Urban Indonesia Research Articles

School children's Lifestyle Behaviours and Their Predictors: Healthy Weight Development Model in Urban Indonesia

Objectives: Child obesity, a major risk factor of non-communicable diseases such as diabetes or heart diseases, has become a major health issue in Indonesia, especially in the wake of economic growth. Nevertheless, child obesity prevention programs and relevant information is limited. Our study aimed to investigate child obesity status, lifestyle behaviours (LSBs) and their predictors, and their structures, in order to develop a model to discuss a collaborative healthy weight development program for schoolchildren in urban Indonesia. There were two objectives of our study: (1) In order to investigate schoolchildren's obesity status, LSBs, and their predictors and (2) In order to examine relationships among schoolchildren's obesity status, LSBs, and their predictors in urban Indonesia. Methods: The design was a cross-sectional study using physical measurement tools and an 82 item selfdeveloped questionnaire based on interviews for 9 to 11 year old school children in 2015. Sampling included 5 schools resulting in 594 eligible students with 579 (97.5%) responding. Collected data were analyzed by descriptive statistics and a structural equation modeling. The Research Ethics Committee of St. Luke's International University (Approval Number 15-036) approved our study. Results: Physical measurement classified participants 40% as obese or overweight and 35% as underweight. Descriptive statistics revealed limited behaviours and environments in access to snacks, physical activity (PA), weight-monitoring, obesity education, and support. The models by type of schools and by sex (CFI=0.88-0.91) indicated; boys' trouble sleeping (β=-0.18), private schoolchildren's frequency of junk and outside foods (β=-0.18 and -0.19) predicted Body Mass Index. Safe-PA environment (β=0.17-0.48) and family support (β=0.36-0.59) predicted PA LSBs. For girls, PA-peer presence predicted PA LSBs (β=0.88). Conclusion: These findings could help developing the effective obesity-prevention programs such as healthy dietary environment, safe-PA-environment, PA-peer-group support for girls, family-involved dietary-PA interventions in urban Indonesia.

The effectiveness of nutrition education for overweight/obese mothers with stunted children (NEO-MOM) in reducing the double burden of malnutrition in Indonesia: study protocol for a randomized controlled trial.

BackgroundNutrition transition in developing countries were induced by rapid changes in food patterns and nutrient intake when populations adopt modern lifestyles during economic and social development, urbanization and acculturation. Consequently, these countries suffer from the double burden of malnutrition, consisting of unresolved undernutrition and the rise of overweight/obesity. The prevalence of the double burden of malnutrition tends to be highest for moderate levels (third quintile) of socioeconomic status. Evidence suggests that modifiable factors such as intra-household food distribution and dietary diversity are associated with the double burden of malnutrition, given household food security. This article describes the study protocol of a behaviorally based nutrition education intervention for overweight/obese mothers with stunted children (NEO-MOM) in reducing the double burden of malnutrition.MethodsNEO-MOM is a randomized controlled trial with a three-month behavioral intervention for households involving pairs of 72 stunted children aged 2–5 years old and overweight/obese mothers (SCOWT) in urban Indonesia. The SCOWT pairs were randomly assigned to either an intervention group or to a comparison group that received usual care plus printed educational materials. The intervention consisted of six classroom sessions on nutrition education and home visits performed by trained community health workers using a motivational interviewing approach. The primary outcomes of this study are the prevalence of double burden of malnutrition as measured in SCOWT, child’s height-for-age z-score (HAZ) and maternal body mass index (BMI).DiscussionBecause previous studies are mainly observational in nature, this study advances understanding of the double burden of malnutrition through a fully powered randomized controlled trial. The intervention assists participants in self-administered goal setting to improve diet and child feeding behaviors by improving self-efficacy. Maternal self-efficacy may be enhanced through vicarious and active mastery of experiences gained during six sessions of nutrition education and verbal persuasion during home visits.Trial registrationThe Universal Trial Number (UTN) for this study is U1111-1175-5834. This trial was registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) and is allocated the registration number: ACTRN12615001243505 on 12 November 2015.

Household Food Insecurity Access Scale (HFIAS) and Household Food Insecurity Access Prevalence (HFIAP) as Predictor of Stunted Child and Overweight/Obese Mother (SCOWT) in Urban Indonesia

BACKGROUND AND PURPOSEFood insecurity exists whenever the availability of nutritionally adequate, safe foods or access to attain basic foods in socially acceptable ways is deteriorated. The purpose of this study was to determine the relationship between the household food insecurity and double burden of malnutrition as indicated by household stunted child and overweight/obese mother (SCOWT).METHODThe household food insecurity access scale (HFIAS) is a continuous measure of the degree of food insecurity in the household in the past 30 days. While the household food insecurity access prevalence (HFIAP) is a categorical indicator of food insecurity status. Stunting was defined as <−2.0 height‐for‐age Z‐score (HAZ) by WHO‐Anthro 2005. Maternal overweight was defined as BMI >25.0 to 30.0 and obesity defined as BMI>30.0. Trained interviewers administered the HFIAS questionnaire to 685 urban households with children aged 2 to <5 years in Surabaya, Indonesia. Logistic regression models were constructed to test the association between SCOWT and HFIAS or HFIAP.RESULTS/FINDINGSResults showed that the prevalence of child stunting was 36.5%, maternal overweight and obesity was 58.8% and SCOWT prevalence was 21.2%. Based on the HFIAP, 42% of households were food secure, 22.9% were mildly food insecure, 15.3% were moderately food insecure, and 19.7% were severely food insecure. After adjustment for family size, maternal education, maternal occupation, food expenditure and maternal height, the models revealed that higher HFIAS scores were associated with higher likelihood of SCOWT (OR=1.044; 95%CI=1.003–1.087; p‐value=0.036), but not with child stunting (OR=1.022; 95%CI=0.985–1.060; p‐value=0.251), or maternal overweight/obesity (OR=1.031; 95%CI=0.995–1.068; p‐value=0.095). Similar pattern shown in logistic regression models for HFIAP. The adjusted models showed significant association between HFIAP and SCOWT (OR=1.254; 95%CI=1.024–1.535; p‐value=0.028), but not with child stunting (OR=1.167; 95%CI=0.976–1.395; p‐value=0.090), or maternal overweight/obesity (OR=1.127; 95%CI=0.949–1.338; p‐value=0.173). Subsequent logistic regression analysis for HFIAP and SCOWT using food secure households as reference group revealed that all food insecure households have higher risk of SCOWT. Moderately food insecure households have greatest odds (OR=3.665; 95%CI=1.782–7.538; p‐value<0.001) followed by the mildly food insecure (OR=2.964; 95%CI=1.544–5.693; p‐value=0.001) and severely food insecure households (OR=2.016; 95%CI=1.011–4.021; p‐value=0.047).CONCLUSIONThese results support the hypothesis that double burden of malnutrition is robustly related to food insecurity and HFIAS and HFIAP is a good predictor of SCOWT.Support or Funding InformationThis study is part of a self‐funded dissertation project by Trias Mahmudiono under supervision of Dr. Richard Rosenkranz at Kansas State University.

Self-care practices and health-seeking behavior among older persons in a developing country: Theories-based research

PurposeThe aim of this study was to examine the self-care practices and health-seeking behaviours of older adults in urban Indonesia. MethodsThe cross-sectional study was performed from January to March 2014 in the Tammua sub-district of Indonesia. At the time of the study, 273 older adults resided in Tammua, and half of them (51.2%) participated in this study. Data collection was carried out including self-care practices, health literacy, self-efficacy and basic conditioning factors. ResultsIt was found that most respondents (124; 88.6%) always ate various protein sources daily. However, many participants never limited consumption of sugar (55; 39.3%) or salt (40; 28.6%), and more than half of respondents (96; 68.6%) did not regularly visit MHCs. Health status (p < 0.05), health maintenance (p < 0.01) and salt limitation (p < 0.05) were all significantly associated with salt limitation. It was found that respondents with higher self-efficacy, those who did not want to get information, and those of younger ages are less likely to visit MHCs regularly. ConclusionAn understanding of self-care practices and self-efficacy is needed to improve health care in developing countries. High self-efficacy should be promoted along with adequate health literacy. Older persons should learn the importance of regular health examinations to promote health, prevent diseases, and slow the progress of chronic diseases. The number of respondents who never limit their sugar and salt intake was especially surprising. An intervention program should be developed to limit salt and sugar intake of Indonesian elderly and to motivate older persons to use primary health services.

Gender Inequalities in Noncommunicable Disease Risk Factors Among Indonesian Urban Population.

Gender is an important determinant of health. We conducted a study to examine hypertension, obesity, hypercholesterolemia, and smoking behavior among adults aged >15 years in urban Indonesia. We compared the prevalence, predicted socioeconomic factors, the gender inequalities, and the contributing factors to the inequalities. Women had a higher risk of obesity and hypercholesterolemia and raised blood pressure in later life (P< .001). In contrast, men had a higher risk of being a current smoker and raised blood pressure at younger age (P< .001). The gender inequalities in hypertension, obesity, and hypercholesterolemia can be accounted for by disparities in socioeconomic factors between men and women, particularly involvement in paid work. However, the inequalities were also accounted for by different effects of the socioeconomic factors in men and women. Gender is interlinked with socioeconomic and biological factors in determining health. This emphasizes the need of gender responsive policies to control and prevent chronic disease.

Street Vending as Ethical Citizenship in Urban Indonesia

Street traders in many Indonesian cities face social and legal constraints because they are deemed to be hampering the city's order and cleanliness. I describe how a group of vendors adopted the state's concern over greenery and developed their own “green” project. They also called themselves the rakyat kecil (small people) and argued that they were the poor underdogs being mistreated by the corrupt government. This moral positioning is best seen as an expression of what I am calling “citizenship as ethics,” in which the legitimacy of being in a public space is validated through discourses and actions deemed “good” or “right” in the local public imagination.

Gender in the Midst of Reforms: Attitudes to Work and Family Roles among University Students in Urban Indonesia

ABSTRACTThe onset of the Reform era in 1998 after the fall of Suharto bears interesting prospects on gender relations among youth in Indonesia. Using a survey of 1,761 university students from 12 universities in two contrasting urban settings, this article explores attitudes to work and family roles among senior university students in 2004: this is the year when people were preparing to elect a president directly for the first time in history, with the incumbent president the first woman in the role. Results determined that women were less traditional than their male counterparts in their attitudes toward gender roles. This article further explores correlates of gender role attitudes, offering insights on the role of sex, sample sites, gender ratio in faculty, parental role models, religion, and ethno-cultural background.

The prevalence and patient characteristics of chronic obstructive pulmonary disease in non-smokers in Vietnam and Indonesia: An observational survey.

An estimated 25-40% of patients with chronic obstructive pulmonary disease (COPD) have never smoked. We investigated the prevalence and patient characteristics of COPD in non-smokers from Vietnam and Indonesia. This population-based cross-sectional survey of participants from urban and rural Vietnam and Indonesia used a stratified multistage cluster sampling design, with sample and population weights applied to ensure representativeness. Participants were female or male (recruited in the ratio 2:1) non-smokers, 40 years or older and able to perform a spirometry test. Spirometry was performed at a single study visit. Other clinical information was collected via standardized questionnaires. The 1506 evaluable participants were approximately equally distributed between Vietnam and Indonesia, and rural and urban areas. Overall prevalence of COPD was found to be 6.9% (95% confidence interval (CI): 5.7-8.3), with almost three times higher prevalence in men than women (12.9% (95% CI: 9.1-18.0) vs 4.4% (95% CI: 3.0-6.5)). We found higher rates of COPD in Vietnam than Indonesia (8.1% (95% CI: 5.8-11.3) vs 6.3% (95% CI: 4.8-8.3)), with a particularly high prevalence in urban Vietnam (11.1% (95% CI: 8.1-15.1)). Very few participants (6%) diagnosed to have COPD during the study had been previously diagnosed with COPD. Respiratory symptoms and lower health-related quality of life were more common in participants with COPD. The prevalence of COPD in non-smoking individuals from rural and urban Vietnam and Indonesia was 6.9%, of which a significant proportion (94%) were previously undiagnosed.

Absolute Traffic: Infrastructural Aptitude in Urban Indonesia

AbstractThis article draws attention to the emergent modes of urban sociality and circumscribed mobility that define the lives of traffic‐stricken residents in the megacity of Jakarta, Indonesia. I argue that Jakarta traffic has exceeded the scale and discourse of a technopolitical problem of failed infrastructure; rather, the systemic and rhizomic nature of traffic provides the temporal infrastructure that governs the flow of living and leisure, and the patterning of individual desires and struggles in urban Indonesia. I use the term ‘absolute traffic' to convey the limit horizon of gridlock as a set of exhausting physical and psychic states that urban residents survive daily. Despite such overwhelming challenges to mobility, particularly for the city's underprivileged populations, I argue for an agentive perspective of absolute traffic in which forms of play, negotiation and disruption form important moments for the public display of infrastructural aptitude. Strategies for surviving and engaging with absolute traffic emerge in ephemeral sites of finely attuned traffic subjectivity––in the sociality of strangers, the political demonstrations of activists, the growing citizen journalism for traffic reports on radio shows and social media sites, and finally, in the artistic sensibility of artists captivated by the vernacular forms of urban chaos.

Otitis media in indonesian urban and rural school children.

Although the epidemiology of otitis media is well-known in industrialized countries, the extent of otitis media in developing Asian countries, especially in south East Asia is not well studied. To define the burden of otitis media and its sequelae in children 6-15 years of age, we enrolled elementary and junior high school children in 6 areas in rural and urban Indonesia. Randomly selected schools and classrooms were selected. All children were administered a questionnaire and had ear examinations, pneumatic otoscopy and screening audiometry. Children with any abnormality on examination or with a relevant history underwent diagnostic audiometry and tympanometry, if indicated. Of the 7005 children studied, 116 had chronic suppurative otitis media (CSOM), 30 had acute otitis media and 26 had otitis media with effusion. 2.7% of rural children had CSOM compared with 0.7% of urban children (P < 0.0001). The rates per 1000 of CSOM in rural Bali and Bandung were significantly higher (75 and 25, respectively) than in the rest of Indonesia (P < 0.05). In rural Bali, the rate per 1000 children of inactive CSOM was 63 in 6- to 9-year-old children, compared with 37 in children aged 13-15 years. Concomitantly, the rates of tympanosclerosis were 7 and 26/1000, respectively, in these age groups. In Indonesia, the prevalence of CSOM is relatively high with most disease occurring in rural areas. The high rates in rural Bali with early progression to tympanosclerosis suggest a significant burden of potentially vaccine preventable illness.

The willingness to pay for in‐house piped water in urban and rural Indonesia

AbstractThis paper analyses household preferences for in‐house piped water in urban and rural Indonesia via a hedonic price model, specified as a constrained autoregression‐structural equation model (ASEM). ASEM reduces bias due to time‐varying omitted variables and measurement errors. In addition, it provides a convenient way of testing and correcting for endogeneity. On the basis of the Indonesia Family Life Survey data set, we find that on average urban and rural households have the same willingness to pay for in‐house piped water, that is, 34.24 per cent of their monthly house rent. For the 25 per cent urban and rural households with lowest expenditure, this percentage is equivalent to 9.41 per cent and 7.57 per cent of their monthly expenditure, respectively. The findings support a need for further investment in in‐house piped water in both areas, particularly for the households with the lowest expenditure levels.

Images of the West in Urban Indonesia: Muslims Negotiating the Western Path to Modernity

Islamic fundamentalism and terrorism is unjustified. In fact, the political change after 1998 and the increasing influence of religion combined with an intensified process of globalization have led to socio-cultural vicissitudes inIndonesia beyond which we can only estimate what future patterns of orientation the population will have. Based on data from informal conversations, interviews and participant observation, it will be argued that, notwithstanding considerable variations, Muslim Indonesians uphold not solely negative but ambivalent images of the West and that in comparison with and opposition to the „Self‟ or „Own‟ the West is examined as one of many frames of reference by which modernity is negotiated and can be put into practice. Many interlocutors overcame the binary of East and West by envisioning that Indonesia could combine the advantages of both, the Own and the Foreign in order to step into a desirable future.

What happens after you drop out? Transition to adulthood among early school-leavers in urban Indonesia

The high incidence of young people dropping out of school prior to completing secondary schooling remains a nationwide problem in Indonesia. While it is commonly assumed that early school-leavers will become child workers, in fact little is known about the

“Anybody Can Do It”: Aesthetic Empowerment, Urban Citizenship, and the Naturalization of Indonesian Graffiti and Street Art

AbstractBased on ethnographic fieldwork in the cities of Jakarta and Yogyakarta, this paper investigates the recent surge in the production and circulation of street art through technology and media in post‐New Order Indonesia. The global style of street art communicates how public space and the street have become emblematic of changing discourses of individual rights, urban aesthetics, and the practice of citizenship in urban Indonesia. While the history of Western graffiti as a form of defacement and resistance continues to exert a powerful hold on the imagination of Indonesian street artists, I argue that the vernacular meaning of street art and graffiti refuses an easy bifurcation of public and private spaces, while blurring the lines between commercial and cultural urban interventions. [Indonesia, street art, graffiti, media, citizenship]

Thouhgts on Music Ethnography in Urban Indonesia: From Yogyakarta Recordings to Translocal Popular Culture in the Melayu Borderlands

Previous studies on Indonesian music focused on cultural heritage and traditional preservation or western-style modern music such as pop and rock music. Both were perceived as separate genre, even modern music often downplayed traditional one. The author argues analysis of hybrid genre like keroncong and dangdut would provide more complicated picture than such dichotomy. He explained long history of cultural exchanges in various parts of Indonesia which showed these two genres influenced each other. As a case study the author presents urban music as main character of urban social lives in Indonesia. This article depicts street music and campursari in Yogyakarta and linking it to popular cultures in some cities. Popular culture refers to informal recreation in different social settings. Eventually, this article reveals new ways to understand relation between music style and social identity in urban Indonesia. Key words: intercultural exchange, popular culture, translocal, music style, identity

Housing deficits as a frame for housing policy: demographic change, economic crisis and household formation in Indonesia

The idea of housing deficit is a common, seemingly objective frame for housing policies that promote increased supply. This paper critically examines the concept through a case study of Indonesia, where different sources report a deficit of between 3 and 14 million dwelling units estimated without a transparent methodology. The wide range of estimates demonstrates the multiple interpretations of the term's meaning. In the paper, changes in household formation trends in urban Indonesia from 1990 to 2007 are used to estimate a quantitative housing deficit. I find the decreasing rate of household formation that is being interpreted as a housing deficit. However, this interpretation is complicated by the country's demographic transition and the high urbanization rate. Further, the abrupt change in household formation occurred around the year 2000, suggesting that the economic and political upheavals following the Asian financial crisis played an important role. Comparison of household formation rates across socioeconomic groups and urban areas shows housing markets also matter, illustrating the complexity of the issue.

Hedonic price models with omitted variables and measurement errors: a constrained autoregression–structural equation modeling approach with application to urban Indonesia

Omitted variables and measurement errors in explanatory variables frequently occur in hedonic price models. Ignoring these problems leads to biased estimators. In this paper, we develop a constrained autoregression–structural equation model (ASEM) to handle both types of problems. Standard panel data models to handle omitted variables bias are based on the assumption that the omitted variables are time-invariant. ASEM allows handling of both time-varying and time-invariant omitted variables by constrained autoregression. In the case of measurement error, standard approaches require additional external information which is usually difficult to obtain. ASEM exploits the fact that panel data are repeatedly measured which allows decomposing the variance of a variable into the true variance and the variance due to measurement error. We apply ASEM to estimate a hedonic housing model for urban Indonesia. To get insight into the consequences of measurement error and omitted variables, we compare the ASEM estimates with the outcomes of (1) a standard SEM, which does not account for omitted variables, (2) a constrained autoregression model, which does not account for measurement error, and (3) a fixed effects hedonic model, which ignores measurement error and time-varying omitted variables. The differences between the ASEM estimates and the outcomes of the three alternative approaches are substantial.

Communal Consumption of VCD/DVD and Social Change in the Urban Kampung Community Indonesia

This study looks at the consumption of video disc among the viewers in such urban middle-lower class community settlement in Surabaya, Indonesia. The entertainment consumers in urban Indonesia have been spoiled with cheap of abundance piracy productions of foreign and national films, TV soaps, dramas, and other audio visual materials in the form of VCD and/or DVD in the market. Apart from this feature, the consumption of sexual scenes and pornographic materials has become the so-called ‘common secret’ among those social class communities in their everyday of media consumption. They do not just buy the discs, but also rent and swap each other within the kampung neighbourhood environment. Applying an ethnography method, this study observes the discourse of cultural consumption of the middle-lower class community toward the audio-visual productions of VCD and/or DVD in such neighbourhood alley and the practice of communal consumption. The result shows how those kampung communal viewers have experienced as spectators of a “dish of entertainment” in their particular class context, as well as practicing the mode of communal imaginative experience in the contemporary cultural liberalisation in Indonesia post-authoritarian era. Keywords: urban kampung community, cultural consumption, communal consumption, spectatorship

Traditional jamu versus industrial jamu: perceptions and beliefs of consumers in the city of Yogyakarta: what future for traditional herbal medicine in urban Indonesia?

Jamu is the Indonesian traditional herbal medicine practiced in the Indonesian community to maintain good health and to treat diseases. The Jamu industry in Indonesia is predominant among Indonesia’s traditional health systems and its popularity is increasing. The paper analyses the different socio-cultural values and perceptions of traditional jamu and industrial jamu among young consumers in the urban environment. It provides insights on the ways in which these traditional practices are perceived to improve the health and well-being of the jamu customers. This paper also aims to give an understanding of the process of internationalisation of the herbal sector in Indonesia and to shed light on the challenges met in exporting the traditional medicinal products in Asia as well as in other western countries. The comprehension of these elements can give some interesting insights on the future evolution of this traditional medicinal system in Asia as well as in other Western countries.

Using Engel curves to measure CPI bias for Indonesia

To measure real income growth over time, a price index is needed to adjust for changes in the cost of living. The consumer price index (CPI) is often used for this task; but several country studies show that it is a biased measure of such changes, leading to potentially inaccurate estimates of the rate of real income growth. This paper calculates CPI bias for urban Indonesia by estimating food Engel curves for households with the same level of CPI-deflated incomes at four different points in time between 1993 and 2008. The results suggest that CPI bias was negative during the 1997–98 crisis but has been positive since 2000. From 1993 to 2008, CPI bias averaged 4% annually, equivalent to almost one-third of the measured inflation rate.