Lead is one of ten hazardous chemicals of public health concern and is used in more than 900 occupations, including the battery, smelting, and mining industries. Lead toxicity accounts for 1.5% (900,000) of deaths annually in the world. In Indonesia, reports of high Blood Lead Level (BLL) were associated with residency in Used Lead Acid Battery (ULAB) recycling sites. The present study aims to investigate the BLL and the evidence of lead toxicity of children living in an ULAB recycling site in Bogor Regency, Indonesia. A cross-sectional study involving 128 children aged 1–5 years was conducted in September-October 2019. The socio-economic factors, BLL, nutritional status, and hematological parameters, were evaluated. Data were analyzed by univariate and bivariate using the Chi-Square test. Socio-economic factors revealed only 2.3% children have pica and 10.9% children have hand-to-mouth habits. Majority of parents had low income, education, and have stayed in the village for years. Analysis on BLL revealed that 69.5% children had BLL of >10 μg/dL, 25% had abnormal BMI, 23.4% had underweight, 53.9% had stunting, 33.6% had anemia, and 22.6% had basophilic stippling. The average BLL and hemoglobin levels of respondents were 17.03 μg/dL and 11.48 g/dL, respectively. Bivariate analysis revealed that children with high BLL had double risk of having underweight and protected from stunting. Analysis on the association between BLL and BMI for age revealed a higher risk to have abnormal BMI. The high BLL also had 1.017 times risk of developing anemia, and almost doubled risk of having basophilic stippling, although they were not statistically significant. In conclusion, the high BLL of children living in the ULAB recycling indicates that lead exposure as well as lead toxicity are still occurring in Cinangka Village, and alerts to the need for a systematic action to mitigate the exposure.

Polymorphisms in the Aminolevulinic acid dehydratase (ALAD) gene responsible for the ALAD1 and ALAD2 alleles have been implicated in susceptibility to lead toxicity. This study aimed to determine the allelic frequency of ALAD2 among children living in Bogor District, Indonesia, and its association with BLLs and lead toxicity. A cross-sectional study involving 128 children was conducted during September-October 2019 in the former ULAB area in Cinangka Village. The ALAD polymorphism, BLLs, and hematological parameters were evaluated. Blood samples were taken for dried blood spotting on filter paper, blood film, and BLL measurement. PCR amplification and sequencing of the genomic DNA revealed the presence of two forms of the ALAD2 allele: 177C and 177T with a frequency of 0.05. Analysis of the correlation between the ALAD2 allele, BLLs, and basophilic stippling revealed that ALAD2 carriers had a five times higher risk of high BLLs, (OR=5.359, p=0.155) and had a slightly higher risk of exhibiting basophilic stippling (OR=1.09, p=1.000). Although not statistically significant, these findings suggested that the ALAD genotype may modify BLLs and lead to toxicity. The ALAD2 allele (177T) is firstly reported in any population in the world.

Objective: The Healthy Indonesia Programme with a family approach strategy was launched by the Indonesian government in 2015. Pharmaceutical service, including drug supply management and clinical pharmacy, is one of the essential components for the program implementation. This study was aimed to evaluate the pharmaceutical services support in the Healthy Indonesia Programme in West Java Indonesia. Methods: This was a cross-sectional study observed on pharmaceutical services under the family approach programme description. A self-completed questionnaire was distributed to 39 accredited community health centres (CHCs) in West Java, Indonesia. Several indicators of the Standard Pharmacy Services were assessed. Results: Thirty-nine CHCs were involved in this study. Most of the CHCs were accredited as intermediate (59%) and have applied good pharmaceuticals and consumables inventory management. The online system and more training will give room for improvement. A big gap was found in human resources number and competencies, impact on clinical pharmacy standard services including counselling services (23.1%) and home visit (7.7%). Conclusion: Applying an online system is needed to improve the inventory management system in CHCs. The quality of clinical pharmacy standard services in CHCs can be improved by fulfilling the minimum numbers and competencies of human resources.