Urban Indonesia Research Articles

Social determinants and socioeconomic inequalities in adherence to antenatal iron-folic acid supplementation in urban and rural Indonesia.

Adherence to iron-folic acid supplementation (IFAS) has been linked with maternal anaemia. While findings about determinants of IFAS adherence have been mixed across different research, there is inadequate evidence in relation to socioeconomic inequalities. This study aims to examine social determinants and socioeconomic inequalities of adherence to IFAS in urban and rural Indonesia. We conducted a secondary analysis of the 2017 Indonesia Demographic and Health Survey by including a total of 12 455 women aged 15-49 years. The outcome was adherence to IFAS for at least 90 days. We used multiple logistic regression analysis adjusted for the survey design to analyse factors associated with IFAS adherence. We estimated socioeconomic inequalities using the Wagstaff normalized concentration index and plotted them using the concentration curve. About half of women consumed IFAS for at least 90 days, with a higher proportion in urban areas (59.0%) than in rural areas (47.8%). Social determinants of adherence to IFAS were similar for urban and rural women. Overall, being an older woman, having weekly internet access, antenatal care for at least four visits, and residing in Java and Bali were significantly linked to IFAS adherence. Higher maternal education was significantly linked to IFAS adherence in urban settings, but not in rural settings. There were interactions between place of residence and woman's education (p<0.001) and household wealth (p<0.001). Concentration indices by woman's education and household wealth were 0.102 (p<0.001) and 0.133 (p<0.001), respectively, indicating pro-educated and pro-rich inequalities. However, no significant education-related disparity was found among rural women (p=0.126). Women (age, education, occupation, birth number, internet access, involvement in decision-making), household (husband's education, household wealth), health care (antenatal care visit) and community (place of residence, geographic region) factors are associated with overall adherence to IFAS. These factors influence the adherence to IFAS in a complex web of deep-seated socioeconomic inequalities. Thus, programs and interventions to improve adherence to IFAS should target women of reproductive age and their families, particularly those from socioeconomically disadvantaged groups residing in rural areas.

The Impact of Lifestyle Changes on the Prevalence of Prediabetes and Diabetes in Urban and Rural Indonesia: Results from the 2013 and 2018 Indonesian Basic Health Research (RISKESDAS) Survey

(1) Background: Prediabetes represents reversible glycemic abnormalities between normal glucose regulation and diabetes. Indonesia has a high burden of non-communicable diseases, such as diabetes. This study aims to evaluate the impact of lifestyle changes on prediabetes and diabetes in rural and urban populations. (2) Methods: This is a repeated cross-sectional study, and data were obtained from Basic Health Research (RISKESDAS) in 2013 and 2018. (3) Results: The study found that urban populations who ate &gt;3 days/week of vegetables had a lower proportion of prediabetes and diabetes. Rural populations with 2 days/week of vegetable consumption had a higher risk of prediabetes in 2018. From 2013 to 2018, urban and rural populations consumed excessive amounts of sweet food/drink, salty food, fatty/cholesterol/fried food, and meat/chicken/fish-based food with preservatives. In 2018, urban and rural populations who consumed sweet food/drink more than once daily had a higher risk of prediabetes and diabetes. The prevalence of active physical activity declined in normoglycemic individuals, while it increased in prediabetes and diabetes in urban and rural areas. In 2013, physical activity was a protective factor for prediabetes. (4) Conclusions: Lifestyle changes impacted prediabetes and diabetes prevalence. Further research is needed to promote healthy diets and lifestyle modifications.

Sociodemographic Influence on the Management of Orofacial Cleft in Urban and Rural Indonesia.

To explore the social experiences of orofacial cleft patients and contextualize sociodemographic influence on management disparities in rural and urban areas of Indonesia. This study explores patients' lives in two demographical settings in South Sulawesi Province, Makassar and Selayar Islands Regency. It employs ethnography, including open-ended interviews and observations of patients, their neighborhoods, schools, and workplaces. Secondary data from the two regencies and South Sulawesi province are employed to demonstrate demographic disparities in patient care between urban and rural areas. Thematic content analysis was performed according to socio-demographical differences and networks involved in the management. This study engaged a diverse group of participants, including patients, family caregivers, medical team members, and patient peers (n = 40), primarily from middle to low-income families. Parents in both regions had limited knowledge about treatment modalities, which resulted in concerns regarding the safety of surgical procedures and the postponement of mandatory surgeries. In rural areas, patients faced significant financial burdens when referred to Makassar. In contrast to parents in Selayar, parents in Makassar prioritized more social interaction to ensure that their children attended school, college, and work. Patients in both settings reported facing various obstacles at different stages of their lives. Sociodemographic conditions contribute to disparities in treatment, social positioning, and self-perception. Promoting education about the safety of medical and rural surgical procedures is vital. Involving patients in public activities and providing support from family caregivers is paramount to nurturing patients' optimistic outlooks.

Rural-urban differences in common mental disorders among Indonesian youth: a cross-sectional national survey.

The onset of common mental disorders (CMDs) is most prevalent among youth; thus, mental health management is crucial. We examined differences in risk and risk factor determinants regarding CMDs prevalence among youth in rural and urban Indonesia. This cross-sectional study utilized data from the 2018 Indonesia National Health Survey. The population comprised 122,114 respondents, aged 15 to 24 years, who had completed the 20-item Self-Report Questionnaire along with providing demographic and health behavior data. Chi-square testing and logistic regression were employed for analysis. The CMDs risk was higher among urban than rural youth. Risk factors impacting both populations included being female, having a lower education level, consuming fewer than 7 portions of vegetables weekly, smoking, and drinking alcohol (p<0.05). Consuming under 7 portions of fruit weekly and being in the highest or lowest wealth quintile were significant risk factors only in urban youth, while unemployment and divorce were significant only among rural respondents (p<0.05). Marriage was protective against CMDs among rural participants. Being male, possessing a college degree, consuming at least 7 portions of vegetables weekly, not smoking, and not consuming alcohol were associated with reduced CMDs risk in urban and rural youth. Among rural youth, marriage and employment were linked to decreased risk, whereas divorce displayed the opposite relationship. In urban populations, consuming at least 7 portions of fruit weekly and belonging to neither the highest nor the lowest economic quintile were protective factors. Management strategies for CMDs in young people must address these considerations.

Caregiver perceptions of complementary feeding in rural and urban Indonesia: A qualitative comparative study

ObjectiveTo explore caregivers’ perspectives on complementary feeding in rural and urban areas of Central Java, Indonesia. DesignA qualitative comparative study using in-depth interviews. We applied thematic analysis to identify themes and subthemes and presented representative quotes. SettingRural and urban villages in Central Java Province, Indonesia. Participants46 mothers and grandmothers of 6- to 23-month-old children. FindingsWe identified five themes: 1) timing of food introduction, 2) types of complementary foods, 3) meal preparations, 4) complementary food benefits, and 5) expectations toward complementary foods. While caregivers in urban areas had more favourable perceptions of complementary feeding, some misperceptions existed regarding complementary feeding in both areas. These misconceptions included the age of complementary food introduction, the delay in introducing animal-source foods, and the emphasis on any food the child preferred as long as they ate rather than on healthy food choices. Key conclusionsThere were similarities and differences in complementary feeding perspectives between caregivers in rural and urban areas. Therefore, policymakers and public health workers should design interventions to enhance complementary feeding practices by addressing the contextual issues in specific settings.

Obesity in urban Indonesia: evidence from the 2007 and 2018 Basic Health Research

BACKGROUND The prevalence of obesity in urbanizing Indonesia is rising, where the double burden of malnutrition poses a significant challenge. This study aimed to examine the prevalence and increment of obesity-related noncommunicable diseases (NCDs) of diabetes and hypertension. METHODS Secondary data from the latest 2018 Basic Health Research (RISKESDAS) were used to analyze the obesity rate and its associations with lifestyle, sociodemographics, and certain comorbidities among urban Indonesians. This study included non-pregnant adults aged ≥18 years who lived in the urban area and whose blood pressure and glucose levels were measured in the survey. Results were compared to a similar study using data from 2007. RESULTS The proportion of obesity among Indonesia’s urban population was more than doubled from 23.0% in 2007 to 50.1% in 2018 for obesity and 28.0% to 57.2% for central obesity. Additionally, females, individuals with higher socioeconomic status, and higher education levels exhibited a higher obesity prevalence. CONCLUSIONS Urban Indonesia has witnessed a dramatic rise in obesity prevalence. Our findings highlighted the urgent need for policymakers to consider the escalating prevalence of NCDs associated with obesity. Strengthening and concretizing health promotion and prevention policies at the community level are crucial to combat this alarming public health challenge.

Business and Politics in Urban Indonesia: Patrimonialism, Oligarchy and the State in Two Towns

Studies of the Indonesian political economy suggest a transformation of government-business relationship from a “patrimonial administrative” state, in which bureaucrats are dominant, to a “patrimonial oligarchic” state dominated by business actors. We examine this proposition by analysing government-business relationship in two towns: a town in Sulawesi, dominated by trade, and a town with a strong industrial base in Java. In the first, politics still approximates that of a patrimonial administrative state with a weak business sector and a dominant bureaucracy. In the second, a local business dynasty has come to power, but without promoting regularisation of state-business relationship. Despite the differences, patronage politics are similarly dominant in both locations, which we illustrate by zeroing in on the construction sector and the distribution of infrastructure projects. We conclude by discussing the implications of our findings for the nature of urban politics in Indonesia, underscoring the significance of patronage across a range of settings.

POLICY AND REALITY: A DESCRIPTIVE ANALYSIS OF TOLERANCE IN MEDAN

Setara Institute studied the application of tolerance values in urban Indonesia. This study places Medan in the 10 cities with the lowest tolerance index. One of the indicators is government policy. Therefore, this research aimed to describe: 1) the tolerance policy in Medan City, 2) the realization of the tolerance policy in Medan City, and 3) intolerant events or disturbance of religious/belief harmony in Medan City. The research was conducted with a qualitative-descriptive approach. Interview, observation, and documentation are the data collection techniques used. The informants were selected purposively consisting of the government, FKUB, and PAMK of Medan city. Data analysis was conducted in stages: data reduction, data presentation, and conclusion drawing. To ensure data validity, FGDs, triangulation of sources, techniques, and time were conducted. The results showed that: 1) The Medan City Government's policies in the 2021-2024 period have sufficiently contained aspects of religious tolerance and moderation. 2) Policy realization is carried out regularly and incidentally by the Government and FKUB of Medan city, and 3) There is a decrease in intolerant events or disturbance of KBB in 2021-2022.

Earthquakes and Housing Rental Prices in Urban Indonesia: A Hedonic Price Analysis

Earthquakes and Housing Rental Prices in Urban Indonesia: A Hedonic Price Analysis

Cultural Transformation in Indonesian Urban Society: A Case Study of The Millennial Generation

This study highlights the cultural transformation of the millennial generation in urban Indonesia, influenced by technological advances, social media and globalisation. Despite maintaining a unique cultural identity, this generation faces challenges in maintaining a balance between modernity and cultural heritage. The implications include policy development and cultural maintenance in the future. Previous research has examined the influence of globalisation on young people, but this study provides a specific focus on millennials' responses to foreign culture and behavioural changes, making a valuable contribution to previous understanding.

Infant and Young Child Feeding (IYCF) Practices in Rural and Urban Regions of Indonesia

Background. The global strategy on infant and child feeding recommends the best pattern of feeding for infants and young child feeding (IYCF) from birth to 24 months. Practices of proper feeding of children up to 2 years of age contribute to a child’s survival, growth, and development because they can prevent micronutrient deficiencies, morbidity, and obesity in later life. This study aims to determine the risk factors for the failure of IYCF practice in urban and rural Indonesia. Materials and Methods. The study used Indonesia Demographic and Health Survey (IDHS) 2017 data with a cross-sectional research design. The sampling technique used systematic probability proportional to size sampling. The number of samples was 4,869 children consisting of 2,424 children in urban and 2,445 children in rural. Bivariate analysis using chi-square test. Multivariate analysis using multivariate logistic regression. Results. The study found that most of the children in urban (79.3%) and rural (97.2%) did not practice IYCF under the recommendations. There is a difference in the proportion of IYCF practices between urban and rural areas (p &lt;0.001). The risk factors for the failure of IYCF practice in urban areas are socioeconomic, maternal age, and age at first marriage. The poorest socioeconomic is at risk of 2.4 times, maternal age &gt; 35 years are at risk of 1.5 times, age at first marriage is less than 21 years at risk of 2.1 times carrying out IYCF practices not according to recommendations compared to the comparison group. The risk factors for the failure of IYCF practice in rural are socioeconomic, maternal education, quantity, and quality of antenatal care (ANC). The poorest socioeconomic is at risk of 2.1 times, mothers with primary education are at 1.5 times, the quantity of ANC is not good at risk at 1.9 times, the quality of ANC is not good risk at 1.5 times practicing IYCF is not according to the recommendations compared to the comparison group. Conclusion. The practice of IYCF in Indonesia starting from giving early breastfeeding initiation, exclusive breastfeeding, and complementary feeding according to recommendations is still low. The priority of IYCF intervention through education and assistance to pregnant women needs to be a sustainable program.

Ensuring Fairness: Strategies for Providing Affordable Housing for Low-Income Communities in Urban Indonesia

Indonesia's population growth has slowed, yet low-income people still require affordable urban housing. Land scarcity, limited financial options, and complicated home funding provide significant challenges. This study analyses existing literature to find ways to provide cheap housing to Indonesian middle-class residents. The study examines land use, financing, and cash availability. The findings show that MBR cannot get funding due to high costs and strict criteria, while the scarcity of urban land is hindering development. The analysis recommends using unused government land and promoting vertical housing to maximise land use, investigating microfinance and lease-purchase schemes, and simplifying housing fund access. These hurdles can be overcome to provide fair and affordable housing for all in Indonesia, promoting social stability and sustainable urban expansion.

Risk Behavior and Psychological Stress on the Incidence of Hypertension among Productive Age in Urban Communities

Indonesia has an increasing trend of hypertension cases annually. The incidence of hypertension in Indonesia was 25,8% in 2013 and 34,1% in 2018, with a higher prevalence in urban areas. Although the prevalence of hypertension is higher in older age, the potential burden of disease is greater at a younger age in experiencing cardiovascular disease and kidney failure in the future. This study aims to determine the relationship between risk behavior and psychological stress on hypertension among productive age in urban Indonesia. This is analytical observational research with a cross-sectional design that uses secondary data from the fifth Indonesian Family Life Survey (IFLS-5). The sample size was 3193 respondents who met the inclusion and exclusion criteria. The analysis is univariate, bivariate, and multivariate. Bivariate analysis using Chi-square and Fisher test obtained factors related to hypertension incidence are age 55-64 years old (p&lt;0,001), age 45-54 years old (p&lt;0,001), age 35-44 years old (p&lt;0,001), education level (p=0,004), physical activity (p=0,020), and obesity (p&lt;0,001). There is no significant relationship in other variables, including psychological stress. While through the test of logistic regression in multivariate analysis, factors that affect hypertension are age (p&lt;0,001), gender (p=0,011), and obesity (p&lt;0,001). The study concludes that obesity is the strongest influential variable on the incidence of hypertension among productive age in urban Indonesia. After controlling for other variables, obese individuals had 3,538 times more potential to develop hypertension compared to non-obese individuals (OR=3,538; 95% CI=2,763-4,532).

Evaluation of a participatory citizen approach to monitor microbial water quality of self-supply in urban Indonesia

ABSTRACT A participatory citizen approach was established to monitor microbial water quality in household self-supply in Bekasi, Indonesia, and evaluated using a conceptual framework for context analysis, process evaluation and impact assessment (CPI). Households tested their self-supplied water for Escherichia coli presence every two weeks for six months, accompanied by pre- and post-monitoring surveys. The approach provided reliable water quality results, and increased awareness of water quality; however, nearly half of the households dropped out of the monitoring and increased awareness did not translate into actions that improved water quality within the study period. Contamination rates ranged from 11% to 70% at source and from 15% to 44% at point-of-use. Household-led testing could fulfil an important monitoring role in self-supply contexts, however it may have little impact on the drinking water safety unless accompanied by support to improve source protection and strengthen household water treatment and storage practices.

Policy and regulatory context for self-supplied drinking water services in two cities in Indonesia: Priorities for managing risks

Self-supply is the dominant drinking water service model for urban Indonesia. This paper examines its governance arrangements to identify risks due to the inexistence or implementation gaps of laws and regulations. The research applied a socio-ecological perspective to analyse interactions between water resources, governance, infrastructure and users and related-water security outcomes. We adopted a case study approach focused on two self-supply dominant urban areas by reviewing relevant regulations and conducting interviews with stakeholders.The findings show that water security outcomes for self-supplied services were at risk. Overarching laws exist to support groundwater preservation. However, in practice over-extraction and contamination are common, resulting in environmental risks. Governance of groundwater use and associated permits demonstrate fragmented responsibilities and lack of a coordinated institutional framework to guarantee water safety and availability. Whilst construction standards define minimum distance of wells to pollution sources, non-compliance is common, pointing to technical risks. Users are formally responsible for storage, treatment and monitoring water quality but practice varies across households. The result is a range of potential social and health risks.The study demonstrates a need for strengthened and coordinated implementation of the existing laws and regulations as well as increased acknowledgement of self-supply in policies in a concerted effort to ensure accessibility, safety and reliability of those services. We propose a modified governance framework to support further analytical and practical efforts to address risks to self-supplied services, towards improving safe and equitable water service delivery in Indonesia and elsewhere.

Effect of handwashing on the reduction of Escherichia coli on children's hands in an urban slum Indonesia.

Poor hand hygiene practice has been linked to an increase in the number of infections among children in urban slums. Hands are considered an intersection for bacterial transmission, but it is unclear whether the handwashing technique affects bacteria elimination. This study investigated the effect of handwashing on the concentration of Escherichia coli (E. coli) and factors related to its reduction among children in an urban slum in Bandung, Indonesia. We observed handwashing and conducted repeated hand swabs before and after handwashing among 137 participants. The mean E. coli concentration on the hands decreased after handwashing, with a higher reduction in E. coli count among students who used soap and had soap contact for more than 10 s during handwashing. Cleaning in-between fingers, using soap, soap contact for more than 10 s, and drying hands with a single-use towel were effective factors for reducing E. coli concentration after handwashing (p < 0.05). More than half of the swab samples (59%) tested positive for E. coli after handwashing, indicating that the children's handwashing technique was not effective in completely removing E. coli from the hands. Moreover, sustained and consistent handwashing practice as a daily behavior in children would maximize the effect.

INTEGRATING THE CULTURE OF ZIKIR AND SLAWATAN ON THE COMMITMENT OF THE MAULID NABI MUHAMMAD

This work examines the rituals of the Prophet Muhammad's birthday in traditional forms and neo-Soufism performances. religious leaders such as Habib Sheikh help motivate people seeking a different experience in the form of neo-Soufism practices in urban Indonesia. This work adopts participant observation and ritual theory to examine the process, actions, and performance actors such as sholawatan assembly. ideas that underlie the existence of music and the spirit of the marginal Muslim community that uses music as a symbol of existence. In addition, it also discusses philosophical conceptions in the form of practical assumptions and useful work principles as a reference for the performance of musical creativity.

Associations between seasonality and faecal contamination of self-supply sources in urban Indonesia

Abstract Water quality monitoring that accounts for seasonal variability is crucial to ensure safe water services at all times, including groundwater self-supply, which provides drinking water for more than 40 million people in urban Indonesia. Seasonal variation of self-supply water quality remains a key evidence gap in Indonesia and elsewhere; therefore, this study investigated the associations between seasonality and faecal contamination of groundwater self-supply in the Indonesian cities of Bekasi and Metro. The study demonstrated mixed results in terms of associations between seasonality and microbial water quality. McNemar's test showed that high concentrations of Escherichia coli (E. coli) (≥100 MPN per 100 mL) were significantly more likely during the wet season than during the dry season in Bekasi (p = 0.050), but not in Metro (p = 0.694). There was no statistically significant association between the season and the presence of E. coli in self-supply sources for both study sites, nor was there a significant association between the season and the presence of high concentrations of E. coli at the point-of-use. At both study sites, presence and high concentrations of E. coli during the dry season significantly increased the risk of contamination in the wet season, but the predictive power was weak. Regular water quality testing complemented by sanitary inspection is required to understand the contamination risks of self-supply sources.

Hanya ada Satu Kata: Lawan! On decolonising and building a mutual collaborative research practice on gender and climate change

ABSTRACT Our title is borrowed from a famous line of Wiji Thukul’s poem Peringatan (translated as Warning), about the everyday lives of the working class and their struggles to be heard, resonating with many of our experiences in working to decolonise climate knowledge production. As in Thukul’s words: ‘There is only one word: Fight!’ We critically reflect on our recent experiences working with artists, communities, activists, and practitioners to better understand the gender–age–urban interface of climate change: how climate impacts are shaped by gender and age in urban Indonesia. In a deliberate challenge to problematic conventions of academic publishing, we choose to frame this paper around a series of creative processes focused on women’s experiences and responses to climate change, including Madihin – a Banjarese tradition of musical storytelling – and Trans Superhero Perubahan Iklim (Transgender Superheroes for Climate). We centre these different forms of knowledge and voice in our discussion as a series of provocations for researchers and practitioners to think creatively about the languages we use, the methods we draw on, the collaborations we build, how we disseminate ‘academic’ knowledge, and to push at institutional barriers and the boundaries of what ‘inclusion’ truly means at each stage of our research processes. We explore how feminist, ethnographic, and arts-led methodologies can foreground knowledge, perspectives, and art forms that are traditionally excluded in climate change knowledge production – long dominated by colonial and patriarchal hegemonies (and tyrannies) of science and ‘experts’; and unpack our un/learning in this imperfect ‘fight’ to decolonise our research process and build a mutual collaborative research practice.

Short-Term Effects of a School-Based Comprehensive Sexuality Education Intervention Among Very Young Adolescents in Three Urban Indonesian Settings: A Quasi-Experimental Study

PurposeTo evaluate the effects of a comprehensive sexuality education (CSE) intervention on short-term psychosocial outcomes related to healthy sexuality among very young adolescents in urban Indonesia. MethodsA quasi-experimental study was conducted between 2018 and 2021 with students aged 10-14 years at 18 schools in Indonesia (Lampung, Denpasar, Semarang). Three schools per site were purposefully selected to receive the SEmangaT duniA RemajA intervention, a two-year, rights-based teacher-led CSE intervention delivered in classrooms (or online after the 2020 COVID-19 outbreak); and matched with three control schools. Surveys were completed by 3,825 students at pre- and posttest (82% retention). The final analytical sample included 1852 intervention and 1483 control students (N = 3,335). Difference-in-difference analysis was conducted to examine the intervention effect on healthy sexuality competencies (knowledge, skills, and attitudes) and personal sexual well-being. ResultsBaseline characteristics for intervention and control groups were similar in terms of sex (57% female) and age (mean 12 years). Students receiving SEmangaT duniA RemajA demonstrated significantly greater increase in competencies, including greater pregnancy knowledge, more gender equal attitudes, and communication about sexual and reproductive health and rights, compared to controls. There was no intervention effect on personal sexual well-being, except for self-efficacy to prevent pregnancy. Subgroup analysis indicated more significant effects among females and students in Semarang and Denpasar, than males or students in Lampung. DiscussionWhile findings demonstrate the potential for CSE programs to improve healthy sexuality competencies in early adolescence, the effect appears to be highly contextualized which may be due to varying levels of implementation quality, especially since the COVID-19 outbreak.