INTRODUCTION

CHILD HEALTH SITUATION in

INDONESIA
and CONTRIBUTING FACTORS

Bagian Ilmu Kesehatan Anak FK UNSRAT/

RSU. Prof. Dr. R.D. Kandou-Manado

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 CHILDREN IN INDONESIAN : 77.8 million
(Unicef, 2000)

• Infants 4.5 m
• Underfives 22 m
• Primary School Ages 29 m
• Adolescences 22 m

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 GROWTH
Increase of physical size
Height, weight, head circumference etc.

DEVELOPMENT
Increase of ability in human function
-physical (motoric),
-cognitive (intelligence)
- affective (emotion-social),
.

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CHILD GROWTH & DEVELOP. QUALITY
Determinants : INTRINSIC (genetic- heredoconstitutional)
+ EXSTRINSIC ( environment)
(Kobayashi, 1985;
Sularyo, 1989;
Ismael, 1991,) ENVIRONMENT
ROLE:
to met :

Bio +
Psycho-
social need
PSYCHO Mother, subtitute

SOCIAL
mother BIO:
, Parent, sibling, caregiver,
toys, norm, rule, stimulation nutrition,
Love, care, imunisation,
Health Service, Education
Stimulation Neighbor, peer
medicine,
cognitive, Gov. Policy, International cloth, etcl
emotion- UNICEF, WHO
sociall
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 THE QUALITY OF FAMILIES
1. EDUCATION : illiteracy 16 millions
• Father: 49 % Primary + Secondary School
• Mother : (Primary 31.7%, Secondary 11,7 %).
• Illiteracy : adult female 12 %, male 10 % (Unicef, 1999).
• Female illiteracy (1997) on village 19.12 %, urban 8.06%,
• Male illiteracy on village 9.26 %, urban 2.87 %.
(females 2 - 3 X > males )
.
2. AGE ON FIRST MARRIED, FAMILY PLANNING
first married < 17 tahun : village 24.4 %, urban 16.1 %
Use contraceptive (1997/1998) 66.9 %

3. FEMALE STATUS IN FAMILY

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 QUALITY OF FAMILIES

4. HYGIENE and SANITATION

• UNSAFE WATER : village 38 %, urban 13 %
Coliform contamination > 100 / 100 ml  63 %.
Contaminated Risk : very high 15.04 %, high 21.06 %
• UNSAFE SANITATION : village 79 % urban 36 %

• House without window 32 %

5. POVERTY : 39.1 % keluarga miskin

6. UNEQUAL POPULATION DISTRIBUTION,

GEOGRAPHICAL HANDICAP, DISTANCE

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 THE QUALITY OF MATERNAL
and CHILD HEALTH SERVICES

1. MATERNAL and INFANT HEALTH SERVICE

• unreach 22 % ( 1,1 m) pregnant women and infant
• geographics, population distribution, sosio-economic,
• social status of females, education (Depkes, 1997).

2. DELIVERY
• traditional birth attendance 47.5 % (2,3 m deliveries)
• by family 8.2 % (400.000 deliveries),
• at home 71.9 % (SKRT 1995).

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 THE QUALITY OF MATERNAL
and CHILD HEALTH SERVICES
3. POSYANDU (INTEGRATED SERVICE POST)
• 244.032 Posyandu : 45 % elementary (110.563),
active posyandu 80 % ( 37.6 % - 85.6 %).
• 1996 ; each Posyandu have 4.6 kader,
1997  4.4 kader / Posyandu
• balita brought to Posyandu : 1.2 x / fam / year
(range 0.1 - 4.62)

4. BKB, PADU, PPA, TPA, TK ?  limited area

• geographic handicap, unequal population distribution
• SUPERVISION ?: unintensive, poor monitoring and
evaluation ?, project oriented ?

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 THE QUALITY OF MATERNAL
and CHILD HEALTH SERVICES

5. PRIMARY HEALTH SERVICE

•Puskesmas : 12 % no doctor.
•Puskesmas doctor 45 % - 80 % (some Province)
•Nurse : unequal distribution (3 - 4/1000 people)
•PTT Midwive : poor quality of skill ( crash program)
•Geographic handicap, socio-culture.
6 .REFERRAL HOSPITAL
•Pediatricians on Hospital type D : 0.24 / Hospital,
•Obs-Gyn : 0.35 / H.
•blood bank, medicine, budget, facility
• Distance, geographic, transportation

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 MATERNAL HEALTH STATUS

1. NUTRITIONAL STATUS ON PREGNANT WOMEN

• CHRONIC MALNOURISHED : 30 % (1,5 million) pregnancy
• FE DEFF ANEMIA : 40.5 - 51 % (2 – 2,5 m) since first
trimester
• Fe tablet (minimum 90 tebletss) just 23.4 % pregnancy
12,2 % (600.000) never had Fe tablet
• SHORT STATURE (small pelvic)
•height < 140 cm : 5 % (250.000 women),
•140 - 144 cm : 11 % (550.000 women ) .

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 MATERNAL HEALTH STATUS

2. REPRODUCTIVE CHARACTERISTIC (age, spacing,

number of delivery)
• too young (< 20 year) : 14 % (700.000 pregnancy),
• too old (r > 35 tahun) : 12.7 % ( 600.000 pregnancy).
• too short spacing (< 2 tahun) : 17 %,
• too frequent (> 4 X ) : 35.1 %

3. MATERNAL HEALTH CARE

• never : 22.1 % ( 1,1 m illion pregnancy).
• delayed (since 7 mo) : 18,2 % (900.000 pregnancy),
• delyed (since 4 mo) : 33.1 %.
• < 4 X during pregnancy : 26 %

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 MATERNAL HEALTH STATUS
4. MATERNAL MORTALITY
• 373 / 100.000 pregnancy (18.000 maternal /year )
• Every day : 50 maternal mortality
• Every hour : 2 maternal mortality

THREE DIRECT CAUSES OF MATERNAL MORTALITY

• bleeding (36.1%),
• toksemia gravidarum (25%),
• Infection, delayed delivery, abortus (11.1%)

THREE TOO LATE:

1. to identify dangerous signs,
2. to reach the hospital
3. to get adequate intervention

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 MATERNAL HEALTH STATUS
MATERNAL MORTALITY
UNDIRECT CAUSES
1. Nutritional status (Chronic malnutrition, anemia)
2. Reproductive characteristic (age, spacing, no. of
delivery)
3. Maternal health care (delayed or never)
4. Unable to pay for delivery
.
BASIC CAUSES
• Education (< Secondary school)
• Women status in society or family
• Poverty
• Geographic handicap, distance, transportation

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 CHILD MORTALITY
BIRTH RATE : 4.8 million / year (9 babies /minute)
PERINATAL MORTALITY (umur < 1 bulan)
 1 baby < 1 mo / 10 minutes
INFANT MORTALITY (age < 1 year)
40/ 1000 life birth / year (Unicef, 2000)
186.500 babies die / year, 511 babies / day,
22 babies / hour ,  1 baby / 3 minutes
UNDERFIVE MORTALITY (56-59 / 1000 lifebirth)
(Depkes 1998, Unicef 2000), 261.000 under5 / year,
715 under5/ year , 30 under5/hour 1 under5/ 2 mnt

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 Perinatal Mortality (> 1 mo)
Direct cause :
Fetal/perinatal problems :
respiratory & circulatory distress (45.5%),
Low birth weight / premature (32.8 %)
Infection (6.9%)
Hypothermia (5,9 %)
Tetanus (3.4%)
Metabolic (1.7%)
Maternal problems :
Nutritional status, reproduction (age, spacing, birth), prenatal
care, diseases

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Cause of death
on infant and underfives
Severe acute respiratory tract infection (pneumonia)
diarrhoea
malnutrition
other infection

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 INFANT & CHILD HEALTH STATUS
1. LOW BIRTH WEIGHT (< 2.5 kg) : 450.000/year
2. PERINATAL CARE (< 1 mo) unadequate
Umbilical care : traditional 17,7% (800.000 perinatal).
Never seen by health staff before 1 mo of age (30 % )
Pra lacteal feeding :
banana 17 % air tajin 9.3%, sugar or honey 3.1 %,
others 9.5%.
Geographical handicap, poverty, culture

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 INFANT and CHILD HEALTH STATUS

2. NUTRITIONAL STATUS
• SEVERE MALNUTRITION (Unicef 2000) 8 % under5
(1,8 milllions underfive)
• SEVERE + MODERATE MALN.: 34 % (7 million under5)
• MILD MALNUTRITION : 26 % (5.2 million underfive).
1996 : mild malnutrition 20.96 %,
increase 5 % (1 millions underfive).
• VITAMINE A DEFF  Severe Malnutrition
• Fe ANEMIA : underfive 40.5 % (9,4 million underfive)
• . Primary School age : 45 – 70 % anemia
• IODIUM DEFF. 30 million s  lower intelligence
• family consumed Iodine Salt 62 %

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 INFANT and CHILD HEALTH STATUS

3. IMMUNIZATION
10 % (450.000) not fully basic immunization .
4. DENTAL:
• Decay, missing, filled : school-age 74.41 %,
• mean 2.5 teeth / child
• Dental health service for primary school 60.16 %.
•  malnutrition
5. MORBIDITY & MORTALITY
• Acute respiratory tract infection (pneumonia),
• Diarrhoea,
• Malnutrition
 Geographic handicap, poverty
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 INFANT and CHILD HEALTH STATUS

6. DELAY DEVELOPMENT  LOWER

INTELLIGENCE
Early detection at Puskesmas
Jabar 1987-1992 : delay development : 2 – 13,2 %
Jateng 1988 – 1992 : delay dev. :2.6 – 4.4 %

7. EDUCATION
• Drop out Primary School : 900.000 child/year
• Primary & Second. School Age not enroll : 6 million
• Secondary School age not enrollbut : 3.6 juta
• Enrollment on Secondary School : 71, 87 %
• Lower intelligence ? : IQ borderline ?, Mentally
retarded ?
• Parent appreciation, poverty, geographics

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 INFANT and CHILD HEALTH STATUS

8. OTHER SOCIAL PROBLEMS

• Child workers :2.5 millions
• Street Childreen : 150.000 child
•l Sexual exploitation : 40.000 – 70.000 child
• Child abuse : ??
• Crime : 4000 child
• Child neglect: ?
• Drug abuse : 120.000 – 1 million ?
• Orphanage ?
• Disabled ?
• in refugee camp ?
•
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 STRATEGI FOR OPTIMIZING
QUALITY OF
CHILD GROWTH and DEVELOPMENT

• Direct to the infant and child

• Indirect : improving quality of family,

especially mother, father and adolescence
girl

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 Improving quality of mother, father
and adolescens girl
1. Improving nutritional status of mother and adolescence
girl: chronic malnutrition, Fe deffiency Anemia Iodium
defficiency
2. Improving educational status mother, father and
adolescen girl : reading for health information and its
application

3. Improving knowledge and skill mother, father and

adolescen girl on :
a. FAMILY PLANNING : pregnant >21 year < 35 year,
spacing for 2 – 3 years, number of child < 3 ,
b. MATERNAL HEALTH : prevention for anemia,
malnutrition, infection
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 c. PREGNANCY CARE : prevention for anemia,
malnutrition, imunization, early identification of bleeding,
toxemia, infection
d. SAFE DELIVERY : especially for high risk mother
(chronic malnourish, anemia, too young or too old, too short,
too short spacing, too frequent, delayed care)
e. INFANT and CHILD CARE : perinatal care,
umbilical, MM, immunization, infant feeding, prevention for
infection, accident, early identification for ARTI, diarrhoea,
malnutrtion

f. EARLY STIMULATION for COGNITIVE and

EMOTION-SOCIAL : playing, BKB, PADU / Early Child
Education
.
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 g. HYGIENE & SANITATION : washing hand
before handle baby, safe water, disposal, safe cooking,
feeding, home ventilatioan

4. Improving knowlegde mother, father and adolescence

girls onf CHILD RIGHT, especially : child protection for
child abuse, neglect, exploitation, drug abuse

5. Improving knowledge and skill for family income

generating by optimizing resource in family at home

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