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Indonesia: country report on children’s environmental health

Article  in  Reviews on Environmental Health · March 2020

DOI: 10.1515/reveh-2019-0088

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 Rev Environ Health 2020; 35(1): 41–48

Review

Budi Haryanto*

Indonesia: country report on children’s

environmental health
[Link]
Received November 4, 2019; accepted January 31, 2020; previously
Introduction
published online March 5, 2020
Indonesia is the world’s largest archipelago, consisting of
Abstract: Children’s bodies are in dynamic stages of devel- approximately 17,504 islands. It is geographically located
opment that make them more susceptible to harm from in South East Asia. The land area is about 1.9 million km2
exposure to environmental agents. Children’s physical, with an estimated population of 266.91  million people
physiological and behavioral traits can lead to increased in 2019 (population density of 134,000 people per km2),
exposure to toxic chemicals or pathogens. In addition, the making it the fourth most populated country in the world.
social determinants of health interact with this exposure The annual growth rate as of 2016 is 1.36%. About 25%
and create an increasing risk for further disparities among of the population is below the age of 15, while 6.5% is
children. In Indonesia, the fourth most populated coun- above 65 years old. It has 300 ethnic groups speaking 350
try in the world, children are under threat of exposure to languages. As of 2018, Indonesia has 33 provinces, 349
contaminated water, air, food and soil, which can cause districts and 91  municipalities, 5656  sub-districts, 71,563
gastrointestinal and respiratory diseases, birth defects villages, and 55,942,000 households.
and neurodevelopmental disorders. A safe and balanced Adult literacy is at 92.74%, with the male population
nutrition is still an unmet need for too many children. At having a higher literacy rate than the females (95.66%
the same time, the prevalence of obesity and the risk of male compared with 89.88% female). Child mortality indi-
later development of metabolic diseases, including diabe- cators have improved in recent years. The improvement
tes and cardiovascular diseases, are increasing as a conse- could be attributed to several factors, such as increased
quence of both unhealthy diets and inadequate physical immunization coverage, community participation, eco-
activity. The risks of potential long-term toxicity, including nomic growth in rural areas, health promotion and educa-
carcinogenic, neurotoxic, immunotoxic, genotoxic, endo- tion, greater community awareness, and improvement in
crine-disrupting and allergenic effects of many chemicals, health facilities and services.
are also close to their lives. This paper provides an over- The general disease pattern has not changed signifi-
view of common disease risks in Indonesian children, cantly over the past decade. The public health sector is
including: acute hepatitis A, diarrheal diseases, dengue currently facing a two-fold burden. First, it has to cope
and malaria due to lack of water supply and sanitation, with the continued presence of a high rate of infectious
vectors, and parasites; asthma, bronchopneumonia, diseases. Second, it has to cope with an increasing trend
chronic obstructive pulmonary disease (COPD) and acute of degenerative, non-infectious diseases due to changes in
respiratory infections (ARIs) due to air pollution and cli- lifestyles. The principal causes of morbidity (2007) were
mate change; some chronic diseases caused by toxic and reported to be infectious diseases and non-infectious
hazardous waste; and direct or indirect consequences due diseases. The highly infectious diseases include acute
to the occurrence of disasters and health emergencies. respiratory infections (ARIs), diarrhea, malaria, typhoid,
dengue hemorrhagic fever (DHF), tuberculosis and HIV/
Keywords: children’s health; environmental exposure;
AIDS. The prevalence rate of ARI is 2.6 per 1000 popula-
Indonesia.
tion, and of diarrhea is 0.9 per 1000 with a case fatality rate
(CFR) of 2.5%. The annual parasite index of malaria is 23.9
per 100,000 population out of Java Bali. The incidence of
tuberculosis is 104 per 100,000 population. The incidence
*Corresponding author: Budi Haryanto, University of Indonesia,
Research Center for Climate Change, Depok, Jawa Barat, Indonesia;
of DHF is 52.5 per 100,000 population with a CFR of 1.04.
and University of Indonesia, Environmental Health, Depok, Jawa In 2007, the reported number of cases for HIV was 5230
Barat, Indonesia, E-mail: bharyanto@[Link] and the number of cases of AIDS was 8194. In addition,

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42      Haryanto: Indonesia: country report on children’s environmental health

avian influenza is considered as a threat to human health. 1.8%; prevalence of stroke increased from 7% to 10.9%;
Immunization coverage of Bacillus Calmette-Guérin (BCG) prevalence of chronic renal disease increased from 2% to
for children aged 12–13 months is 86.9%; for polio3 is 71%; 3.8%; diabetes mellitus increased from 6.9% to 8.5%; and
for diphtheria, pertussis and tetanus (DPT)3 is 67.7%; hypertension increased from 25.8% to 34.1%. The preva-
for hepatitis B (HB)3 is 62.8%; and for measles is 81.6%. lence of smoking among teenagers (10–18 years old) was
Immunization coverage varies widely, and outbreaks of reported to increase from 7.2% to 9.2%, and the propor-
measles frequently occur. The non-infectious diseases tion of less physical activities was found to increase from
include hypertension, cardiovascular disease, diabetes 26.1% to 33.5% (2, 3).
mellitus and stroke. The prevalence of stroke was reported
to be 8.3%, hypertension was 7.6%, cancer of all types was
4.3% and diabetes mellitus was 1.1% (1).
Over the past decades, Indonesia has made signifi-
Children’s environmental health
cant progress in improving the health status of its popula-
Environmental health focuses on the relation between
tion. Life expectancy has risen from 63.9 years in 1997 to
the environment and human health, especially diseases
69 years in 2007. The infant mortality rate (IMR) fell from
caused by agents (biological, chemical, physical and radi-
46 per 1000 live births in 1997 to 21.4 live births in 2017.
ation) in air, water, soil, food and vectors, and the methods
The maternal mortality ratio (MMR) has recorded a sig-
used to diagnose and prevent such diseases. The main
nificant decline from 334 per 100,000 live births in 1997
burden of diseases due to environmental exposure include
to 228 in 2007 and 126 in 2015. The mortality rate in chil-
the following: (1) exposure to contaminated water, air,
dren under 5  years of age has also declined from 58 per
food and soil can cause gastrointestinal and respiratory
1000 live births in 1997 to 25.4 per 1000 live births in 2017.
diseases, birth defects and neurodevelopmental disorders,
Nevertheless, these figures are still high when compared
all of these accounting for another one-sixth of the total
to those in neighboring Asian countries.
burden of disease; (2) safe and balanced nutrition is still an
The principal causes for prenatal mortality are res-
unmet need for too many children, and at the same time the
piratory infections (35.9%) and premature births (32.3%),
prevalence of obesity and the risk of later development of
and for neonatal mortality are sepsis neonatorum (20.5%)
metabolic disease, including diabetes, and cardiovascular
and congenital malformations (18.1%). The principal
disease are increasing as a consequence of both unhealthy
causes for infant mortality are diarrhea and pneumo-
diets and inadequate physical activity; and (3) potential
nia, and for children under 5 years of age, the causes are
long-term toxicity, including the carcinogenic, neurotoxic,
diarrhea (25.2%) and pneumonia (15.5%) (1). The leading
immunotoxic, genotoxic, endocrine-disrupting and aller-
causes of all ages in-hospital deaths (2007) were stroke,
genic effects of many chemicals. The effects of environ-
5.2%; intracranial hemorrhage, 4.4%; diarrhea, 3.3%;
mental tobacco smoke (ETS), persistent organic pollutants
slow development of embryo, 3.1%; septicemia, 3.0%;
(POPs), heavy metals and physical agents (such as ultra-
renal failures, 3.0%; intracranial injury, 3.0%; pneumo-
violet radiation, ionizing radiation and noise) contaminate
nia, 2.1%; diabetes mellitus, 2.9%; and DHF, 2.6%. There
the environment to which men and women of reproduc-
is a discrepancy of IMR between provinces such as West
tive age, as well as children, may be exposed. The profile
Nusa Tenggara (72 per 1000 live births) and Yogyakarta
focuses on four main issues that closely relate to impacts
(19 per 1000 live births). Reaching the poor, especially
of environmental exposures to human health as follows:
children and women, and providing them with adequate
(a) water and sanitation, (b) air pollution, climate change,
and nutritious food at an affordable price is challenging.
and radiation, (c) vectors and parasites, (d) toxic and haz-
The prevalence of malnutrition in children under 5 years
ardous wastes, and (e) disaster and health emergency.
of age is 54 per 1000 children, and for low birth weights
(<2500 g) is 115 per 1000 live births.
Stunting among children aged 5 or below was 37.2% in
2013 (2) and this decreased to 30.8% in 2018 (3). A similar Water and sanitation
trend was also found for malnutrition status, decreas-
ing from 19.6% (2) to 17.7% (3). The prevalence of ARIs Poor water quality continues to pose a major threat to
decreased from 13.6% to 4.4%; malaria decreased from human health. Diarrheal disease alone amounts to an
1.4% to 0.4%; and diarrhea decreased from 18.5% to 12.3%. estimated 4.1% of the total disability-adjusted life years
In contrast, the prevalence of pneumonia increased from (DALY) and is responsible for the deaths of 1.8  million
1.6% to 2%; prevalence of cancer increased from 1.4% to people every year (4, 5). It is estimated that 88% of that

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 Haryanto: Indonesia: country report on children’s environmental health      43

burden is attributable to unsafe water supply and poor the government partners should participate in child pro-
sanitation and hygiene. The population that is most likely tection through provision of water and sanitation services.
to be threatened by waterborne diseases is children, in In 2007, in some provinces, there were still a high
particular those in poor rural communities. Young chil- proportion of population with access to unprotected
dren (<5  years) are at a higher risk than older children clean water, such as 54.1% in Bengkulu, 48.3% in Papua
because of behavior that increases their contact with and 45.8% in Central Kalimantan. The national average
the environment, and diarrheal diseases are an impor- of household clean water usage of less than 20 L/day
tant contributor to malnutrition. A significant amount of is 14.4% with 20 provinces below the average. About a
disease could be prevented through better access to safe quarter of households have a risk of excreta contami-
water supply, adequate sanitation facilities and better nation to their clean water source due to less than 10  m
hygiene practices. ­distance to ­adequate excreta disposal facilities.
Water and sanitation conditions remain very poor in Drinking water services in Indonesia are well estab-
most areas of Indonesia. In 2007, 48.7% of the total pop- lished. Among the total population, 90% were provided
ulation have access to clean water from several sources, with basic water service in 2015. Most residents in the
including piped water from the district-owned water urban areas were provided with basic water service (97%).
company (PDAMs), mineral bottled water, electric pump In addition, 18–20% of the total population had piped
and protected spring water. The remaining population water supplies in Indonesia (9).
obtained water from unprotected waters sources, includ- In 2007, only a little more than half of the households
ing rain water, dug wells, streams and other surface water. (57%) had sanitation facilities at their home, with 40%
Most of the unprotected water sources were contaminated coverage in rural and 73% coverage in urban areas. The
by fecal coliform (6). As some of the piped water systems use of latrines was in 60% of households, with 20 prov-
were contaminated with Escherichia coli and experienced inces with a lower proportion. It was reported that 28.2%
leakage, the results make the proportion of people with of households in rural areas had no latrine (open def-
access to safe water supplies less than 20%. Provision of ecation), while this was only about 8.4% in urban areas.
piped water supply in Indonesia is carried out by PDAMs. About one-fifth of households shared toilet facilities, both
There are more than 400 PDAMs in the country; however, in rural and urban areas. Less than half of all households
they are not able to provide good quality of services used a septic tank facility (71.1% in urban and 32.5% in
because of inefficiency, bureaucratic red tape and lack rural areas) (10). In the same year, the proportion of the
of investment. The main issues in the provision of piped population with adequate excreta disposal facilities was
water supply include operational efficiency and finan- 79.9% in the urban and 54.9% in the rural areas. Of the
cial investment. In 2008, 100% of clean water samples in total household solid waste generated in 2007, only about
Jakarta, the city of Bekasi and the district of Bogor; 50% a quarter was collected. The national average of house-
in the district of Bekasi; and 26% in the city of Cilegon holds without wastewater treatment is 24.9%, with 23
were contaminated by coliform bacteria. Meanwhile, for provinces below that average.
drinking water, 6–57% of water samples in Jakarta, and In 2007, the total annual morbidity attributable to
0–55% in Bekasi, Bogor, Tangerang and Cilegon were con- poor sanitation and hygiene was 124,271,743 people and
taminated by coliform and fecal coli (7). Contamination the total annual mortality attributable to poor sanita-
of chemicals was found in 0–50% of clean water samples tion and hygiene was 50,132 deaths (11). In 2006, it was
in Jakarta, and 25–100% in Bekasi, Bogor, Karawang, reported that the prevalence of diarrhea in Indonesia was
Tangerang and Cilegon. 423 per 1000 population for all ages with a CFR of 2.5%.
The Government of Indonesia has targeted 60% of The outbreaks occurred in 16 provinces.
the population in urban areas, and 40% for those in Sanitation and hygiene are strongly linked and asso-
rural areas for access to piped water, as well as the Mil- ciated with other areas of human development. Improved
lennium Development Goals (MDGs) target in 2015. It sanitation has positive effects on child and adult health,
was estimated that more than USD 3.0 billion would be gender equality, hunger, environmental sustainability,
needed to achieve the target (8). Without such investment, and water resources (clean drinking water). Both directly
it is very hard to reach the MDGs target on water supply and through the various pathways to development,
systems. The provision of adequate drinking water has not improved sanitation will contribute to lifting populations
yet become a developmental priority in Indonesia at the out of poverty, as well as preventing them from slipping
central, provincial and district levels. There are so many back into poverty. Furthermore, improved resource allo-
Indonesian children in vulnerable situations; therefore, cations and incomes at the micro-economic level will

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44      Haryanto: Indonesia: country report on children’s environmental health

eventually lead to positive macro-economic effects that It influences air pollutant emissions as higher emissions
can lead to greater distribution of resources and further of carbon dioxide (CO2) that have caused rapidly worsen-
lift populations out of poverty. ing air pollution, with urban areas being most affected
One of the leading arguments for improving sanitation by air pollution. The transportation sector contributes
is health improvement, which not only has direct impacts the most (80%) to the air pollution, followed by emis-
on welfare through improvements in the quality of life sions from industry, forest fires and domestic activities.
and a reduced risk of premature death, but also affects the The large number of vehicles together with lack of infra-
household economy and leads to greater production in structure results in major traffic congestions, resulting
enterprises. Diarrheal disease is one of the leading causes in high levels of air-polluting substances, which have
of disease, as reflected by the number of related cases and a significant negative effect on public health. Current
deaths. Diarrheal disease predominantly affects children air pollution problems are greatest in Indonesia, as it
under 5, but also children of school age, thus affecting has caused 50% of morbidity across the country (13).
their education. ­Diseases stemming from vehicular emissions and air
The mortality rates due to acute hepatitis A, diarrheal pollution include ARIs; bronchial asthma; bronchitis;
diseases, dengue and malaria have shown a declining eye and skin irritations; lung cancer and cardiovascu-
trend since 1990 (see Figure 1) (12). lar diseases. The prevalence and incidence rate (IR) of
diseases related to air pollution is predicted to become
worse in the near future, as the range of growth of energy
Air pollution and climate change consumption is about 6–8% per year. This has contrib-
uted to an increase of NOx (up to 51%, from 814 kt/year
Climate change in Indonesia greatly affects the economy, in 2015 to 1225 kt/year in 2030), PM2.5 (up to 26%, from
poor populations, human health and the environment. 87.7 kt/year in 2015 to 110.5 kt/year in 2030), as well

Figure 1: Child mortality rate per 100,000 due to infectious diseases in Indonesia (red circles: ages 1–4; green triangles: ages 5–9; blue
diamonds: ages 10–14 years) (source: IHME GBD Results Tool).

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 Haryanto: Indonesia: country report on children’s environmental health      45

as other pollutants, such as SO2, PM10, volatile organic elementary school children in Bandung were above the
compounds (VOCs) and O3. CDC (Centers for Disease Control and Prevention, USA)
In Indonesia, lead (Pb), which is allowed to be injected level of 10 μg/dL in 2005, and this number was 53% in
in gasoline at up to 0.30 g/L (SK Dirjen Migas No. 108.K/72/ 2006 (17). The Committee of Leaded-Gasoline Phasing Out
DDJM/1997) up until July 1, 2006, had been phased out. found 90% of children under 5  years of age living near
However, the impact of the pollutant on the environment roads had BLLs above 10 μg/dL in Makassar in 2005. An
and human health has not entirely disappeared. The indoor air study found about 50% of Jakarta’s profession-
effects on human health were observed several years later. als reported symptoms of Sick Building Syndrome on an
Lead concentration in the air of 10 cities was found to be average of 5 times during a period of 3 months observed
between 0.026 and 0.783 μg/m3 with Jakarta and Surabaya due to indoor air quality at their work place.
with the highest levels. Sulfur (S) is allowed to be used Pneumonia is overall the number one killer disease
for diesel energy with concentrations up to 5000 ppm (SK for infants (22.3%), children under 5 years of age (23.6%),
Dirjen Migas No. 113.K/72/DDJM/1999), compared to levels and among the top 10 diseases that result in deaths among
in other countries of 500 ppm (EURO 2), 350 ppm (EURO 3) the adult population. The World Health Organization
and 50 ppm (EURO 4). The average sulfur content used for (WHO), in 2002, estimated the acute lower respiratory
diesel fuel in Indonesia is 2156  ppm (between 400 and infection (ALRI) deaths attributable to solid fuel use (for
4600  ppm) in 2007 (14). The sulfur concentration was children under 5  years of age) in Indonesia to be 3130,
higher than in 2006 (1494 ppm). In 29 cities, sulfur con- while chronic obstructive pulmonary disease (COPD)
centrations were found to be above 1000 ppm. deaths attributable to solid fuel use (for people 30 years
The index of air pollution in Jakarta and Surabaya old and higher) was estimated at 12,160.
in 2007 [using an air quality monitoring system (AQMS)] Air quality impacts are not limited to source regions
showed the status of Good Day on only 72 days and 62 days, (primarily Central and Southern Sumatra and Southern
respectively. Air quality monitoring using non-AQMS in 30 Kalimantan), but can be transported in the atmosphere
cities showed high concentration for NO2 (0–30 ppm) and to affect transboundary locations such as Singapore. Air
SO2 (0–50 ppm). The number of vehicles used on the road pollution from forest fires in Sumatra and Kalimantan
increased annually with an average of 12% (motorcycles, has affected millions of people in Sumatra, Kalimantan
30%), which are in line with increasing fuel consump- and neighboring countries like Singapore and Malaysia.
tion. Emission tests in Jakarta in 2005 found that 57% of The human cost of air pollution in Indonesia is shocking:
vehicles did not pass the test. Meanwhile, the traffic jams the 2015  haze caused more than 28  million people to be
among cities continue to worsen. Air pollution is proven to exposed, with at least 10 deaths from haze-related illness
be a major environmental hazard to residents in Jakarta, and 560,000 people suffering from haze-related respira-
regardless of their socioeconomic status. Transportation tory problems. The actual number is likely to be higher
comprises 27% of Indonesia’s greenhouse gas (GHG) emis- as people living in remote areas and villages did not go
sions, and traffic congestion is a huge problem in Jakarta to hospitals or local health centers (18), and fire-fighting
(15). Diseases stemming from vehicular emissions and air costs were close to $50 million per week. In 2010, 57.8%
pollution include ARIs, bronchial asthma, bronchitis, and of the population in Jakarta was reported to have suffered
eye and skin irritations, and it has been recorded that the from air pollution-related illnesses (e.g. asthma, bron-
most common disease in northern Jakarta communities is chopneumonia and COPD, among others). Associated
acute upper respiratory tract infection (63% of total visits costs were estimated at IDR 38.5 trillion, with the result-
to health care centers) (16). The prevalence of ARI exceeds ant decline in productive days impacting on economic
the national prevalence (25.5%) in 16 provinces, whereas growth (19). Moreover, the national 35,000-megawatt
the top 10 highest ranks of the prevalence are in the fol- development project is expected to increase the number
lowing cities/districts: Kaimana (63.8%), Manggarai Barat of premature deaths from 6500 to 28,300 per year due to
(63.7%), Lembata (62%), Manggarai (61.1%), Pegunungan impending air pollution from coal-fired power plants (20).
Bintang (59.5%), Ngada (58.6%), Sorong Selatan (56.5%), Thus, emissions and subsequent air pollution from mobile
Sikka (55.8%), Raja Ampat (55.8%) and Puncak Jaya sources (i.e. motor vehicles) affect a range of sectors and
(56.7%). The prevalence of coughing in 2007 was 45% and contribute to or affect the economy as a whole. Increased
flu was 44%, without any significant difference between health costs and reduced activity days (lower productiv-
urban and rural areas. ity) from air pollution-related illnesses directly cause a
Studies on air pollution of leaded-gasoline exposure lower quality of life and indirectly reduce the gross domes-
impact found that blood lead levels (BLLs) of 66% of tic product (GDP) for a specific city or country. The total

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46      Haryanto: Indonesia: country report on children’s environmental health

economic cost, including direct damage (crops, forests, 3.9%), North Maluku and Maluku (CFR 2.6%). The IR trend
infrastructures), cost of responding to the wildfires and has increased since 2003, from 23.9 per 100,000 popula-
losses in other economic trades, is estimated to exceed US tion to 37.1 in 2004, 43.4 in 2005, 52.5 in 2006 and 71.8 in
$16 billion (IDR 221 trillion), more than double the costs of 2007. DHF outbreaks occurred in 11 provinces in 2007. Chi-
the 2004 tsunami and 3 times the national health budget kungunya in 2007 occurred in Central Jawa, West Jawa,
in 2015 (21). This number is higher than the estimates of Banten, DKI Jakarta and East Jawa, with a total of 2378
economic losses from the 1997 forest fires. cases without any deaths. Filariasis in 2007 occurred in
In Indonesia, cases of malaria, dengue, diarrhea and 33 provinces (304 regencies/cities) with a total of 11,473
cholera are predicted to increase as temperatures rise and cases. An increasing trend of the number of cases has
water becomes contaminated, affecting scores of poor pop- been observed since 2002 (23, 24).
ulations that do not have the resource to cope. Water scar- DHF is among the top 10 causes of deaths reported in
city is an additional issue as a result of global and regional hospitals in 2006 (2.6%). Among other causes of infant
climate change in which between 2010 and 2015 the deaths in the 10 provinces surveyed (West Nusa Tenggara,
country was predicted to experience a major clean water West Kalimantan, South Sulawesi, East Java, South East
shortage, and this is expected mainly in urban areas (22). Sulawesi, South Sulawesi, Banten, South Kalimantan,
West Java, West Sumatera, Jambi, Daerah Istimewa Yog-
yakarta), DHF accounted for 1.4%, and malaria accounted
Vectors and parasites for 0.8%. Among other causes of deaths of children under
5 in the 10 provinces surveyed, DHF accounted for 1.4%
The emergence of vector-borne diseases (VBDs) like dengue and malaria accounted for 2.9%.
and DHF, along with the endemic transmission of malaria,
Chagas diseases and onchocerciasis in many develop-
ing countries, is intimately associated with the complex Toxic and hazardous wastes
social and economic transition faced by these countries.
The growth of populations, especially in urban centers, In Indonesia, the composition of solid waste is gradu-
unplanned urbanization, lack of provision of public ser- ally changing over time. In 2001, the solid waste compo-
vices like potable water, sewage and garbage collection sitions were garbage (65%), rubbish (13%) and plastics
systems, and the ecological disruption caused by global (11%) (25). In 2007, garbage decreased to 50% and plastic
warming, agricultural practices and deforestation, are materials increased to 15% (26). The daily averages of solid
major determinants in the transmission dynamics of VBDs waste production in the 10 biggest cities in Indonesia in
in the region. These economic and social forces are facili- 2007  were as follows: Jakarta – 28,196.7  m3, Surabaya –
tating the routes of infection. The threats to the health of 9560 m3, Bandung – 7500 m3, Medan – 4985 m3, Makassar
children are a major concern, as this age group is the most – 3661.8 m3, Palembang – 5100 m3, Semarang – 4500 m3,
affected by VBD. There are no vaccines available to prevent Tangerang – 3367 m3, Bekasi – 2790 m3 and Depok – 3764 m
transmission, and the severity of infection and lethality are (27). It was estimated that the total production of solid
higher in children, especially in the under-nourished. The waste in 170 cities and districts in Indonesia in 2007  was
house index (HI) of Aedes aegypti in Indonesia was found 45,764,364.30 m3 per year or equal to 11,441,091.08 tons per
to increase in 2007 (83.5%) from the HI in 2006 (81.5%) and year. Methane (CH4) produced from the total production of
2005 (75.9%). About 60% of villages in DHF endemic areas solid waste was 517,366,138.41 Gg/year or equal to 517,366.14
conducted cleaning of the breeding habitat. tons per year. About 41% of the solid waste was transported
Prevalence of malaria in Java and Bali is <0.5%; mean- and disposed to the final location of disposal treatment.
while, in 15 provinces, the prevalence of malaria exceeded Around 36% of solid wastes were burned, 8% was buried,
the national prevalence rate (2.85%). The prevalence and 1% was recycled and treated as compost, while 14%
of filariasis exceeded the national prevalence (0.11%) was disposed to rivers, open land, streets, etc. (28). Based
in eight provinces. The prevalence of DHF exceeded the on the data collected by the Program Adipura Team of the
national prevalence (0.62%) in 12 provinces. The number MOE in 2007, almost all of the cities surveyed used open
of DHF cases in 2007 was 158,115 cases, with an IR of 71.8 dumping for final treatment of solid waste (99.7%).
per 100,000 population and a CFR of 1.01%. The highest Toxic and hazardous waste volumes amounted to
IR was in DKI Jakarta at 392.6 per 100,000 population, 3,023,585.37 tons in 2007, mainly containing fuel sludge,
with rates in Bali being 193.2, and in East Kalimantan coal ash, treatment sludge, steel slag, copper slag, used
being 193.2. The highest mortality rate was in Papua (CFR oil, waste water rags, sludge scale and used batteries (27).

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 Haryanto: Indonesia: country report on children’s environmental health      47

Only about 10% of the wastes had been managed in 2007 found that Bogor-Jakarta had the highest river sediment
(31,910.935 tons). A total of 2,464,780.543 tons of wastes concentration of pp-DDT (45.8 ppb) compared with the
was managed through the 3R program (reduce, reuse other two urban sites (Surabaya and Semarang).
and recycle). However, a very huge amount of toxic and
hazardous wastes was managed improperly. A total of
167,559,573.715 tons were dumped into river banks or open Disaster and health emergency
land (27). The mining industry contributes significantly
to toxic and hazardous waste production in Indonesia. Geographically, Indonesia is a potential disaster area
In 2007, mining industries produced toxic and hazardous (1). Most disasters have occurred in Indonesia, includ-
wastes of fuel sludge to an amount of 329.13 tons, 183.6 ing floods, landslides, droughts, forest fires, industrial
tons of used batteries, 914.02 tons of materials contami- accidents, oil spills in the sea, tsunamis, volcanic erup-
nated by fuel, and 19,471,604.5 l of used oil. Most of the tions, storms and others. It was recorded in 2007 that
wastes produced by the mining, energy and fuel sectors there were 205 disasters affecting thousands of people
are from those located in Java and Sumatra. in 28 provinces: floods in DKI Jakarta, Banten, West Java,
Pesticides are used throughout the developing world, Central Java and East Java; floods and landslides in East
primarily for agricultural purposes and for malaria control. Nusa Tenggara and Central Sulawesi; tectonic earthquake
Many areas in developing countries rely on agricultural in Bengkulu and West Sumatera; storms, raising of sea
production as a major source of economic and social levels, volcanic activities, transportation and industrial
development through the exportation of products such as accidents, food contamination outbreaks, and bombing
coffee, cotton, sugar, fruits and vegetables, and flowers in several provinces.
among others. Pesticides are often incorrectly handled In Indonesia, 80% of disasters are associated with
in agricultural and home use, producing acute intoxica- climate change in 1998–2018, including flooding (39%),
tion among workers and their families and contaminating heavy wind/storms (26%), landslides (22%) and droughts
water, soil and food. Children are more vulnerable than (8%). In 2017, there were 2263 events, and 198 of these
adults to experiencing latent or delayed effects over the events were considered health crises. There were 305,837
long course of their lifetime. There is little available data people impacted and 198 deaths, major injuries in 2314
on the incidence of acute pesticide intoxication because of people, minor injuries in 63,578 people, and 243,691 refu-
the lack of surveillance systems. Chronic exposure is also gees in 2017. The estimated cost to the national economy
of major concern because of its potential association with would be about IDR 132 trillion (approximately USD 8.8
cancer, developmental neurotoxicity, teratogenesis and billion) in 2050 as a consequence.
endocrine disruption.
In Indonesia, in 2007, the registered pesticides used Research funding: None declared.
for household and malaria control purposes totaled 254 Conflict of interest: None declared.
formulas. The names of the active materials and formulas Informed consent: Not applicable.
used for household and vector control purposes, which Ethical approval: Not applicable.
are registered by the government, totaled 56 active materi-
als from 85 companies. For agriculture and forestry pur-
poses, there were 1336 formulas registered and allowed for References
use by the government (28).
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