ≥3 kali/minggu (13,435 g/dL) secara signifikan memiliki kadar Hb darah lebih tinggi dibandingkan konsumsi 3 kali/bulan atau tidak pernah (13,357 g/dL). Setelah distratifikasi jenis kelamin, kadar Hb darah tertinggi secara signifikan pada penduduk dengan konsumsi tepung terigu ≥3 kali/minggu baik pada perempuan (12,701 g/dL) maupun laki-laki (14,115 g/dL). Tidak terdapat perbedaan kadar Hb darah menurut frekuensi konsumsi tepung terigu setelah distratifikasi tempat tinggal. Setelah distratifikasi kuintil indeks kepemilikan, perbedaan signifikan hanya terlihat pada penduduk di kuintil 2, yaitu kadar Hb darah lebih tinggi pada frekuensi konsumsi tepung terigu 1-2 kali/minggu (13,458 g/dL) dibandingkan konsumsi 3 kali/bulan atau tidak pernah (13,299 g/dL). Kadar Hb darah lebih rendah pada penduduk perempuan, umur lebih muda, pendidikan rendah, tidak bekerja, tinggal di pedesaan, tinggal di region Maluku Papua, dan mengonsumsi tepung terigu 3 kali per bulan/tidak pernah. Mempertahankan keberlanjutan fortifikasi Fe pada terigu berpotensi penting dalam menurunkan anemia.Kata kunci: anemia, fortifikasi Fe, konsumsi tepung terigu