Background
This study examined the population-level factors associated with the under-five mortality rate (U5MR) across 34 provinces in Indonesia using an ecological study design.
Methods
U5MR data were obtained from BPS-Statistics Indonesia. Demographic, healthcare, and fertility-related factors were included as independent variables. An ecological study design was applied, with 34 provinces serving as the units of analysis. Hierarchical Poisson regression was used to assess the associations between the variables. All variables were log-transformed prior to the analysis.
Results
The U5MR in 2020 was 19.83 per 1,000 live births. Fertility and demographic factors were significantly associated with changes in U5MR. A 1% increase in the provincial gross domestic product (P=0.042) and the doctor-to-population ratio (P<0.001) was associated with 3% and 6% reductions in U5MR, respectively. Conversely, a 1% increase in the bed-to-population ratio (P<0.001), age-specific fertility rate (P=0.004), and total fertility rate (P<0.001) was associated with increases of 19%, 5%, and 117% in U5MR, respectively. The midwife ratio (P=0.433) and vaccine availability at primary health centers (P=0.851) were not significantly associated with U5MR.
Conclusion
Improving the U5MR requires equitable healthcare access, addressing doctor shortages with incentive-based placements, enhancing healthcare facilities, and implementing policies to reduce teenage pregnancies through sex education and contraceptive promotion.

Background
Malnutrition is common among children under 5 years of age in Indonesia, with the rates varying between urban and rural areas. The minimum acceptable diet (MAD) assesses nutrient quality and quantity. This study aimed to identify the potential variables for MAD in 6–23-month-old children in both urban and rural Indonesia.
Methods
We used the data from the 2017 Indonesia Demographic and Health Survey to conduct this nationally representative study. A total of 4,688 children aged 6–23 months were included in the study. MAD was classified using the 2017 World Health Organization global nutrition monitoring framework. The determinants of MAD were analyzed using multiple logistic regression.
Results
Overall, 45% of children aged 6–23 months received the required MAD, with 47.4% receiving the MAD in urban areas and 35.7% in rural areas. Children’s age, fathers’ age, parents’ education level, mothers’ employment, and wealth index were strongly linked to MAD in both rural and urban homes. The factor specifically related to MAD in urban areas was mother living with her husband. For rural households, mothers’ involvement in decisionmaking and a minimum of four antenatal care (ANC) visits significantly increased the likelihood of their children’s MAD status.
Conclusion
MAD status was determined by increased child age, higher parent education, younger father, working mother, and higher wealth index in children aged 6–23 months in both urban and rural settings. Mothers living with a spouse determined the MAD status only in urban areas. More frequent ANC visits and mother participation in household decisions were other factors related to MAD status in rural areas.

Citations

• Determinants of Minimum Acceptable Diet (MAD) among children aged 6 to 23 months in rural Belagavi – A cross-sectional study
  Ayesha Abdullatif Dhalayat, Mubashir Angolkar, Anusha Kulkarni, Alex Carvalho
  Clinical Epidemiology and Global Health.2026; 41: 102417.     CrossRef
• Health behaviors, lifestyle factors, and healthcare challenges in family medicine: a comprehensive review of recent evidence from Asian populations
  Joung Sik Son
  Korean Journal of Family Medicine.2025; 46(4): 215.     CrossRef