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Tobacco is well known as a risk factor for early morbidity and mortality worldwide. However, the relative risk of mortality and the effects of smoking vary among the countries. Indonesia, as one of the world’s largest market for smoking tobacco, is significantly affected by tobacco-related illness. Previous research has shown that smoking causes several diseases, including stroke, neoplasm and coronary heart disease. There has to date been no research on the hazard risk of smoking for all-cause mortality in Indonesia. This study aimed to identify the association between smoking and all-cause mortality rates in Indonesia. Information from a total of 3,353 respondents aged 40 years and older was collected in this study. The data were taken from the Indonesian Family Life Survey (IFLS) Wave 4 (2007) to collect personal information and determine smoking status and from Wave 5 (2015) to collect information about deaths. Current smokers make up 40.3% of Indonesia’s population. Current smokers were more likely to have a higher risk of all-cause death (hazard ratio = 1.48, 95% confidence interval = 1.11 to 1.98) than non-current smokers. The number of smokers in Indonesia remains high and is expected to increase gradually every year. A firm government policy is needed to reduce the number of smokers in Indonesia which would automatically reduce the health problem of smoking-related illness in the future.

Lack of knowledge often leads to nonchalant attitudes and improper practices that expose people to greater risks during a pandemic. Therefore, improving the general public’s knowledge, attitudes, and practices (KAP) concerning coronavirus disease (COVID-19) can play a pivotal role in reducing the risks, especially in a country such as Indonesia with its scarcity of health resources for testing and tracing. Using the case of Malang District, this study set out to evaluate KAP regarding COVID-19 and its risk factors immediately after the Malang health authorities implemented various preventive measures. A population-based survey involving 3425 individuals was carried out between 1 May and 20 May 2020. Our findings revealed that less than half of the respondents demonstrated accurate knowledge (25.3%), positive attitudes (36.6%), or frequent best practices (48.8%) with regard to COVID-19 prevention. The results of logistic regression analyses showed that more accurate knowledge was associated with more positive attitudes and more frequent best practices (OR = 1.603, p-value < 0.001; OR = 1.585, p-value < 0.001, respectively). More positive attitudes were also associated with more frequent best practices (OR = 1.126, p-value < 0.001). The level of KAP varied according to sociodemographic characteristics, access to the services of community health workers, and mobile health technology for COVID-19 screening. Some global health proposals to improve health behaviors among the general public in the context of the scarcity of health resource settings are suggested based on the study findings.

Introduction This study investigates specific behavioural and social factors influencing the adoption of mobile health (mHealth) technologies by Community Health Workers (CHWs) in rural Indonesia. Using the SMARThealth cardiovascular risk management programme in Malang as a case study, the study examines how constructs from the Technology Acceptance Model (TAM) and related frameworks explain CHWs’ intention to use and actual use of mHealth tools. Methods A cross-sectional survey was conducted with 573 CHWs participating in the SMARThealth programme. Data was collected using a structured questionnaire and analyzed using Partial Least Squares Structural Equation Modelling to test ten hypotheses derived from TAM and Unified Theory of Acceptance and Use of Technology. Results Five of the ten hypotheses were supported. Behavioural intention significantly predicted actual use of the SMARThealth app (β = 0.277, p < .001). Behavioural intention was positively associated with perceived usefulness (β = 0.513, p < .001), perceived ease of use (β = 0.372, p < .001), social relationships (β = 0.051, p = .037) and non-financial incentives (β = 0.071, p = .016). Other factors including financial incentives, government support, community support, IT training and motivation were not statistically significant. Conclusion Perceived usefulness, ease of use, social relationships and non-financial incentives significantly influence CHWs’ intention to adopt mHealth tools in Malang, Indonesia. These findings highlight the need for user-friendly design and peer-based, non-monetary support strategies. However, due to contextual differences in CHW roles, infrastructure and community dynamics, these results may not be generalisable. Further research is needed to assess their relevance across other low- and middle-income countries settings.

ObjectivesCOVID-19 has challenged health systems in low-income and middle-income countries, particularly in rural areas where communities face barriers to information, prevention and timely care. Digital health interventions delivered through community health workers (CHWs) offer a promising approach to closing these gaps. This study evaluated whether a CHW-led digital intervention improved knowledge, attitudes and practices (KAP), vaccination uptake, COVID-19 outcomes and access to hospital care in rural Indonesia.MethodsA quasi-experimental study was conducted from June 2022 to June 2023 with 10 023 individuals across four intervention and four control villages in Malang Regency. In intervention villages, CHWs used a mobile application (AREEMA Skrining Mandiri) to conduct contact tracing, symptom screening, vaccination outreach and referrals, while control villages received standard care. Outcomes included KAP, vaccine uptake, COVID-19 diagnoses and related hospitalisations.ResultsIntervention participants demonstrated greater improvements in attitudes (mean change=3.5, SD=2.1) and practices (0.02, SD=2.2) compared with controls (attitudes: −2.2, SD=4.6; practices: −2.0, SD=2.1). Vaccine uptake was higher in intervention villages (50.6% vs 40.9%), while COVID-19 diagnoses were lower (1.5% vs 2.4%). Among diagnosed cases, hospitalisation was more frequent in intervention villages (21.3% vs 14.5%).DiscussionThe intervention enhanced CHWs’ effectiveness in promoting protective behaviours, facilitating early detection and improving referrals. These findings highlight the potential scalability of CHW-led digital health strategies in low-resource settings.ConclusionIntegrating digital tools into CHW-led care can strengthen COVID-19 prevention, vaccination and access to hospital care in rural populations.

Although 91% of 12–23-month-old children in Indonesia received at least one immunization in 2013, only 76% completed DTP3 immunization. This percentage is below the UNICEF and WHO recommended standards. Thus, this study aims to investigate trends, spatial disparities, and social determinants related to low coverage of DTP3 immunization in Indonesia. Using a multilevel approach, we analyzed data from 305,090 12–23-month-old children living across approximately 500 districts in Indonesia to study demand and supply factors determining DTP3 immunization status. We examined unique, nationally representative data from the National Socioeconomic Survey (Survei Sosial Ekonomi Nasional or Susenas) and Village Potential Census (Potensi Desa or Podes) from 2004 to 2016. The percentage of children receiving complete DTP3 immunization increased from 37.8% in 2004 to 75.9% in 2016. Primarily income, parity status, and education, showed influence on DTP3 coverage. Among individual-level factors, the presence of a professional birth attendant was the most influential factor. At the district level, the factors varied. Low progress in DTP3 immunization status in Indonesia is due to huge disparities across the country’s islands, in the density of health services, and in household socioeconomic status.

Background Immunization is one of the most cost-effective public health interventions to prevent children from contracting vaccine-preventable diseases. Indonesia launched the Expanded Program for Immunization (EPI) in 1977. However, immunization coverage remains far below the United Nations International Children’s Emergency Fund (UNICEF) and World Health Organization (WHO) target of 80%. This study aims to investigate the determinants of complete immunization status among children aged 12–23 months in Indonesia. Methods We used three waves of the Indonesian National Socioeconomic Survey (2008, 2011, and 2013) and national village censuses from the same years. Multilevel logistic regression was used to conduct the analysis. Results The number of immunized children increased from 47.48% in 2008 to 61.83% in 2013. The presence of health professionals, having an older mother, and having more educated mothers were associated with a higher probability of a child’s receiving full immunization. Increasing the numbers of hospitals, village health posts, and health workers was positively associated with children receiving full immunization. The MOR (median odds ratio) showed that children’s likelihood of receiving complete immunization varied significantly among districts. Conclusions Both household- and district-level determinants were found to be associated with childhood immunization status. Policy makers may take these determinants into account to increase immunization coverage in Indonesia.

Background: Airway masks helps protect the wearer's respiratory environment. There are many types of airway masks which differ in materials and effectiveness. This study aims to evaluate the effect of a surgical mask, the N95 mask, and an elastomeric respirator mask on cardiopulmonary, metabolic, and subjective parameters on healthcare workers.  Methods: We conducted a controlled clinical trial on healthcare workers aged between 17-35 years old. Each subject performed a treadmill test (speed 5.6 km/hour) for 30 minutes while their physiological variables were monitored (pulse rate, respiratory rate, oxygen saturation, end-tidal CO2, body temperature, Borg scale, talk test, blood lactate, intermittent blood sugar, and subjective indicators). Each healthcare workers will be tested for four treatments, namely without using a mask, surgical mask, N95 mask, and elastomeric respirator. Results: All healthcare workers (age 25.10 ± 2.2 years old; 5 males and 5 females) completed the protocol with no adverse event. Pair-wise comparison using two-way ANOVA reported no significant difference within the mask condition for pulse rate ( p=0.6497), respiratory rate ( p=0.6772) , oxygen saturation, ( p=0.2587) , end-tidal CO 2 ( p=0.0191) , body temperature ( p=0.7425), Borg scale ( p=0.0930) , blood lactate ( p=0.6537) and glucose ( p=0.8755). A statistically significant difference was reported in talk test ( p=0.0129) with elastomeric respirator group showing highest result compared to control. Similarly, statistical significance was reported in subjective indicator of tightness ( p=0.0017) with highest mean rank seen in N95 mask condition. However, these differences were clinically insignificant. Conclusions: The effect of surgical mask, N95 mask, and elastomeric respirator on the cardiopulmonary parameters, metabolic parameters, and subjective indicators during 30 minutes of low-moderate intensity exercise is negligible and generally well tolerated by healthcare workers. Registration: TCTR20230630001

According to the World Health Organization (WHO), degenerative diseases have caused nearly 17 million deaths worldwide. This increasing number makes degenerative diseases the most significant human killer disease that continues to occur today. Degenerative diseases with high morbidity and mortality rates are vascular diseases. Stroke is considered one of the vascular diseases that often causes high morbidity and mortality rates because stroke is the number 1 cause of disability and the number 3 cause of death after coronary heart disease and cancer. The success of stroke treatment starts from people's knowledge that stroke is an emergency. The philosophy must be adhered to is that time is the brain and the golden hour. To achieve that, education and counselling need to be sought primarily by the community because they are the most likely to meet stroke patients directly. The purpose of this study was to determine the relationship between individual characteristics based on age, gender, education level, address, marital status, employment status, income level, number of family members in one house, information media used, sources of information obtained and family history of stroke owned with public knowledge about stroke which is divided into 4 indicators, namely knowledge about stroke symptoms, stroke risk factors, stroke treatment and stroke prevention. This research is an observational-cross-sectional study conducted on 801 respondents using an accidental sampling technique through the distribution of a validated questionnaire. The distribution of the questionnaire was carried out online with the line and WhatsApp applications through personal chat and existing group chats. The data results were then analyzed and processed using a logistic binary and multivariate logistic regression tests. All tests were conducted using the Statistical Package for Social Sciences (SPSS) version 25 program.