Peer-reviewed article

Trends and inequalities in acute respiratory tract infections in Indonesia: an application of the World Health Organization's Health Equity Assessment Toolkit.

Adnani QES, Adeleye K, Giri B, Osborne A, Aboagye RG et al. · 25 Mar 2026

Abstract

Background Acute respiratory tract infections in children present a substantial public health burden. Understanding the trends and determinants in Indonesia is essential for designing and implementing interventions to lower incidence, especially among children under five. Therefore, we examined trends and disparities related to acute respiratory tract infections in Indonesia. Methods We conducted a cross-sectional analysis of data from the Indonesia Demographic Health Survey (2003-2017) using the online version of the World Health Organization's Health Equity Assessment Toolkit (WHO HEAT). Prevalence estimates for acute respiratory tract infections in children were computed using the designated stratifiers within the WHO HEAT software. Four metrics: difference (D), ratio (R), population attributable fraction (PAF), and population attributable risk (PAR) were employed to assess the inequality in acute respiratory tract infections. Results The results showed a decline in acute respiratory tract infections and disparities across the inequality dimensions. The age-related inequality decreased from a difference of 0.1 in 2003 to -1.5 in 2017. Economic-related inequality decreased from a difference of 3.1 in 2003 to 3.0 in 2017. Education inequality decreased from a difference of 3.1 in 2003 to 1.8 in 2017. The disparity in place of residence was zero in 2003 and reduced to -8.7 in 2017, signifying a reduction in inequality in this domain. Sex-related inequality increased from a difference of -0.3 in 2003 to -0.5 in 2017, suggesting a higher prevalence among male children. Regional inequalities in acute respiratory infection declined from 17.5 in 2003 to 9.1 in 2017, indicating that children in certain regions are disproportionately affected by acute respiratory infections in Indonesia, but the gap has reduced over time. Conclusion Our study found that acute respiratory infections are prevalent among children living in rural areas, those from low-income households, and those whose mothers have lower educational level in Indonesia. The current findings provide vital insights for governing bodies at all levels on ensuring that health services are accessible, reliable, and equitable. Consequently, stakeholders must work to improve the effectiveness of health policies and legislation affecting households, especially in rural regions, among those from economically disadvantaged backgrounds, and those with limited or no access to formal education. These measures may reduce acute respiratory infections and lessen their adverse effects on children in Indonesia.