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Background Children in urban informal settlements are vulnerable to enteric pathogen exposures due to inadequate availability of clean water, sanitation, and wastewater treatment. These exposures can contribute to diarrhea, malabsorption, and poor growth. Understanding how children interact with their environments – particularly through mouthing behaviors – can help identify high-risk environmental sources, exposure pathways, and opportunities for intervention. The objective of the study is to characterize mouthing behaviors among young children and assess the environmental contexts in which these behaviors occur, in order to identify potential pathogen exposure risk. Methods Two videography campaigns were conducted involving 192 children under five years old (106 in Fiji and 86 in Indonesia), with a mean observation duration of 4.1 h per child. Mouthing behaviors were recorded along with the environmental context (location and presence of risk factors (i.e., near human or animal feces, close to animals, or interacting with environmental water)). Results All children mouthed objects during observation. Mouthing frequencies were similar across countries: 68.6 contacts/h in Indonesia and 68.2 contacts/h in Fiji. Most frequently mouthed objects were food (25.5 in Indonesia, 16.9 in Fiji), fomites (17.4 and 24.4), and the child’s own hand (17.6 and 20.4 contacts/h). Outdoors, mouthing was common: 98% of Indonesian children and 91% of Fijian children, with frequencies of 58.9 and 50.1 contacts/h, respectively. Indonesian children spent significantly more time outdoors (26.3 vs. 8.2 min/h; p  < 0.001). High-risk contexts were observed in 66% of children in Fiji and 93% in Indonesia, with over half mouthing objects while in these settings. Conclusions Systematically incorporating contextual information on the settings where mouthing occurs, enables a broader understanding of children’s potential pathogen exposure risks through child-environment interactions.

Backgrounds The increasing burden of cardiovascular disease (CVD) has become a major challenge globally, including in Indonesia. Understanding the readiness of primary health care facilities is necessary to confront the challenge of providing access to quality CVD health care services. Our study aimed to provide information regarding readiness to deliver CVD health services in public primary health care namely Puskesmas. Methods The study questionnaire was adapted from the World Health Organization (WHO) Service Availability and Readiness Assessment (SARA), modified based on the package of essentials for non-communicable disease (PEN) and the Indonesian Ministry of health regulation. Data were collected from all Puskesmas facilities ( N  = 47) located in Makassar city. We analysed relevant data following the WHO-SARA manual to assess the readiness of Puskesmas to deliver CVD services. Human resources, diagnostic capacity, supporting equipment, essential medication, infrastructure and guidelines, and ambulatory services domain were assessed based on the availability of each tracer item in a particular domain. The mean domain score was calculated based on the availability of tracer items within each domain. Furthermore, the means of all domains’ scores are expressed as an overall readiness index. Higher scores indicate greater readiness of Puskesmas to deliver CVD-related health care. Results Puskesmas delivers health promotion, disease prevention, and prompt diagnosis for cardiovascular-related diseases, including hypertension, diabetes, coronary heart disease (CHD), and stroke. Meanwhile, basic treatments were observed in the majority of the Puskesmas. Long-term care for hypertension and diabetes patients and rehabilitation for CHD and stroke were only observed in a few Puskesmas. The readiness score of Puskesmas to deliver CVD health care ranged from 60 to 86 for. Furthermore, there were 11 Puskesmas (23.4%) with a score below 75, indicating a sub-optimal readiness for delivering CVD health services. A shortage of essential medicines and a low capacity for diagnostic testing were the most noticeable shortcomings leading to suboptimal readiness for high-quality CVD health services. Conclusion Close cooperation with the government and other related stakeholders is required to tackle the identified shortcomings, especially the continuous monitoring of adequate supplies of medicines and diagnostic tools to achieve better CVD care for patients in Indonesia.

Background Risk factors for non-communicable diseases (NCDs, cardiovascular diseases, cancers, chronic respiratory diseases, diabetes, and mental disorders) arise in adolescence but are mostly framed as relevant to health in adulthood; little is known about the relationship between co-occurring NCD risks and mental wellbeing in young people. This study aims to describe the prevalence and co-occurrence of distinct NCD risk factors, and how they relate to current mental wellbeing amongst adolescents in Indonesia, a young and populous country where NCD burden is increasing rapidly. Methods We assessed NCD risk and mental wellbeing amongst 1,331 school-based 16–18-year-olds in Jakarta ( N  = 609) and South Sulawesi ( N  = 722). Five domains of NCD risk (adiposity, substance use, physical inactivity, excess sedentary time, and diet) were either measured or self-reported. In Jakarta, we also measured blood glucose, triglycerides, cholesterol, and blood pressure. Wellbeing was assessed using three indicators: general quality of life (QoL), physical function QoL, and psychological distress. We used linear regression to estimate the associations between co-occurring risks and wellbeing, adjusted for covariates of wellbeing: province, sex, socioeconomic status, and religion. Results NCD risk clustering was common, and more than half of adolescents had co-occurring risks in 3 or more of the 5 domains (58.9% (95%CI 53.7—63.9)). Adolescents with any NCD risk were more likely to report psychological distress, with this relationship most pronounced in those with excess sedentary time spent on video gaming and computer use. A higher number of NCD risk factors was associated with poorer psychological wellbeing and decreased general and physical function QoL. In the Jakarta subsample, reduced HDL and raised blood glucose was associated with psychological distress; and a higher number of risk biomarkers was associated with lower physical function QoL. Conclusions Our analysis also shows that these NCD risks (both individual risks and co-occurring risk count) are related to poorer profiles of mental wellbeing in adolescents, after adjusting for likely confounders.

The implementation of Smoke-Free Area policies in health facilities is critical in promoting public health, especially in rapidly urbanizing regions such as Makassar. Smoking remains one of the leading causes of preventable illness and death globally. Thus, understanding the factors influencing the establishment and enforcement of smoke-free policies has become increasingly important. This study aimed to examine the influence of organizational, environmental, and sustainability factors on process indicators for smoke-free area policy implementation in healthcare facilities in Makassar, Indonesia. A quantitative correlational study was conducted across seven healthcare facilities that provide inpatient services. Using random cluster sampling, 232 healthcare workers were selected. Path analysis was employed to evaluate causal relationships between independent variables (organizational, environmental, and sustainability factors) and dependent variables (process indicators including functional role arrangements, health education, policy dissemination, smoke-free area signage). The findings indicate that sustainability factors significantly influenced health education, policy dissemination, and smoke-free signage, while organizational factors had a notable impact on policy announcement, whereas environmental factors showed no significant effects on the process indicators of smoke-free policy implementation. These findings emphasize the importance of reinforcing sustainability and organizational commitment to ensure long-term compliance with smoke-free regulations in health facilities.

Background: Stunting is the impaired growth and development of children due to poor nutrition, repeated infection, and inadequate psychological stimulation. This research aims to examine the impact of maternal nutritional literacy (MNL) in increasing the height or score of a stunted child. Design and Methods: This study is a randomized control trial, which uses a sample size of 85 participants, 43 interventions and 42 controls, an 80% stress test and a 95% confidence level. The intervention group of the MNL consists of families with children under the age of five, focused on the mother’s ability to perform breastfeeding, hygiene activities, care, and intervention for 3 months. Result: The status of stunting was determined by the different distribution of stunting before and after the intervention in both the intervention and control groups. There was a decrease of about 9.3% of MNL in the intervention group, while in the control group it decreased by just 2.4% (p<0.05). Conclusions: It can be concluded that MNL has an effect in preventing stunting, and it is recommended that preventive measures should focus more on normal children, while stunted children should be provided with breastfeeding as the core of MNL. Significance for public health Preventing stunting requires an effort based on the family potential, and the nutritional literacy of the maternal is the most appropriate measure in achieving the preventive goals. This article shows that the maternal nutrition literacy interventions are very good in such a way that they become a reference for improving the nutrition and public health.

Background Tuberculosis (TB) and diabetes mellitus (DM) co-morbidity is a growing public health challenge, particularly in Indonesia, where TB incidence remains high and DM prevalence is increasing. DM co-morbidity is known to increase the risk of TB incidence and have negative effects on TB treatment outcomes. This study aims to analyze the geographical co-distribution of TB and DM and their sociodemographic determinants in Indonesia, to help inform public health response and targeting of screening programs. Methods Using data from the 2023 Indonesian Health Survey (SKI), a nationally representative, population-based survey, we applied a Bayesian geostatistical model to estimate disease prevalence and assess associations with key sociodemographic factors. Results The predicted TB prevalence varied from 0.1% to 3.0%, highest in eastern Indonesia, particularly Papua, while DM prevalence ranged from 0.6% to 6.2%, concentrated in Java and Sumatra. Approximately 62 districts showed more than a 50% posterior probability that both TB and DM prevalences simultaneously exceed their respective national thresholds. The proportion of the poor population is significantly associated with higher TB prevalence (0.106; 95% CrI: 0.039, 0.174), while population density has a strong positive correlation with DM prevalence (0.198; 95% CrI: 0.156, 0.241). Proportion of the poor population (− 0.053; 95% CrI: − 0.096, − 0.009) and hospital services (− 0.071; 95% CrI: − 0.116, − 0.027) show a negative association with DM prevalence. Conclusion Spatial analysis revealed significant regional variations, with high TB-DM co-distribution observed in rapidly urbanizing and high-poverty districts, including parts of West Java, East Java, Sumatra, and Kalimantan in Indonesia. These findings emphasize the need for strengthened TB-DM integration in healthcare services, especially in areas that have a high prevalence of both diseases. Strengthening integrated disease management strategies in local areas can help mitigate the burden of both TB and DM in Indonesia, particularly given likely low case detection and health care access in lower income regions. Graphical Abstract

Good quality information helps adolescents with their menstrual health. It supports them in realising their human rights. Many adolescents find information on menstrual health online through websites, social media, or health apps. Online information is increasingly important. But we know little about how adolescents access and use it for menstrual health. We conducted a qualitative study in junior high schools in two districts of Bali, Indonesia. 24 school girls aged 13-15 took part. We wanted to understand how they accessed online information and what they learnt from this about menstruation. We carried out five group discussions in each of four junior high schools. We also did five in-depth interviews, a solicited diary activity and participant observation. Our study confirmed that online sources were important for menstrual health information. Participants shared that they looked for menstrual health information through search engines. They also came across it via social media, especially the video platform TikTok. Many participants saw online information as positive. They felt it offered personalised, private, entertaining and convenient information. But there were also risks. Excessive information caused them to worry and misinformation reinforced menstrual myths. Our findings highlight the need for menstrual health programming and policy to take into account the role of online information. It would also commit to understanding the lived experiences of adolescents. Critical health and digital literacy could be part of puberty and health education. This would be very helpful in countries like Indonesia with growing digital engagement. Informasi berkualitas memberikan remaja akses terhadap kesehatan menstruasi sekaligus mendukung kesadaran mereka akan hak asasi manusia. Mayoritas remaja mengakses informasi kesehatan menstruasi secara daring melalui situs web, media sosial, atau aplikasi kesehatan. Meskipun informasi daring semakin relevan, pemahaman kita tentang bagaimana remaja mengakses dan menggunakan informasi daring untuk kesehatan menstruasi sangat jauh dari kata cukup. Penelitian ini dilakukan dengan kajian kualitatif pada 24 remaja putri berusia 13-15 tahun di sekolah menengah pertama di dua kabupaten di Bali, Indonesia (Kabupaten Gianyar dan Kota Denpasar). Penelitian ini bertujuan untuk memahami bagaimana remaja mengakses informasi daring dan apa yang mereka pahami dari informasi tersebut terkait menstruasi. Sebanyak lima kegiatan diskusi kelompok dilakukan di setiap empat sekolah menengah pertama. Selanjutnya, dilakukan lima wawancara mendalam, aktivitas buku harian singkat, dan observasi partisipan. Hasil dari penelitian ini menegaskan bahwa sumber daring berperan penting untuk informasi kesehatan menstruasi. Partisipan menyatakan bahwa mereka secara aktif mencari informasi kesehatan menstruasi melalui mesin pencari (Google) dan/atau menemukannya secara tidak sengaja melalui media sosial, khususnya platform video pendek TikTok. Sebagian besar partisipan berpendapat bahwa informasi daring membawa dampak positif. Selain itu, mereka menyatakan bahwa platform daring menawarkan informasi yang bersifat pribadi, rahasia, menghibur, dan praktis. Namun, terdapat risiko dari informasi daring tersebut. Terkadang terdapat informasi yang berlebihan yang membuat mereka cemas atau informasi yang salah yang memperkuat mitos tentang menstruasi. Dari penelitian ini dapat disimpulkan bahwa pentingnya program dan kebijakan kesehatan menstruasi untuk lebih memperhitungkan peran informasi daring dan berkomitmen untuk memahami pengalaman hidup remaja. Program atau kebijakan lebih lanjut dapat mengintegrasikan literasi kritis tentang kesehatan dan digital ke dalam pendidikan kesehatan dan pubertas, khususnya di negara-negara yang mengalami perkembangan digital yang pesat, seperti Indonesia.

BACKGROUND: Anemia in pregnancy is a major public health problem, especially in developing countries. The most common cause is nutritional deficiencies, especially iron deficiency. Adequate nutritional intake from food is essential during pregnancy. Therefore, this study aimed to investigate the relationship between food access and intake patterns with the incidence of iron deficiency among pregnant women living in the slum settlement in Makassar City. MATERIALS AND METHODS: This research is a sub-study of the Indonesian Birth Cohort Study based in Makassar City. This sub-study used a cross-sectional design and recruited 173 pregnant women in their second and third trimesters using total sampling. All data were collected using a structured questionnaire and recorded using KoboToolbox software. Serum ferritin levels were examined for iron status using the ELISA method at the Microbiology Laboratory Unit at Hasanuddin University Teaching Hospital. The statistical data were analyzed using STATA version 14 with Chi-square analysis and logistic regression. RESULTS: The prevalence of iron deficiency in pregnant women living in slum settlements in Makassar City was 78%. Logistic regression analysis showed that inadequate food diversity (AOR: 2.58; 95% CI: 1.17-5.69; P = 0.019) and food taboos (AOR: 2.81; 95% CI: 1.26-6.26; P = 0.011) were significantly associated with the incidence. CONCLUSIONS: Most pregnant women living in slum settlements in Makassar City experienced iron deficiency. Pregnant women who experience iron shortages have been connected to food taboos and dietary diversity.

Non-communicable diseases (NCDs) are the leading cause of morbidity and mortality globally, with the burden largely borne by people living in low- and middle-income countries. Adolescents are central to NCD control through the potential to modify risks and alter the trajectory of these diseases across the life-course. However, an absence of epidemiological data has contributed to the relative exclusion of adolescents from policies and responses. This paper documents the design of a study to measure the burden of metabolic syndrome (a key risk for NCDs) and poor mental health (a key outcome) amongst Indonesian adolescents. Using a mixed-method design, we sampled 16-18-year-old adolescents from schools and community-based settings across Jakarta and South Sulawesi. Initial formative qualitative enquiry used focus group discussions to understand how young people conceptualise mental health and body weight (separately); what they perceive as determinants of these NCDs; and what responses to these NCDs should involve. These findings informed the design of a quantitative survey that adolescents self-completed electronically. Mental health was measured using the Centre for Epidemiologic Studies Depression Scale-Revised (CESD-R) and Kessler-10 (both validated against formal psychiatric interview in a subsample), with the metabolic syndrome measured using biomarkers and anthropometry. The survey also included scales relating to victimisation, connectedness, self-efficacy, body image and quality of life. Adolescents were sampled from schools using a multistage cluster design, and from the community using respondent-driven sampling (RDS). This study will substantially advance the field of NCD measurement amongst adolescents, especially in settings like Indonesia. It demonstrates that high quality, objective measurement is acceptable and feasible, including the collection of biomarkers in a school-based setting. It demonstrates how comparable data can be collected across both in-school and out of school adolescents, allowing a more comprehensive measure of NCD burden, risk and correlates.