Strengthening emergency preparedness and response systems: experience from Indonesia.

Indonesia has made excellent progress on emergency preparedness in compliance with the International Health Regulations, 2005, including a joint external evaluation (JEE) of IHR core capacities in 2017. Development of the National action plan for health security (NAPHS) began soon after the JEE, through multisectoral coordination and collaboration and with the support of a presidential instruction. The logic model approach was used to develop the NAPHS, and provided a robust framework to ensure that activities were linked to indicators at the various capacity levels delineated in the JEE. The NAPHS includes a comprehensive tool within which monitoring and evaluation are completely separated and different indicators applied. Furthermore, development of the NAPHS was done in parallel and in line with that of the National medium-term development plan 2020-2024, which included a focus on health system strengthening based on the primary health-care approach. An innovative approach taken in 2018 was the inclusion of emergency preparedness in the mandatory minimum service standards for provincial and district governments. These standards clearly articulate the importance of local emergency preparedness in Indonesia's decentralized governance through the development of contingency plans and simulation exercises for natural disasters and potential disease outbreaks. Development of the NAPHS has benefited from Indonesia's extensive experience in pandemic influenza preparedness planning and exercises, integrated with a national disaster management system. By signing the Delhi Declaration on Emergency Preparedness in the South-East Asia Region, Indonesia has signalled its commitment to implementing the NAPHS in full, focusing on enhanced emergency preparedness at all administrative levels.

Risk factors for nutrition-related chronic disease among adults in Indonesia.

OBJECTIVE: To conduct a secondary data analysis detailing the associations between sociodemographic and behavioral factors and nutrition-related chronic disease. METHODS: These analyses utilized 2014 data from the Indonesian Family Life Survey, a home-based survey that collected socioeconomic, dietary intake, physical activity, and biological data among adults. We explored four outcomes in relation to sociodemographic and behavioral determinants: 1) hypertension, 2) elevated high-sensitivity c-reactive protein (hs-CRP), and 3) central obesity, as these are critical metabolic determinants in the progression to cardiovascular disease, and 4) type 2 diabetes. Hypertension was defined as systolic blood pressure ≥140 mm or diastolic blood pressure ≥ 90mm or current use of antihypertensive medication. Elevated hs-CRP was defined as hs-CRP >3 mg/dL. Central obesity was defined as waist circumference ≥ 90 cm if male and waist circumference ≥ 80 cm if female, which are specific to South Asia. Type 2 diabetes was defined as glycated hemoglobin ≥ 6.5%. We employed separate gender-stratified multivariate logistic regression models to test the associations between sociodemographic and behavioral determinants and each nutrition-related chronic disease outcome. All analyses employed sampling weights, which account for the survey design. RESULTS: In 2014, about 30% of adults were hypertensive and one-fifth had elevated hs-CRP. Approximately 70% of women had central obesity and 11.6% of women and 8.9% of men had diabetes. Older-age was consistently associated with nutrition-related chronic disease and being overweight was associated with hypertension, elevated hs-CRP, and type 2 diabetes. Regularly consuming instant noodles (women) and soda (men) were associated with elevated hs-CRP and soda consumption was associated with central obesity among men. CONCLUSIONS: Large segments of the adult population in Indonesia now have or are at risk for non-communicable disease. Our analyses provide preliminary empirical evidence that interventions that target healthful food intake (e.g. reduce the intake of ultra-processed foods) should be considered and that the reduction of overweight is critical for preventing chronic diseases in Indonesia.

Iodine Intake Estimation from the Consumption of Instant Noodles, Drinking Water and Household Salt in Indonesia.

The objective of this study was to assess the contribution of iodine intake from iodised household salt, iodised salt in instant noodles, and iodine in ground water in five regions of Indonesia. Secondary data analysis was performed using the 2013 Primary Health Research Survey, the 2014 Total Diet Study, and data from food industry research. Iodine intake was estimated among 2719 children, 10-12 years of age (SAC), 13,233 women of reproductive age (WRA), and 578 pregnant women (PW). Combined estimated iodine intake from the three stated sources met 78%, 70%, and 41% of iodine requirements for SAC, WRA and PW, respectively. Household salt iodine contributed about half of the iodine requirements for SAC (49%) and WRA (48%) and a quarter for PW (28%). The following variations were found: for population group, the percentage of estimated dietary iodine requirements met by instant noodle consumption was significantly higher among SAC; for region, estimated iodine intake was significantly higher from ground water for WRA in Java, and from household salt for SAC and WRA in Kalimantan and Java; and for household socio-economic status (SES), iodine intake from household salt was significantly higher in the highest SES households. Enforcement of clear implementing regulations for iodisation of household and food industry salt will promote optimal iodine intake among all population groups with different diets.