Background
This study investigates disparities in the utilization of primary health care (PHC) between urban and rural populations in Indonesia, focusing on socioeconomic and demographic determinants. Understanding these patterns is essential for promoting equity under the National Health Insurance (Jaminan Kesehatan Nasional, JKN) program.
Methods
Data were obtained from the 2023 National Socioeconomic Survey, which included 334,887 individuals. Binary logistic regression was used to examine the association between individual characteristics and PHC utilization.
Results
Overall utilization rates were similar across urban and rural areas, but significant disparities were observed. Women were more likely to use PHC than men (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.10–1.13). The association between higher education and PHC utilization was negative (OR, 0.78; 95% CI, 0.75–0.81), while access to information technology slightly reduced utilization (OR, 0.98; 95% CI, 0.96–0.99). Wealth effects diverged sharply: affluent urban residents were less likely to use PHC (OR, 0.84; 95% CI, 0.81–0.87), whereas wealthier rural residents were more likely to utilize PHC (OR, 1.09; 95% CI, 1.05–1.13). Dual insurance ownership had a strong positive effect in rural areas (OR, 1.56; 95% CI, 1.25–1.94).
Conclusion
These findings highlight structural inequalities in PHC utilization. Policy efforts must prioritize enhancing the quality and attractiveness of PHC in urban areas, improving financial protection and infrastructure in rural areas, and addressing the digital divide. Such targeted measures are essential for achieving equitable and inclusive health coverage under JKN.

Prolonged or irregular menstrual bleeding is common in women, particularly in the early years after menarche. Over time, menstrual cycles often become regular; however, persistently irregular menstruation warrants further investigation. Serious conditions, such as endometrial cancer, which is often linked to prolonged unopposed estrogen exposure, can be prevented with timely detection. We report a case involving a 27-year-old obese, nulliparous woman with a history of prolonged irregular menstrual bleeding since menarche. She had not undergone regular health checkups and had never been properly evaluated until multiple admissions for severe anemia prompted further investigation, which confirmed the diagnosis of endometrial carcinoma. Delays in seeking care for abnormal menstrual bleeding resulted in serious outcomes. Endometrial carcinoma may significantly reduce future fertility potential. Therefore, primary healthcare providers play a pivotal role in educating and raising public awareness about this frequently under-recognized issue, as timely investigation for early recognition is paramount.

Background
Indonesia faces significant maternal and child health challenges, including a high maternal mortality ratio. The country’s vast geography results in disparities in healthcare facility availability. This study aimed to identify factors influencing maternal delivery choices in health facilities across Indonesia’s rural and urban areas.
Methods
This cross-sectional study analyzed data from the 2017 Indonesia Demographic Health Survey. The study population included women aged 15–49 who had given birth within 5 years preceding the survey. A total of 14,162 women were included, with 6,339 from urban and 5,009 from rural areas. Logistic regression was performed to identify factors associated with maternal delivery locations.
Results
The findings showed that 91.37% of urban and 69.33% of rural mothers delivered in healthcare facilities. All analyzed variables were significantly correlated with maternal delivery in health facilities across both areas. In rural areas, the sex of the household head (adjusted odds ratio [AOR], 1.32; 95% confidence interval [CI], 1.02–1.71; P=0.031) and the absence of barriers to healthcare access (AOR, 1.31; 95% CI, 1.07–1.60; P=0.008) were significant factors. Conversely, in urban areas, only maternal age was significantly associated with delivering in health facilities.
Conclusion
Determinants of maternal delivery choices vary between rural and urban settings. In rural areas, healthcare access and household head sex are key factors, while maternal age is significant in urban areas. The government should prioritize equitable healthcare facility distribution, particularly in rural areas, and promote family involvement, especially among husbands, during antenatal care to encourage facility-based deliveries.

Citations

• Family medicine for all stages of life: turning knowledge into actionable care
  Joung Sik Son
  Korean Journal of Family Medicine.2026; 47(2): 95.     CrossRef

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