Child

health
Indonesia
Profile 1. Demographics and Information System
Under-five population (2005)1 22 000 000
Compiled Annual number of births (2005)1 4 000 000
Birth registration coverage2 55%
by the Coverage of vital registration of deaths (2002) 3 <25%
department … No information available
Sources: 1 World Population Prospects – the 2006 revision. UN Population Division. New York, 2007; 2 UNICEF. The State of the
of Child and World’s Children 2007; 3 WHO. World Health Statistics 2007.

adolescent
2. Health Status Indicators
health and
2.1 Neonatal, infant and under-five mortality
development
Neonatal mortality rate per 1000 live births (2004)1 17
CAH Annual number of neonatal deaths (2004)* 61 000
Infant mortality rate per 1000 live births (2005)1 28
Annual number of infant deaths (2005) 2 126 000
Under-five mortality rate (2005)1 36
Annual number of under-five deaths (2005) 2 161 000
Neonatal causes as a proportion of all under-five deaths (2000) 3 38%
Sources: 1 WHO. World Health Statistics 2007; 2 WHO Mortality database 2007; 3 CHERG/CAH/WHO (published in the World Health
Statistics 2007 ).
* Note: Calculated based on CHERG estimates for neonatal causes of death.

2.1.1 Under-five mortality: when, where, and why

When
Distribution of under-five deaths by age groups
50
Based on mortality estimates from the
Proportional mortality (%)

40 IACMEG for 2005, 78% of all under-five

deaths in Indonesia occur during the
30
first year of life: 38% in the neonatal
20 period and another 40% between
the first and the eleventh month. The
10
remaining 22% occur between the
0 second and the fifth years of age.
0–28 days of life 1–11 months 1–4 years of age
Period of life

Source: Calculated based on data from the Inter-Agency Child Mortality Estimation Group – IACMEG) – WHO/UNICEF/World Bank/
UNPD and independent experts; and on CHERG estimates of the proportion of neonatal deaths.

Distribution of neonatal deaths by day of life

30
Based on 289 neonatal deaths Of the 289 surveyed neonatal deaths by
25 DHS in Indonesia in 2002/2003:
Number of deaths (%)

20
• 30% occurred on day 0;
15 • 52% on days 0 and 1; and
10 • 78% during the first week of life.
5

0
0 5 10 15 20 25 30
Days of life

CAH Source: DHS Indonesia, 2002/2003.

Indonesia


 Where
Child
Bali According to DHS 2002–03, the highest
health DI Yogyakarta
DKI Jakarta
under-five mortality rates were seen in
West Nusa Tenggara province and the
Central Java
Profile Central Kalimantan lowest in Bali. There was a more that
South Sumatra 5-fold difference in the magnitude of
Compiled East Kalimantan U5MRs between the highest and lowest
West Java risk provinces.
by the Jambi
Still according to DHS 2002–03, there
East Java
department South Kalimantan were also important differences in
North Sumatra the neonatal mortality rates (NNMRs)
of Child and North Sulawesi between regions. NNMRs varied from
West Sumatra
adolescent 9.5 per 1000 live births in Bali to
Riau
West Kalimantan
36.1 per 1000 live births in Southeast
health and Lampung Sulawesi.
Bengkulu
development Central Sulawesi
South Sulawesi
CAH East Nusa Tenggara
Southeast Sulawesi
West Nusa Tenggara
0 20 40 60 80 100 120
Under-5 mortality

Source: Indonesia DHS 2002–03.

Why
Infectious diseases such as diarrhea (18%), pneumonia (14%), and measles (5%) account for more 37%
of the 161 000 deaths that occurred among under-fives in Indonesia in 2005.
Among the 61 000 neonatal deaths that are estimated to have occurred in 2004–2005:
• About 22% were due to infections (severe infections including pneumonia, neonatal tetanus, and
diarrhea);
• Another 69% were due to birth asphyxia (30%), preterm births (32%), and congenital anomalies
(7%).

Estimated* distribution of causes of neonatal and under-five deaths

Acute respiratory
infections
Malaria 0.5% 14%
Measles 5% Small/very small at birth: 14%

Diarrhoeal diseases
(post-neonatal) Neonatal
18% causes
38%
Diarrhoeal diseases 1%
Congenital abnormalities 7%

Other 22% Birth asphyxia

30%
Injuries Preterm births
3% 32%

Severe infections 20% Other neonatal 9%

Neonatal tetanus 1%

Sources: DHS Indonesia, 2002/2003 for size of child at birth; CHERG/CAH for distribution of causes of under-five deaths (published
in the World Health Statistics 2007); and CHERG Neonatal Group for distribution of neonatal causes of death (Mortality profiles.
Geneva, World Health Organization, 2007 (http://www.who.int/whosis/mort/profiles)).

* These are estimated proportions of causes of death obtained from models with input data from available population-based
studies from 51 countries (for detailed methods and list of references please refer to Bryce et al, 2005 and Rudan et al, 2005),
CAH including 3 studies carried out in Indonesia (Nelson CM et al, 2000; Humphrey JH et al, 1996;Nazir M, 1985). These estimates are
not necessarily the same as those from the Member State, which may use alternative methods of estimation of causes of death.

However, all Member States have undergone an official country consultation on these estimations (Documents available upon
Indonesia request).


 2.1.2 Rate of progress towards MDG4
Child
Trends in under-five and infant mortality rates (1980–2005)* and extrapolations to the year 2015
health 150 Goal 4 of the Millennium Development

Mortality rates per 1000 live births

Goals is to reduce by two thirds
Profile between 1990 and 2015, the underfive
100
mortality rate.
Compiled Target for
MDG4:
by the 50
30
U5MR
department IMR
0
of Child and
1980 1985 1990 1995 2000 2005 2010 2015
adolescent Source: Child Mortality Coordination Group – WHO/UNICEF/World Bank/ UNDP and independent experts.
* These figures are computed by the UN agencies and are not necessarily the official statistics of Member States, which may use
health and alternative methods of estimation of mortality.
development
• The estimated baseline (1990) under-five mortality rate (U5MR) in Indonesia was 91 per 1000 live
CAH births;
• In order to achieve MDG4, the U5MR should be equal to 30 per 1000 live births in 2015;
• Indonesia has been showing an important decreasing trend in U5MR since 1980. If these trends continue
to be similar to that observed in the most recent period (between 2000 and 2005), U5MR in Indonesia
will be equal to 12 per 1 000 live births in 2015, i.e. 2.5 times lower than the aimed target based on 1990
rates.

Trends in neonatal mortality rates

40 DHS has reported a NNMRs for the
following years/periods: 1987, 1991,
NNMR per 1000 live births

30 1994, 1997, and 2002–2003. These

were 27, 32, 30, 22, and 20 per
20 1000 live births, respectively. WHO
estimated NNMRs were 18 and 17 per
10
1000 live births in the years 2000 and
2004, respectively.
0
1987 1991 1994 1997 2002–2003

Sources: DHS Indonesia 1987,1991,1994,1997and 2002/2003.

2.2 Morbidity and nutritional status

Number of episodes of pneumonia per child per year (2000)1 0.28 e/cy
Total number of cases of pneumonia per year (2000)1 5.8 million
Percent of children under-five with diarrhoea in the two weeks preceding the survey 2 11%
Prevalence of anaemia among children 6–59 months2 …
Percent of babies perceived as very small/smaller than average2 14%
Percent of children under-five stunted (-2SD) 2 …
Percent of children under-five wasted (-2SD) 2 …
Percent of children under-five underweight (-2SD) 2 …
… No information available.
Sources: 1 Rudan I et al. Data not published; 2 DHS Indonesia 2003/2003.

CAH

Indonesia


 Child 3. Outcome Indicators
3.1 Effective coverage of interventions for newborns and infants
health 100
PNC (98%)
Profile 80
Any ANC (92%) Any breastfeeding (96%)

Coverage (%)
60
Compiled
40
by the
20
department
0
of Child and ANC
(at least
TT2
(2 doses
ART
prophylaxis
Skilled
attendant
Delivery by
C-section
PNC
(within
ART
prophylaxis
Breastfeeding Infants <6 months
initiated within exclusively
4 visits) or more) (mother) at birth 2 days) (baby) 1 hour of birth breastfed
adolescent
Sources: DHS Indonesia 2002/2003; UNICEF. PMTCT Report card 2005 (http://www.uniteforchildren.org/knowmore/files/ufc_
health and PMTCTreportcard.pdf

development
3.2 Effective coverage of interventions for older infants and children under-five
CAH 100
45% by
12 months
80
36%
Coverage (%)

60 received ORS

40

20

0
Children 6–59 months Under-fives with ARI Under-fives with fever Under-fives with Children
who received vitamin A symptoms taken to who received any diarrhoea 12–23 months
in previous 6 months health facility/provider antimalarial drugs who received ORT fully vaccinated

Source: DHS Indonesia 2002/2003.

3.3 Trends in coverage of some newborn and child health interventions

100
1987 1991 1994 1997 2002–2003
Proportion of coverage (%)

80

60

40

20

0
Skilled attendant Breastfeeding initiated Infants <6 months Children 12–23 months Under-fives with Under-fives with ARI
at birth within 1 hour of birth exclusively breastfed fully vaccinated diarrhoea who taken to health
received ORT facility/provider

Source: DHS Indonesia 1987,1991,1994,1997and 2002/2003.

3.4 Inequities in coverage of some interventions by education of the mother

100
No education Secondary +
80
Coverage (%)

60

40

20

0
ANC (any) Skilled C-section PNC Breastfeeding Children Under-fives Under-fives
attendant at (at any time) initiated 12–23 months with diarrhea with ARI
CAH birth within 1 hour
of birth
fully
vaccinated
receiving
ORT
symptoms
taken to health
facility/provider

Source: DHS Indonesia 2002/2003.

Indonesia


 Child 4. Input Indicators
4.1 Health policies and political commitment
health User fee protection for women and children …
Legal & regulatory measures on marketing breast milk substitutes …
Profile Establishment of national MNCH task force …
Compiled … No information available

by the
4.2 Health system
department Child hospital system
of Child and Number of baby-friendly facilities (2002)1 91

adolescent Health expenditure 20042

Per capita government expenditure on health (US$) 11
health and
General government expenditure on health as % of total government expenditure 5%
development Out-of-pocket expenditure as % of total expenditure on health 49%

CAH Human resources

Physicians per 1000 population 0.13
Nurses per 1000 population 0.57
Midwives per 1000 population 0.25
Source: 1 UNICEF:http://www.unicef.org/nutrition/files/nutrition_statusbfhi.pdf; 2 WHO. World Health Statistics 2007.

Definitions of acronyms and indicators used

Acronyms
CAH Department of Child and Adolescent Health and Development
WHO World Health Organization
UN United Nations
UNPD UN Population Division
UNICEF The United Nations Children’s Fund
CHERG Child Health Epidemiology Reference Group
DHS Demographic and Health Survey
U5MR Under-five mortality rate ( 5q0)
IMR Infant mortality rate (1q0)
NNMR neonatal mortality rate
ANC Antenatal care
TT Toxoide tetanicus
ART Antiretroviral therapy
ORT Oral Rehydration Therapy
ORS Oral Rehydration Solution
ARI Acute respiratory infection

Indicators*
Any ANC = Percent distribution of women who had a live birth in the five years preceding the survey
receiving at least 1 antenatal care (ANC) visit during pregnancy for the most recent birth.
ANC (at least 4 visits) = Percent distribution of women who had a live birth in the five years preceding
the survey receiving at least 4 antenatal care (ANC) visits during pregnancy for the most recent birth.
TT (2 doses or more) = Percent distribution of women who had a live birth in the five years preceding the
survey who received 2 or more tetanus toxoid injections during pregnancy for the most recent birth.
ART prophylaxis (mother) = Proportion of all HIV-positive pregnant women who received ART prophy­
laxis.
ART prophylaxis (baby) = Proportion of all HIV-exposed babies (babies born from an HIV-infected mother)
who received ART prophylaxis.
CAH Skilled attendant at birth = Percent distribution of live births in the five years preceding the survey that
received assistance from a skilled birth attendant (general practitioner, obstetrician/gynecologist, nurse/
midwife/village midwife) during delivery. If the respondent mentioned more than one person attending
Indonesia during delivery, only the most qualified person is considered in this tabulation.


Delivery by C-section = Percentage of live births in the five years preceding the survey delivered by
caesarean-section.
 PNC (any time) = Percent distribution of women who had a non-institutional birth in the five years
Child preceding the survey who received postnatal care for the most recent non-institutional birth at any time
after delivery.
health
PNC(within 2 days) = Percent distribution of women who had a non-institutional birth in the five years
Profile preceding the survey who received postnatal care for the most recent non-institutional birth within 2
days after delivery.
Compiled Breastfeeding ever = Percentage of children born in the five years preceding the survey who were ever
breastfed.
by the
Breastfeeding initiated within 1 hour of birth = Among children born in the five years preceding the
department survey who were ever breastfed, percentage of those who started breastfeeding within one hour of
of Child and birth. Data are based on all births whether the children are living or dead at the time of interview.

adolescent Infants < 6 months exclusively breastfed = Proportion of youngest children under three years living with
the mother who were exclusively breastfed until 6 months of age. Breastfeeding status refer to a 24-
health and hour period (yesterday and the past night).

development Children 6–59 months who received Vit A in previous 6 months = Percentage of children age 6–59 months
who received vitamin A supplements in the six months preceding the survey.
CAH Under-fives with ARI taken to a health facility/provider = Percentage of children under five years of age
with symptoms of acute respiratory infection (cough accompanied by short, rapid breathing) and/or fever
in the two weeks preceding the survey for whom treatment was sought from a health facility or provider
(excludes pharmacy, shop, and traditional practitioner).
Under-fives with fever who received any antimalarial drugs = Percentage of children under five years who
were ill with fever during the two weeks preceding the survey and who received an antimalarial drug.
Children 6–59 months who received Vit A in previous 6 months = Among all children 6–59 months the
percentage who were given vitamin A supplements in the six months preceding the survey.
Under-fives with diarrhoea who received ORT = Percentage of children under age five who had diarrhoea
in the two weeks preceding the survey and who received oral rehydration therapy (ORT). ORT includes
solution prepared from packets of oral rehydration salt (ORS), recommended homemade fluids (RHF), or
increased fluids.
ORS = Percentage of children under age five who had diarrhoea in the two weeks preceding the survey
and who received solution prepared from oral rehydration salt (ORS) packets.
Children 12–23 months fully vaccinated = Percentage of children age 12–23 months who received all
vaccines (BCG, measles, and three doses each of DPT-HB and polio vaccine (excluding polio vaccine given
at birth)) at any time before the survey, by either source of information (vaccination card or mother’s
report).
By 12 months = Percentage of children age 12–23 months who received all vaccines (BCG, measles, and
three doses each of DPT-HB and polio vaccine (excluding polio vaccine given at birth)) by 12 months of
age, by either source of information (vaccination card or mother’s report).
* Definitions are those provided in the surveys where data were obtained from.

References
Bryce J, Boschi-Pinto C, Shibuya K, Black RE; WHO Child Health Epidemiology Reference Group. WHO
estimates of the causes of death in children. Lancet 2005; 365:1147–52.
Rudan I, Lawn J, Cousens S, Rowe AK, Boschi-Pinto C, Tomaskovic L, Mendoza W, Lanata CF, Roca-
Feltrer A, Carneiro I, Schellemberg JA, Polasek O, Weber M, Bryce J, Morris SS, Black RE, Campbell H.
Gaps in policy-relevant information on burden of disease in children: a systematic review. Lancet 2005;
365:2031–40.
Nelson CM, Sutanto A, Gessner BD, Suradana IG, Steinhoff MC, Arjoso S. Age- and cause-specific
childhood mortality in Lombok, Indonesia, as a factor for determining the appropriateness of introducing
Haemophilus influenzae type b and pneumococcal vaccines. J Health Pop Nutr 2000; 18:131–8.
Humphrey JH, Agoestina T, Wu L, Usman A, Nurachim M, Subardja D, Hidayat S, Tielsch J, West KP Jr,
CAH Sommer A. Impact of neonatal vitamin A supplementation on infant morbidity and mortality. J Pediatr
1996; 128:489–96.
Nazir M, Pardede N, Ismail R. The incidence of diarrhoeal diseases and diarrhoeal diseases related mortality
Indonesia in rural swampy low-land area of south Sumatra, Indonesia. J Trop Pediatr 1985; 31:268–72.