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Background There are both genetic and environmental factors which contribute to a child’s chances of being obese. When low birth weight (LBW) has been specifically evaluated relative to its association with childhood obesity, the results have produced conflicting findings. This study aims to describe the relationship between birth weight and childhood obesity and investigate the influence that residence and household wealth has on this relationship. Methods I performed a secondary analysis on the 2013 Riskesdas (or Basic Health Research), a cross-sectional, nationally representative survey of the Indonesian population. Height, weight, information regarding child’s birth weight, and basic characteristics of the study population were collected from parents with children aged 0 to 5 years (n = 63,237) in 2013. The exposure was child’s birth weight and the outcomes were child’s current weight, BMI z-score, and obesity. Data were analyzed by using multiple linear regression and multiple logistic regression. Results I found a significant increase in the weight, BMI z-score, and risk of childhood obesity to be associated with LBW. LBW children in rural area were associated with higher BMI z-score (mean ± standard error: 1.44 ± 0.02) and higher odds (odds ratio (95% confidence interval): 7.46 (6.77–8.23)) of obesity than those in urban area. LBW children from low class families were associated with higher BMI z-score (1.79 ± 0.04) and had higher odds (14.79 (12.47–17.54)) of obesity than those from middle class and wealthy families. Conclusions Effective prevention and intervention to childhood obesity as early as possible are imperative. As far as this study was concerned, efforts, policies, and targets are required to reduce the prevalence of LBW. Children born of LBW, who live in a rural area and from low income families, should be emphatically intervened as early as possible.

Background Although child malnutrition has been reducing, the coexistence in mothers and children of various forms of malnutrition has continued to rise around the world. In the Indonesian context, a knowledge gap exists on the coexistence of multiple malnutrition burdens. This study examines trends in the coexistence of the triple burden of malnutrition (TBM) among mother–child pairs living in the same house and explores multilevel (individual, household, and community) factors associated with TBM in Indonesia. Methods We used data from the 2013 and 2018 Indonesia Basic Health Research, the nationally representative survey of the Indonesian population, as repeated cross-sectional surveys. Study samples were mothers and children (0–59 months old), who resided in the same household and indicated by the same identifier number. The anthropometric measurements of the mothers and children, and the hemoglobin levels of the children were collected. We employed a multilevel mixed-effects model to consider the hierarchical data structure. The model captured the role of cluster, district, provincial differences, and the individual, household, community-level, and TBM status characteristics. Results Of 3,891 mother–child pairs analyzed, 24.9% experienced TBM. Girls had 63% higher odds than boys of TBM (aOR: 1.63; 95% CI: 1.30 to 2.03). Significantly lower odds were found in children of mothers who had a gestational age lower than 37 weeks (aOR: 0.72; 95% CI: 0.55 to 0.94). At the household level, children with a father who had a high-school, primary-school, or no school education had significantly higher odds of TBM than children of fathers who had graduated from academy. Children of mothers who visited Antenatal Care (ANC) no more than 6 times had significantly lower odds (aOR: 0.65; 95% CI: 0.47 to 0.88). Children of mothers who consumed Iron and Folic Acid (IFA) supplements had significantly lower odds. Conclusion TBM is related to characteristics at not just the individual level but also the family and community levels. To achieve significant outcomes, integrated nutrition interventions in Indonesia should also consider family and community factors.

ObjectivesThe continuing rise of smoking behaviours will inevitably lead to a further increase in hypertension prevalence. However, limited research has examined the impacts of changes in smoking status on blood pressure (BP). We sought to assess correlations between increases or decreases of males’ and females’ cigarette consumption on systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure (PP), and to investigate the relationship between smoking status changes and changes in BP through a 15-year examination period.DesignRetrospective, cohort study.SettingWe used nationally representative secondary data collected in the years 2000, 2007 and 2015 by the Indonesia Family Life Survey.ParticipantsWe measured the smoking habits, BP indices and other socioeconomic factors documented in the multiple follow-up surveys of a sample of 10 338 respondents.Primary and secondary outcome measuresThe primary outcome was the means of SBP, DBP and PP. The secondary outcome was the changes from baseline in SBP and DBP.ResultsSmoking caused different effects on male and female smokers. Female smokers who increased their daily cigarette consumption had significantly higher SBP and PP (p<0.001). During 15 years of follow-up, male and female smokers who decided to quit had the largest change of SBP (adjusted mean=16.64 mm Hg, SE=21.39 and adjusted mean=24.78 mm Hg, SE=23.25, respectively), whereas new male and female smokers exhibited the highest change of DBP (adjusted mean=2.86 mm Hg, SE=11.50 and adjusted mean=7.54 mm Hg, SE=14.39, respectively).ConclusionsOur study confirmed the adverse effects of smoking on BP, which can be used to inform efforts to tackle the growing cigarette epidemic and its negative effects on hypertension among former and new smokers and develop evidence-based tobacco control policies in Indonesia.

Background Parental smoking during pregnancy is associated with lower birthweight and gestational age, as well as with the risks of low birthweight (LBW) and preterm birth. The present study aims to assess the association of parental smoking during pregnancy with birth outcomes in urban and rural areas. Methods This was a secondary analysis of data collected in the Indonesia Family Life Survey, between 1993 and 2007, the first national prospective longitudinal cohort study in Indonesia. Retrospective data of parental smoking habits, socioeconomic status, pregnancy history and birth outcomes were collected from parents with children aged 0 to 5 years (n = 3789). We assessed the relationships between the amount of parental smoking during pregnancy with birthweight (LBW) and with gestational age (preterm birth). Results We found a significant reduction in birthweight to be associated with maternal smoking. Smoking (except for paternal smoking) was associated with a decrease in the gestational age and an increased risk of preterm birth. Different associations were found in urban area, infants born to smoking fathers and both smoking parents (>20 cigarettes/day for both cases) had a significant reduction in birthweight and gestational age as well as an increased risk of LBW and preterm birth. Conclusions Residence was found to be an effect modifier of the relation between parental smoking during pregnancy, amount of parental smoking, and birth outcomes on their children. Smoking cessation/reduction and smoking intervention program should be advised and prioritized to the area that is more prone to the adverse birth outcomes.

Smoking remains the main cause of preventable early death. However, little is known about the association between parental smoking and child mortality in under-fives in developing countries. This study assesses the association between parental smoking status, smoking amount and smoking frequency with child mortality in under-fives in four Southeast Asian countries (Cambodia, Indonesia, Lao People’s Democratic Republic and Timor Leste). We used the Demographic and Health Survey dataset. The information from couples consisting of fathers and mothers (n = 19,301 couples) in the same household were collected. Under-five child mortality was significantly associated with paternal smoking only (odds ratio (OR) = 1.25, 95% confidence interval (CI): 1.14–1.38), maternal smoking only (OR = 2.40, 95% CI: 1.61–3.59) and both parents smoking (OR = 2.60, 2.08–3.26). Paternal, maternal, both parents’ smoking amount and frequency were also assessed. The estimated association decreased after adjusting for covariates but remained highly significant for smoking in both parents, mothers who smoked 1–10 cigarettes/day, when both parents smoked > 20 cigarettes/day, and in mothers who smoked every day. Future behavioural changes and smoking cessation programmes should engage parents as a catalyst for the reduction of child mortality risk in LMICs in the SEA region.

Background Non-communicable diseases (NCDs), notably cardiovascular disease and type 2 diabetes mellitus, are largely driven by metabolic syndrome (MetS), a cluster of critical risk factors. Despite extensive research, the progression of MetS, especially in Indonesia, has received limited attention. This research tracks adult MetS risk dynamics in a populous Bogor District cohort, providing crucial insights into its evolving nature. Methods This prospective open cohort study analysed secondary data from the Special Research - Cohort Study of Non-Communicable Diseases by the Ministry of Health, Republic of Indonesia from 2011 to 2018. The final sample was 1,376 Indonesian adult participants, all residents of Bogor District. MetS outcome, dietary assessment, physical activity, and biomarkers were analysed every two consecutive years. Results The risk of overweight and obese participants developing MetS was 2.4 and 4.4 times higher, respectively (95% CI: 1.176–3.320 and 3.345–5.740) than those with body mass index (BMI) in the normal range. Participants who reported less intentional physical exercise had a MetS risk 1.5 times higher (95% CI: 1.034–2.109) than those with more intentional physical exercise. The role of diet is also significant, evidenced by a 30% reduction in MetS risk for people with fat intakes in the 2nd quartile compared to the 1st quartile (95% CI: 0.505–0.972). Meanwhile, a carbohydrate intake in the 2nd quartile increased the risk of MetS 1.5 times (95% CI: 1.063–2.241) in comparison with the 1st quartile. Conclusions Notably, participants with underweight BMI exhibited the highest cumulative survival of MetS, while those with obese BMI recorded the lowest cumulative survival. There is an urgent need for strategic interventions to enhance the existing early detection and NCD monitoring program. This involves a targeted focus on promoting a community-based healthy lifestyle in the Bogor District. The study emphasizes the importance of tailored public health measures to address specific risk factors identified in the local context, aiming to mitigate the prevalence and impact of MetS in the population.

Hospitals pose a high level of hazard and risks, particularly ones related to occupational health, whose overarching objective is to ensure both healthy workers and a healthy workplace, which can be achieved through effective risk management. This research aims to develop an assessment instrument tailored to hospital occupational safety and health units and their stakeholders across Indonesia to assess hospitals’ efforts to protect workers, with a focus on occupational health services programmes based on identified hazards. It is a qualitative exploratory study. Data collection was made through an in-depth literature review to identify occupational health risk factors in hospitals, focusing primarily on studies involving health risk assessment and/or reports of occupational disease or suspected cases of diseases. This was supported by in-depth interviews and field observations in three hospitals: a government hospital, a private hospital and a teaching hospital. The identified risk factors contributing to hospital workers’ mortality and morbidity were then analysed and formed into measurable indicators. These indicators serve as the basis for developing an instrument prototype to semi quantitatively assess the implementation of occupational health services in the hospitals. The prototype was developed by adapting and modifying the Hospital Safety and Health Management System Self-Assessment Questionnaire from OSHA and then subjected to validation through a 2-day FGD involving experts, practitioners, professional organisations, and other authorities in similar fields of study. The instrument consists of seven main sections; 53 statements with a maximum total score of 159; in addition to guidance. In conclusion, the instrument is a strategic tool that can be used by hospitals to improve the effectiveness of occupational health service implementation in a sustainable manner. Regulatory support, management commitment, and involvement of all elements in a hospital are the keys to realising a healthy, safe, productive workplace for the whole hospital community.

Internal barriers in the procurement process and pharmaceutical supply planning are barriers that can be controlled through interventions. The research focuses on proposing changes to the pharmaceutical supply management system, particularly in the aspects of planning and procurement within the internal team of the RSPG Cisarua Bogor. The intervention in this research applying lean six sigma extends only up to the “improve” phase. Data collection involves in-depth interviews with informants involved in the pharmaceutical supply planning and procurement process, as well as observation and document analysis. The research ends in group discussions to reach an agreement. The research findings reveal that a lack of established procedures in the pharmaceutical supply procurement process contributes to prolonged procedures and the absence of efficiency benchmarks within the system. Moreover, an unavailability of tools to facilitate the pharmaceutical supply procurement process causes low internal team communication. The “improve” phase of lean six sigma leads to proposed changes to the standards of operational procedures for routine pharmaceutical procurement, indicator applications of procurement efficiency and the utilization of the ABC VEN functioning as a tool within the pharmaceutical supply procurement process. The proposed improvement to tackle the matter includes the utilization of ABC VEN and efficiency indicators to overcome waste overproduction identified during the pharmaceutical supply planning process. In addition, it also involves the establishment of a new standard of operating procedure covering timelines, tools for pharmaceutical supply categorization based on ABC VEN and procurement efficiency indicator to handle waste waiting during the pharmaceutical supply procurement process.

AimThe influence of parental smoking on overweight condition of children in Indonesia is poorly understood. We assessed the association between parental smoking and child being overweight (including obesity) in urban and rural areas.Subject and methodsWe performed a secondary analysis on the 2013 Riskesdas (or Basic Health Research), a cross-sectional, nationally representative survey of the Indonesian population. Height, weight, information regarding parental smoking, and basic characteristics of the study population were collected from parents with children aged 0 to 5 years (n = 63,237) in 2013.ResultsUsing logistic regression model adjusted for covariates, the odds ratios for smoking fathers, smoking mothers, and both parents smoking showed an association with a risk of overweight in their children. From the stratified analyses, children of smoking fathers, smoking mothers, and both parents smoking in urban areas (odds ratio (OR) (95% confidence interval (CI)): 1.28 (1.17–1.40), 20.30 (8.93–46.16), 2.40 (1.71–3.37), respectively) were associated with higher odds of overweight than those in rural areas.ConclusionResidence was found to be an effect modifier of the relationship between parental smoking and child being overweight. Smoking cessation/intervention program ought to be put in place for adults and prioritized to areas with increased likelihood of children being overweight.

ObjectiveWHO recommends that every pregnant woman and newborn receive quality care throughout the pregnancy, delivery and postnatal periods. However, Maternal Mortality Ratio in Indonesia for 2015 reached 305 per 100 000 live births, which exceeds the target of Sustainable Development Goals (<70 per 100 000 live births). Receiving at least four times antenatal care (ANC4+) and skilled birth attendant (SBA) during childbirth is crucial for preventing maternal and neonatal deaths. The study aims to assess the determinants of ANC4 +and SBA independently, evaluate the distribution of utilisation of ANC4 + and SBA services, and further investigate the associations of two levels of continuity of services utilisation in IndonesiaDesignData from the Indonesia Demographic and Health Survey, a cross-sectional and large-scale national survey conducted in 2017 were used.SettingThis study was set in Indonesia.ParticipantsThe study involved ever-married women of reproductive age (15–49 years) and had given birth in the last 5 years prior to the survey (n=15 288). The dependent variables are the use of ANC4 + and SBA. Individual, family and community factors, such as age, age at first birth, level of education, employment status, parity, autonomy in healthcare decision-making, level of education, employment status of spouses, household income, mass media consumption residence and distance from health facilities were also measured.ResultsResults showed that 11 632 (76.1%) women received ANC4 + and SBA during childbirth. Multivariate analysis revealed that age, age at first birth, and parity have a statistically significant association with continuity of services utilisation. The odds of using continuity of services were higher among women older than 34 years (adjusted OR (aOR) 1.54; 95% CI 1.31 to 1.80) compared with women aged 15–24 years. Women with a favourable distance from health facilities were more likely to receive continuity of services utilisation (aOR 1.39; 95% CI 1.24 to 1.57).ConclusionsThe continuity of services utilisation is associated with age, reproductive status, family influence and accessibility-related factors. Findings demonstrated the importance of enhancing early reproductive health education for men and women. The health system reinforcement, community empowerment and multisectoral engagement enhance accessibility to health facilities, reduce financial and geographical barriers, and produce strong quality care.