HOUSEHOLD SURVEY IN INDONESIA, 1972: Part 1. Morbidity

Vol. I1 No. 2

Bulletin Penelitian Kesehatan
Health Studies in Indonesia,

1974

!~OUSEHOLD SURVEY IN INDONESIA, 1972
Part I . Morbidity
L. Ratna Pundarika and J. Sulianti Saroso

U/itrlliprrolc2urlann l'elita I1 dalanz bidang lceselzatan, diperlztkart keterangarz2 dasar dari penduduk
Potlo hll/~llSclltetn bcr & / IDesernber 19 72, diadalian survey Rumah Tangga urztuk mengumptilkan data
nlengerzai gumharan pei~jjakitdun lcebutrtlzan nzasyarakat akarz pelayanan kesehatan.
Daerah 1!ar7gdisurvey ialah .Jaws clnn Lztar Jawa, yang meliputi :

I. Daerah urban derlgan ,fasilitaskesehatan dan komrtnikasi yang cukup.
2. Daeralz rural dengan .fasilitas lcesehatan dan komzlnikasi yang cukup.
3. Daeralz nrral dengan fasilitas kesehatatz dart konzunikasi yang kurang.

IVa~nncamdatz pcmerilcsaan kesehatan dilakukan oleh tenaga2 dokter darz Mahasiswa kedokteran

tirzgkat teralcltir. Sciunzlalz 21.036 nlnzah tangga disurvey, yarzg terdiri dari 111.689 penduduk.
Dalam srinlejl ini didapati 554 7 orang sakit dalam waktu 1 bulan terakhir, atau 5,0% dari penduduk ?>attgdisltrvejl.
h-le~nrnttgolongan ~tnzur,didapati bahwa anak2 dan orang trla yang banyak terserang penyakit :
rate ialal~8.4 per 1.000 bayi, 8.0 per 1.000 anak bentmltr I - 4 tahun, 7,5 per 1.000 orang berurnur
45 - 49 tah~rn~ l a n11,4 per 1.000 orang berunzur 5 0 tahun keatas, sedanglean rate kesakitan darigolongan ~lrlzllrI 0 - 19 tailzltl ha~zva2,0 per 1.000 orang.
Penvakit 1~ar7gterharz~~ak
diderita ialah radarzg alat pernapasan bagian atas 8,8 penyakit kulit 6,4, tuberculosa pan12 5.2 dat~radarzg alat pernapasan bagian bawah 3,7 per 1.000 penduduk.
Palla aanak2 dibawalz ur~zurlima tahurz, penyakit radang akut darz gangguan gizi adalah yang
terbanyak. Pada golongan umur 45 tahun keatas, penyakit tuberculosa dan cardiovascular meningkat
-%
dibandinglcart derzgan golongan umttr yang lebih nzuda.
Menurut keadaarz daerah, rate penyakit didapati berbeda-beda, antara 2,8 per 100 penduduk
di Gowa dan Panpkep (strata Ill) clan 9,4 per I00 penduduk di Asahan dan Tanah Karo (strata 11).

In plailning the health program for the
Second Five Years Developnient Plan population
oriented baseline data were required.
Various studies undertaken previously (Sulianti, 1970; Sarnanto, 1970; Haspara, 1971)
yielded only limited morbidity and mortality
.

.
data.
Since current information reflecting diseases and other health problems prevailing in
communities in Indonesia was lacking a household survey was undertaken in the last quarter
of 1972.
The main objectives of 1.he survey were as
follows :
1. To collect data on the prevalence of
diseases.
2. To investigate the -relationship of household characteritics and the occurrence
of disease.
3. To collect data on the utilization of me-

dical care services and the costs incurred
by the' people.
The survey was conducted in September
and December 1972. During the fasting period
and one month after the Moslem Holidays no
survey activities were carried out. It was thought
that the different way of life during this period

might give bias to the results of the survey.
MATERIAL AND METHODS

Study areas were selected in the provinces
of West Java, Central Java, North Sumatra,
South Kalimantan and South Sulawesi, which
had the following criteria :
1. Urban areas with good health and cornmunication facilities.
2. Rural areas with good health and
communication facilities.
3. Rural areas with poor health and communication facilities.,

1

L. RATNA PUNDARIKA A N D J. SULIANTI SAROSO

From each strata 5,000 to 8,000 households
were taken, providing precisions of 20% at
the 95% probability level for prevalences of
1 per 1,000 population.

Table r shows the areas and number of households arid people surveyed. The total survey
covered 21,036 households consisting of
11 1.,689 people.
~~t~ on illness
during the month
prior to the interview were obtained by questioning the head of the household or a member
who took care of the sick person, and those
found sick at the time of visit were examined
physically.
Head of household was considered to be
that person who was acknowledged as such by
other household members.
Household members were residents of the
household who were present in the house at
the time of the interview and those who were
temporarily absent.
Illness was defined as the lay report of
physical discomfort from household members.

*

Table 1 .

Diagnoses reported in this paper were based on
history taking with or without physical exan~inations undertaken by young medical doctors
or senior medical students.
RESULTS
,The population age structure from the household survey showed a similar pattern as that
of the national population census in 1971.
the
forty-four percent
study ~ o ~ u l a t i oconsisted
n
of children under
15 years of age.
General environmental sanitation was found
unsatisfactory. Treated drinking water was available mainly in the urban areas, covering 6570
of the households. In the rural areas only 0.6?
of the households had safe drinking hater.
Twenty five to 30 percent of the households

had latrines, in urban as well as in rural areas.
The educational level of people in rural areas
was low : about 40% of people aged 10 years
and over could not read nor write.
(4399%)

STUDY AREA AND POPULATION OF HOUSEHOLD SURVEY
IN INDONESIA, 1972.

S T R A T A

I.

-.

II.

URBAN
Available Facilities
- Hospital

- Health Centre.
- Medical Doctor.
- Good Communication.
RURAL.
Available Facilities
- Hospital.

-

Health Centre.

- Medical Doctor

Ill.

Good Communication.

REGENCY OR
MUNICIPALITY

SUB DISTRICT

Semarang.

West Semarang.
North Semarang

CENTRAL JAVA

Banjarmasin

EAST J A V A

Pasuruan

4.028

21,182

3.379

21.242

1,764

8.292

3,893

19,754

3.814

17,417

Lekok * )
Winongan.
N O R T H SUMATERA

Airputih

Tanah karo

Payung
Surade
Jonggol

Sukabumi
Bogor

-

S O ~ H
SU.
LAWESI

Gowa
Pangkep

Loss Data.

POPULATION

East Banjar.

WEST JAVA

T o t a l

HOUSEHOLDS

West Banjar.
SOUTH KALIMANTAN

RURAL.
Available Facilities
Health Centre.
- No Medical Doctor

*J

PROVINCE

Tinggi Moncong
Labakkang Marang

4,124

23,802

21.036

11 1.689

HOUSEHOLD S U R V E Y IN 1972

Table 2. MORBIDITY BY AGE GROUP

Population
Age group (years)

NO

Cases
NO

%

Morbidity per 1,000
population

%

Less than 1 year

1
5
10
15
20
25
30
35
40
45
50

- 4
- 9
- 14
- 19
- 24
- 29
- 34
- 39
- 44
- 49

years and over
Unknown

T o t a l

11 1.689

100.0

5,547

100.0

49.7

Table 3. DISEASE PATTERN
Proportion as
% of total

Disease

Cases

Infectious and parasitic
Nutritional
Cardiovascular
Others

3,500
31 6
120
,l,'6l I

63.1
5.7
2.2
29.0

T o t a l

5,547

100.0

Morbidity per

1,000 population

49.7

Table 3 shows that infectious and parasitic diseases were the most prevalent, 63.1% of the
total number of diseases.

Morbidity by age group is presented in table 2.
Morbidity per 1000 population was high in
infants (8.4) preschool children under five
years (8.0); 45-49 years age group (7.5) and

among persons 50 years and over (1 1.5), anc
lowest in the 10-14 years and 15-19 years agt
group, 2.0 and 2.1 respectively.

L. RATNA PUNDARIKA A N D J. SULIANTI SAROSO

Table 4. PREVALENCE RATE O F DISEASES

1.
2.
3.

D i s e a s e

No.
cases

Acute upper respiratory infections.
Infections and inflammations of the
skin and subcutaneous tissues.
Tuberculosis of the lungs.
Acute lower respiratory infections.
Diarrheal diseases
Malaria
lnfections of the eye
Anaemia
Other diseases of the eye
Nutritional deficencies including
hypo/avitaminosis
Cardiovascular diseases
Other infective and parasitic diseases
Allergic disorders
Arthritis and Rheumatism
lnfections of the ear and mastoid
Diseases of the nervous system
Measles
Others

980
721

8.8
6.4

57 7

5.2

5,547

49.7

T o t a l
Table 4 shows the morbidity rate of various
diseases per 1,000 population. Acute upper
vespiratory infections ranked first (8.8) fol.owed by infections and inflammations of the
kin and subcutaneous tissues (6.4), tuber:ulosis (5.2), acute lower respiratory infecti7ns (3.7), diarrheal diseases (2,7) and Malaria
:2.5).
1 Diseases with low prevalence were grouped
.n Others.
Table 5 shows the age specific prevalence
:ate of the 1 0 major diseases per 1000 po~ulation.' Acute upper respiratory infections
-anked highest in all age groups except in the
ige group of 45 years and over. Tuberculosis
~f the lungs was found low in persons under
5 years of age and ranked high in the age
roups of 25 years and over. Prevalence of
kiarrheal diseases and nutritional deficiencies,
ncluding hypo/avitaminosis were highest in
nfants and preschool children anaemia and
hther diseases o f the eye in people of 45

1

.

1

Morbidity per 1,000
population.

years and older.
In a further analysis of morbidity by age
groups, it was observed that the diseases ranking
as the top ten were slightly different in the
various age groups. Measles andaccidents appeared among the ten major diseases in infants,
and nutritional deficiencies inculding hypo/
avitaminosis were found in the ten major
diseases among preschool children, where as
tuberculosis and anaemia disappeared from
the list.
Infections of the ear and mastoid were found
among children under 15 years of age. Diseases
of the nervous system and sense organs were
among the ten major group in the 15-24 years
age group. Allergic diseases were included in
the list of ten major, diseases in the 25 44 years age group, and cardiuvascuTar diseases
and artheritis in the age group of 45 years and
over where as nutritional deficiencies disappeared from this list.

HOUSEHOLD S U R V E Y IN 1 9 7 2

Table 5. PREVALENCE OF TEN MAJOR DISEASES BY AGE GROUP

Less than 1
D i s e a s e s

year
Number
of
cases

A

G

5 - 14

1-- 4
years
Per Number
1000
of
ooo. cases

years
Per Number
1000
of
DOD.
cases

E

G

R

15 - 24
years
Per Number
1000
of
ooo. cases

O

U

25

P

-

44

years
Per Number
1000
of
ooo. cases

4 5 years and ov
Per

Number
of
ooo. cases

1000

Per

lOO

ooo

Acute Upper Respiratory Infec.
tions
Infections & Inflammations of
the Skin & Subcutaneous tissues
Tuberculosis
Acute Lower Respiratory lnfectio
Diarrheal diseases
Malaria
Infections of the eye
Anaemia
Other diseases of the eye
Nutritional deficiencies including
Hypo/Avitarninosis

Table 6. MORBIDITY BY AREA
A b e a

.
Stratum I.
Semarang (Central Java)
Banjarmasin (South Kalimantan).

Morbidity

Population
Number

21,182
21,242

654
837

Stratum I I .
Pasuruan (East Java).
Asahan and Tanah Karo
(North Sumatera).

8,292

40 1

19,754

1.906

Stratum I I I .
Bogor and Sukabumi (West Java).
Gowa and Pangkep (South Sulawesi)

17,417
23,802

1,088
661

11 1,689

5,547

T o t a l

Table 6 shows morbidity by area; the rate
ranged from 28 per 1,000 population in Gowa
and Pangkep to 94 per 1000 population in
Asahan and Tanah Karo.
Comparing the disease pattern in the different areas. acute upper respiratory infections

per 1000 population

50

were ranked high in the urban as well as t
rural areas. Diarrheal diseases were more pr
dominant in the urban than rural areas, whi
tuberculosis was found more in the rural t h
urban areas.

L. RATNA PUNDARIKA AND J . SULIANTI SAROSO

DISCUSSION

disease increases by age, starting at the age of
15 years, is also consistent wit11prcvious observations.
With regard to the low prevalence of
diarrheal diseases as compared to that of
. tuberc.irlosis, it should be borne in mind that_
rates presented in this paper are point prevalence rates. The incidence rate may by expected
to be much higher. This would be the same for
all acute infectious diseases of short duration
and without rendering immunity afterwards.
Nutritional deviciency prevalence in children
under 5 years of age, as observed in this
survey, is much lower than found in the
longitudinal survey undertaken in Pondok Pinang by Sulianti (1970). Since this disorder.
is not acute and may be regarded as a chronic
disease, a higher prevalence would be more
consistent. It is probable that criteria used for
diagnosing nutritional deficiencies in the two
studies were different. In the household survey
only persons reported as ill were examined,
where as in the longitudinal survey in Pondok
Pinang all children attending the MCH centre,
either because of illness or fur weighing, were
examined.
The differences in morbidity rates found in
the three strata could not be explained.
This survey with all its liminations has been
valuable in pointing at the main disease problems
prevailing in Indonesia. It has confirmed the
findings of previous surveys and will be useful
in designing the types of drugs to be provided
to health centres. With regard to the amount
to be supplied, a good disease surveillance
progralnme should be undertaken in a number
of health centres throughout Indonesia to learn
more about incidence.
Analysis of other data collected in this
survey will be presented in subsequent publications.

Diseases observed in the survey were mainly
rcute i~zfectionswhich consisted of respiratory,
skin and gastrointestinal infections, occuring
nostly in children under 5 years of age. Sarnanto (1 970) found that fever, respiratory diseases
and abdominal diseases were the most prevalent.
Hapsara (1 971) found that among polyclinic
patients the frequency of skin diseases, abdominal diseases, respiratory diseases, malnutrition and eye diseases were the highest. Skin
and eye diseuses were predominantily in children of 0 - 14 years of age, and respiratory were more in adults.
Sulianti (1970) studied the diseases pattern
of children under 5 years of age living in a
sub-urban area and found that the incidence of
respiratory and skin diseases were the highest,
followed by diarrheal diseases, which occured
mostly among children under 2 years of age.
The results of all the studies referred to
above show that respiratory infections were
the most prevalent, which is not surprising.
Even in economically developed countries, this
disease has not yet been controlled and has still
a high prevalence. The reasons for this may be
because its transmission is air-borne and no
satisfactory vaccine is available yet.

Infections and inflamations of the skin and
subcutaneous tissues and diarrheal diseases were
also found prevalent in all the studies. These
may be credited to the poor environmental
sanitation and low educational level of the
people, especially in rural areas. High morbidity
rates, as in other developing countries, were
found in preschool children and low rates in the
school-going-age group. These findings point to
the necessity of strengthening child health services for the under-fives.
The low morbidity rate in school-age children ls also significant. School health services
should not cmcentrate on medical care, but
more on installing health habits and other
preventive health measures, such as vision
testing and immunisation. Tuberculosis prevalence of 5 per 1000 population is the same as
found in tuberculosis surveys previously undertaken. The finding that prevalence of this

SUMMARY
Morbidity data obtained from household
survey were presented.
The ten major diseases were each described
by age groups and for every age group the ten
most important diseases were presented.
-7 -4

HOUSEHOLD S U R V E Y IN 1 9 7 2

,

Morbidity was found in 5 percent of the
study population, and 25% of the cases were
among children under 5 years of age. Respiratory infections were found t o be the most
prevalent in the community.
Among preschool children acute itzfectioizs
were common and nutritional deffi'cieizcics were
found in 5.2% of the cases. In the older age
group of 4 5 years and over, tuberurlosis was
ranked number one, and cardiovascular diseases
was found in 5.4% of the cases.
ACKNOWLEDGEMENT
The authors would like t o thank the Gover-

nors and their staff, tfie Directors or rruvirlcia
Health Service and their staffs of West Java
Central Java, East Java, ~ & t h Sumatera, Soutl
Kalimantan and South Sulawesi and WHO
Consultans Dr. J . Keja and Mr. J . Thorup f01
their advice and support indesigning and conducting this survey.
We thank also the Deans'of the Medica
Faculties and staffs o f the Public Health De
partment, the senior medical students anr
medical doctors, of the Universitiesof Indonesia
Pajajaran, Diponegoro, Gajah Mada, Airlangga
Sumatera Utara and Hasanudin for their assis
tance and cooperation.

REFERENCES
Sulianti Saroso, J . et. a1 (1970) A longitudinal
survey of diseases occuring in children under
5 years of age in Pondok Pinang, Jakarta.
(Presented in KONIKA I, 1971)
Sarnanto, (1969 - 1970) Survey o n the attitude of community towards health services
in Pasuruan, East Java - lndonesia 1970.
Presented in Seminar on Public Health Re-

search, August 1973.
Hapsara, (1 971 ); Review keadaan kesakitar
(morbidity) dari penderita baru, di Puskes.
mas/Ralai pengobatan (diluar R.S.) di Kabu.
paten hceh-pidie, Palembang dan Purwakarta
tahun 1969 s/d 1971. Departemefl Kese.
hatan R.I.