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ORIGINAL RESEARCH

Use of traditional medicines and traditional

practitioners by children in Indonesia: findings
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from a national population survey in 2014–2015

This article was published in the following Dove Press journal:
Journal of Multidisciplinary Healthcare

Supa Pengpid 1,2 Background: Little data are available about traditional and complementary medicine use in
Karl Peltzer 2 children in the general population in Southeast Asia, including Indonesia. The aim of this
1 investigation was to assess the prevalence of the use of traditional medicines and traditional
ASEAN Institute for Health
Development, Mahidol University, practitioners in children in a national population-based survey in Indonesia.
For personal use only.

Nakhonpathom, Thailand; 2Research and Methods: The cross-sectional sample included 15,739 children (0–14 years) (median age
Innovation Office, North West
7.0 years, inter quartile range =7.0) that took part in the Indonesia Family Life Survey in
University, Potchefstroom, South Africa
2014–2015.
Results: The prevalence of use of traditional medicines as a treatment in the past four weeks
was 6.2%, vitamins or supplements 19.9%, and over-the-counter modern medicine 61.1%.
The prevalence of traditional practitioner use in the past 4 weeks was 3.4%, and the
prevalence of the use of traditional medicines and/or traditional practitioner in the past 4
weeks was 8.8%. The purpose of consulting the traditional practitioner was mainly massage
(86.8%) and treatment for illness (14.8%). In the adjusted logistic regression analysis, having
a birth certificate (as a proxy for better economic status) and poor self-rated health were
associated with traditional medicine use. Younger age and poor self-rated health were
associated with traditional practitioners use.
Conclusion: A high prevalence of traditional medicine use in children in Indonesia was
found, and several social factors and poor health status of its use were identified.
Keywords: traditional medicines, traditional practitioner, utilization, children, Indonesia

Introduction
A significant number of people in “Association of Southeast Asian (ASEAN)
member states” utilizes traditional health care.1–4 Among adults in Indonesia,
“24.4% had used a traditional practitioner and/or traditional medicine in the past
four weeks, and 32.9% had used complementary medicine in the past four weeks”.5
There is lack of information on traditional health care among children in the general
population,6 including in Indonesia.
One of the most common types of treatment provided by traditional health
practitioners in Indonesia was found to be massage for babies (71.4%).7 In
Correspondence: Karl Peltzer
Deputy Vice Chancellor Research and a small study of 91 children (6–18 years old) who were admitted to hospital in
Innovation Office, North-West Indonesia, 39.6% had used Indonesian herbal medicine prior to admission.8 Several
University, Potchefstroom Campus, 11
Hoffman Street, Potchefstroom 2531, investigations have been carried out on the use of traditional medicine for specific
South Africa acute and chronic conditions, such as fever, diarrhea, and cancer in Indonesia and
Tel: 27 18 299 4927
Email kfpeltzer@[Link] Malaysia.9–12 Suparmi et al,13,14 have pointed out some of the risks associated with

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the use of jamu, Indonesian herbal medicines, for the namely since [. . .] date, 4 weeks ago?” Response options
general public, including children, in Indonesia. were “Consumed over-the-counter modern medicines (like
The general population prevalence of the past 7 days use bodrexin, inzana, paramex); Consumed traditional herbs or
of “herbal medicinal products” among children and adoles- traditional medicines as treatment; Used topical medicines
cents (0–17 years) in Germany was 5.8%.6 In the USA less (like eyedrops, cream, medical plaster, ointment and the
than 0.5% of the children (0–12 years) had used herbal like); Vitamins/Supplements; Massage, coining, etc.”19
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remedies in the past 7 days,15 in Italy 2.4% in the past 3

years (0–13 years).16 The prevalence of past month use of Traditional practitioner use
traditional and complementary medicine among children “In the last 4 weeks, did [CHILD’S NAME] visit
and adolescents (0–18 years) in Taiwan was 4.7%.17 In a hospital, health center, clinic, doctor’s practice, or
a study in Germany, herbal medicines were mainly used a health worker?” Response options were “Public hospital
for treating coughs and colds of children and adolescents.6 (General or Specialty); Public Health Centre/Auxiliary
Some studies found associations between specific Centre; Private Hospital; Polyclinic, Private Clinic,
sociodemographic characteristics and traditional and/or Medical Centre; Private Physician (General Practitioner,
complementary medicine use among children and adoles- Specialist, Dentist); Nurse, Paramedic, Midwife practi-
cents. For example, younger age,6 female gender,17 and tioner; Traditional practitioner (shaman, wise man, kyai,
higher socioeconomic status.8,16,17 While in a study in Chinese herbalist, masseur, acupuncturist, etc.); Other.”19
Ethiopia, lower education of the parents was associated
For personal use only.

with traditional medicine use for children.18 Having a poor Last health care provider visit
health status was also associated with increased use of “Now, I’d like to ask you some questions about [CHILD’S
herbal medicine in Germany.6 The aim of this investiga- NAME] LAST VISIT to health care providers. What is the
tion was to assess the prevalence of the use of traditional type of medical facility or type of provider?”19 Response
medicines and traditional practitioners in children in options as above.
a national population-based survey in Indonesia. “What was the purpose of [CHILD’S NAME] visit to
that facility?”19 Response options “Immunization;
Consultation; Medical check-up; Medications; Injection;
Methods Treatment for Injury; Treatment for Illness; Massage;
Study design and participants Other.”19 (Multiple responses were possible)
Cross-sectional data were analyzed from the child module of “How much did you pay out of pocket for [CHILD’S
the “Indonesia Family Life Survey (IFLS-5)”, which was NAME]’s outpatient care at [. . .] during the past 4 weeks?”19
conducted in 2014–2015. The IFLS-5 is a household survey “Did you use insurance to pay for all or some of this
representative of 83% of the population in Indonesia, with visit?”(Yes, No)19
a survey response rate above 90%; more details on the com- “What do you think about the services that were pro-
plex sampling method.19–21 “Two randomly selected children vided by this facility?” Response options were “1=
of the head and spouse age 0–14 years” were included per Satisfactory, 2= Somewhat satisfactory, 3= Not satisfac-
household.19 Questionnaires were administered to the child’s tory and 4= Far from satisfactory.”19
mother, guardian, or caretaker or older sibling if the child was Socio-demographic factor questions included age, gen-
less than 11 years old. “Children between the ages of 11 and 14 der, mother’s and father’s education, and having a birth
were allowed to respond for themselves if they felt comforta- certificate as an indicator of socioeconomic status.19
ble doing so.”19 The IFLS-5 had been approved by the ethics Self-reported health status was measured with the
review boards of RAND (“Research ANd Development”) and question, “In general, how is your health?” Response
the University of Gadjah Mada.19–21 Prior to the interview, options ranged from 1= Very healthy to 4= Unhealthy.19–21
informed consent was obtained from all the respondents.19–21
Data analysis
Measures Descriptive statistics were used to describe the sample and
Traditional medicines use the prevalence of health care utilization. Logistic regres-
“Now, we’d like to know whether [CHILD’S NAME] has sion analysis was conducted to calculate the crude and
taken medicine on his/her own during the past 4 weeks, adjusted odds ratios with 95% confidence intervals to

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assess the associations between the independent variables Table 1 Health care utilization in the past four weeks in 15,739
and traditional medicines use and traditional health practi- children (0–14 years)
tioner use, separately. Age and all other variables that were Variable N (%) Average costs
found statistically significant in univariate analyses were over 4 weeks in
included in the multivariable models. Potential multicolli- Rupiaha, M (SD)
nearity was not detected. P<0.05 was considered signifi-
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cant. “Cross-section analysis weights were applied to

Visit of a public hospital, public health center, private hospital, clinic,
match the 2014 Indonesian population”.5,19 All statistical health worker or doctor’s practice or been visited by a health worker
analyses were conducted considering the complex design or doctor?
of the study using STATA software version 13.0 (Stata
Public hospital (general 106 (0.7) 236,578 (790,584)
Corporation, College Station, TX, USA). or speciality)
Public health center/aux- 891 (5.7) 10,385 (29,163)
Results iliary center
Private hospital 138 (0.9) 230,804 (279,600)
Sample characteristics Polyclinic, private clinic, 307 (2.0) 86,142 (160,252)
The sample included 15,739 children (0–14 years) (median medical center
age 7.0 years, Inter Quartile Range =7.0); 51.5% were Private physician (general 609 (3.9) 101,515 (149,642)
male and 48.5% were female, and 17.5% did not have practitioner, specialist,
a birth certificate. dentist, family doctor)
For personal use only.

Nurse, paramedic, mid- 1,024 (6.5) 103,494 (1,882,328)

wife practitioner
Health care utilization Traditional practitioner 528 (3.4) 91,330 (1,312,556)
Among seven different health care providers, traditional (shaman, wiseman, kyai,
Chinese herbalist, mas-
health practitioners had the fourth highest past 4-weeks
seur, acupuncturist, etc.)
prevalence (3.4%), after “nurse, paramedic or midwife
practitioners” (6.5%), public health centers (5.7%) and Self-treatment during the past four weeks

private physician (3.9%). The past 4-weeks prevalence of Consumed over-the- 5,930 (61.1) 10,695 (66,205)
traditional medicine use as self-treatment was 6.2%, vita- counter modern medi-
mins or supplements 19.9%, and over-the-counter modern cine (like bodrexin,
medicine 61.1%. The past 4-weeks prevalence of the use inzana, paramex)
Consumed traditional 917 (6.2) 10,706 (21,894)
of traditional medicines and/or traditional practitioner
herbs or traditional
was 8.8%. medicines as treatment
The average expenditure for the past 4-weeks health Used topical medicines 3,013 (19.9) 10,513 (26,898)
care provider utilization was lowest for public health cen- (like eye drops, cream,
ters (10,385 rupiah) and third lowest for traditional practi- medical plaster, ointment
tioners (91,330 rupiah). The average expenditure for the and the like)
Used vitamin/ 2,024 (12.4) 24,206 (35,034)
past 4-weeks self-treatment utilization was highest for vita-
supplements
mins or supplements (24,206 rupiah), followed by tradi- Massage/coining 2,359 (16.4) 6,548 (13,562)
tional medicines (10,706 rupiah) and the lowest costs
Note: 14,105 Rupiah = 1 USD (as at February18, 2019).22
a

were for massage or coining (6,548 rupiah) (see Table 1).

The prevalence of the use of the different self-
treatment modalities, including traditional medicines, did (86.8%) and treatment for illness (14.8%). Immunizations
not differ much across age groups (see Figure 1). were mainly provided by the private hospital (8.2%) and
the nurse, paramedic or midwife practitioner (6.3%).
Characteristics of the last health care visit Consultations were the highest for the private hospital
The purposes of the child’s last health care visit included (16.4%), and medications were the highest for nurse, para-
eight categories, such as immunization and treatment for medic or midwife practitioner (64.7%). Medical check-up
illness (multiple responses were possible). The purpose of was the highest in the public hospital (42.0%) ad poly-
consulting the traditional practitioner was mainly massage clinic, private clinic or medical center (38.6%). Children

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50

Type of self-treatment in the past

45
40
35

4 weeks (%)
30
25
20
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15
10
5
0
0-2 3-4 5-6 7-8 9-10 11-12 13-14
Age of children (years)

Over-the-counter modern medicine Traditional medicines

Topical medicines Vitamins, supplements

Massage

Figure 1 Prevalence of self-treatment.

For personal use only.

were mostly provided an injection by the private physician past month use of traditional health practitioners was 3.4%,
(18.0%) ad public hospital (12.5%). Treatment for an and the past 4-weeks prevalence of the use of traditional
injury was mainly provided by public and private hospitals medicines and/or traditional practitioners was 8.8%. These
(3.4% and 2.5%, respectively). Except for traditional prac- general child population prevalences of traditional or herbal
titioners, all other health care agencies provided above and/or complementary medicine use seem higher than found
60% treatment for illness. in Italy (2.4% in the past 3 years)16 and USA (0.5% in the
Health insurance did not pay for visits to traditional practi- past 7 days),13 but similar to Germany (5.8% in the past 7
tioners (0.0%) and only a few for “nurse, paramedic or mid- days),6 and Taiwan (4.7% in the past month).17 The purpose
wife practitioners” (1.8%) and for almost in half the cases of consulting the traditional practitioner was mainly massage
(46.6%) for public hospital visits. Among the last health care (86.8%) and treatment for illness (14.8%) in this study. This
service attendees, the highest satisfaction rates were reported is in agreement with a previous study among adults in
for private hospitals (21.3%), followed by traditional health Indonesia that indicated that massage for babies (71.4%)
practitioners (19.8%) and private physician (18.3%). Lower was one of the most common traditional treatment types,9
health care satisfaction rates were found for public health while in a study in Germany, herbal medicines were mainly
centers (12.5%) and public hospitals (9.1%) (see Table 2). used for treating coughs and colds of children and
adolescents.6 Herbal medicines are available in drug stores
without prescription and professional monitoring in
Associations with traditional medicine
Indonesia.8 Parents or guardians should be given health
and traditional practitioner use education about herbal medicines and they should also
In the adjusted logistic regression analysis, having a birth inform health practitioners about the use of herbal medicines
certificate (as a proxy for economic status) and poor self- of their children in order to prevent negative drug
rated health status were associated with traditional medicine interactions.8 In addition, the producers of herbal medicinal
use. Younger age and poor self-rated health status were preparations should follow government regulations in produ-
associated with traditional practitioners use (see Table 3). cing safe herbal medicines.13,14
The past 4-weeks prevalence of over-the-counter mod-
Discussion ern medicine use was in this study 61.1% in the past 4
The study found that in a nationally representative child weeks. This result is much higher than in a national survey
sample in Indonesia in 2014–15 that the past month preva- in children (0–17 years) in Germany, with 25.2% having
lence of traditional or herbal medicines use was 6.2%, the used self-medication, including 17.0% over-the-counter

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Table 2 Characteristics of the last health care provider visit (N=3,109)

Variable N (%) Immunization Consultation Medical Medications Injection Treatment Treatment Massage Insurance Satisfactory Somewhat Not or far
check-up for injury for illness paid some with last satisfactory from satis-
or all visit factory

Journal of Multidisciplinary Healthcare 2019:12

N (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) % % % %

Public hospital (general 88 (2.8) 1 (1.1) 10 (11.4) 37 (42.0) 25 (28.4) 11 (12.5) 3 (3.4) 53 (60.2) 0 46.6 15.9 75.0 9.1
or speciality)
Public health center/ 778 (25.0) 17 (2.2) 68 (8.7) 217 (27.9) 246 (31.6) 16 (2.1) 9 (1.2) 545 (70.1) 1 (0.1) 40.4 12.6 74.9 12.5
auxiliary center
Private hospital 122 (3.9) 10 (8.2) 20 (16.4) 36 (29.5) 34 (27.9) 3 (2.5) 3 (2.5) 84 (68.9) 0 38.5 21.3 73.8 4.9
Polyclinic, private 272 (8.7) 6 (2.2) 33 (12.1) 105 (38.6) 111 (40.8) 6 (2.2) 3 (1.1) 186 (68.4) 0 32.0 11.4 82.0 6.7
clinic, medical center
Private physician (gen- 556 (17.9) 7 (1.3) 60 (10.8) 173 (31.1) 186 (33.5) 10 (18.0) 1 (0.2) 366 (65.8) 0 11.2 18.3 78.2 3.5
eral practitioner, spe-
cialist, dentist, family
doctor)
Nurse, paramedic, 910 (29.3) 57 (6.3) 52 (5.7) 203 (22.3) 589 (64.7) 22 (2.4) 14 (1.5) 624 (68.6) 3 (0.3) 1.8 17.8 79.5 2.7
midwife practitioner
Traditional practitioner 364 (11.7) 0 3 (0.8) 4 (1.1) 2 (0.5) 0 4 (1.1) 54 (14.8) 316 0.0 19.8 78.8 1.4
(shaman, wiseman, (86.8)
kyai, Chinese herbalist,
masseur, acupuncturist,
etc.)
Other 19 (0.6) 7 (36.8) 0 4 (21.1) 1 (5.3) 0 1 (5.3) 6 (31.6) 1 (5.3) 21.1 5.3 94.7 0.0

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Table 3 Associations with current traditional and complementary medicine use

Variable Traditional medicine use in the past 4 Traditional practitioner use in the past
weeks 4 weeks

Crude odds Adjusted odds Crude odds Adjusted odds

ratio ratio ratio ratio
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Age in years

0–4 (35.9%) 1 (Reference) 1 (Reference) 1 (Reference) 1 (Reference)

5–9 (33.6%) 0.97 (0.83, 1.14) 0.95 (0.84, 1.09) 0.30 (0.24, 0.37)*** 0.31 (0.25, 0.38)***
10–14 (30.5%) 1.11 (0.94, 1.39) 0.98 (0.83, 1.16) 0.16 (0.12, 0.21)*** 0.17 (0.12, 0.22)***

Sex

Male (51.5%) 1 (Reference) – 1 (Reference) –

Female (48.5%) 0.96 (0.84, 1.09) 1.11 (0.93, 1.32)

Education (mother)

High school or Higher education (51.5%) 1 (Reference) – 1 (Reference) –

None or elementary (44.8%) 0.69 (0.47, 1.00) 1.02 (0.61, 1.69)

Education (father)
For personal use only.

High school or Higher education (51.3%) 1 (Reference) – 1 (Reference) –

None or elementary (48.7%) 1.15 (0.65, 2.03) 1.27 (0.55, 2.97)

Birth certificate

Has (82.5%) 1 (Reference) 1 (Reference) 1 (Reference) 1 (Reference)

Does not have (17.5%) 0.75 (0.62, 0.91)** 0.74 (0.61, 0.90)** 1.37 (1.10, 1.67)** 1.06 (0.86, 1.31)

Self-rated health status

Very healthy (31.9%) 1 (Reference) 1 (Reference) 1 (Reference) 1 (Reference)

Somewhat healthy (56.3%) 1.04 (0.89, 1.21) 1.04 (0.89, 1.21) 1.44 (1,16, 1,78)*** 1.45 (1.17, 1.80)***
Somewhat unhealthy or unhealthy 1.77 (1.45, 2.19)*** 1.81 (1.48, 2.22)*** 2.40 (1.84, 3.14)*** 1.98 (1.51, 2.59)***
(11.8%)
Notes: ***P<0.001; **P<0.01.

drugs, in the previous week.23 The very common use of This finding is in line with adult use of traditional
over-the-counter drugs among the child population can be and complementary medicine in Indonesia.5
potentially harmful.23 Further research should be con- Several previous studies in high-income countries8,17,25
ducted on the type of self-medication and indication to found an association between higher socioeconomic status
assess possible inappropriate drug use. and traditional and/or complementary medicine use in
Consistent with a previous study in Germany,6 this children. This study also found that having a birth certifi-
study found that the use of the traditional practitioner cate (as a proxy for better economic status) was associated
decreased with age. One reason for this could be the with increased use of traditional medicines. The educa-
large proportion of massages administered to babies tional status of the mother and/or father seem not to
and small children by traditional practitioners in influence the use of traditional medicines and traditional
Indonesia.7,24 However, the use of traditional medi- practitioners in children in Indonesia. In agreement with
cines did not change with age in this study. a study in Germany,6 this study also found that having
A previous study found a preponderance of unconven- a poor health status was associated with increased use of
tional medicine use among girls in Germany,25 while traditional medicines and traditional practitioners in chil-
this study did not find any gender differences in the use dren in Indonesia. One reason for this could be that chil-
of traditional medicines and traditional practitioners. dren with poorer health status, engage in a more frequent

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and greater variety of health care-seeking behavior, Data availability

increasing the chances of traditional and/or complemen- Data from the IFLS-5 is available from RAND at http://
tary medicine use.26 [Link]/labor/FLS/[Link].
In this study, satisfaction (or somewhat satisfied) with
the last health care visit with a traditional practitioner was Acknowledgments
highest (98.6%) compared to other health care provider RAND is thanked for giving us access to the IFLS-5 data
Journal of Multidisciplinary Healthcare downloaded from [Link] by [Link] on 23-May-2019

types. High satisfaction or self-rated improvement of con- ([Link]

ditions treated with herbal medicinal products was also
found in Germany, with 89.2% reporting great or partly
Disclosure
improvement of the condition treated.6 In a previous study
The authors report no conflicts of interest in this work.
among adults in Indonesia similar high levels (98.0%) of
satisfaction (or somewhat satisfied) with the last health
care visit with a traditional practitioner was found.5
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