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Brunei Darussalam: country report on children’s environmental health

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Review
Shirley H.F. Lee*, Anne Cunningham, Rafidah Gharif, David Koh, Linda Lai, Dk Haryanti Petra,
Justin Wong and Siti Rosemawati Yussof
Brunei Darussalam: country report on children’s
environmental health
https://doi.org/10.1515/reveh-2019-0081
Received October 28, 2019; accepted December 4, 2019
Abstract: This is the country report for Brunei Darussalam
pertaining to children’s environmental health. It covers
the current landscape of environmental risk factors which
affect children’s health, existing local policies, as well
as strategies for moving forward in alignment with the
United Nation’s Sustainable Development Goals (SDGs).
Keywords: Brunei Darussalam; children’s environmental
health; country report for Brunei Darussalam on ­children’s
environmental health.
Country profile
Negara Brunei Darussalam is the official name of Brunei,
where Negara Brunei refers to the State of Brunei and
Darussalam means the Abode of Peace. Brunei Darussalam
is located on the island of Borneo, with a coastline facing
the South China Sea, sharing a common border with the
East Malaysian states of Sabah and Sarawak. Brunei spans
*Corresponding author: Shirley H.F. Lee, UBD PAPRSB Institute of
Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei-
Muara, Brunei Darussalam, E-mail: shirley.lee@ubd.edu.bn
Anne Cunningham and David Koh: UBD PAPRSB Institute of Health
Sciences, Universiti Brunei Darussalam, Gadong, Brunei-Muara,
Brunei Darussalam
Rafidah Gharif: UBD PAPRSB Institute of Health Sciences, Universiti
Brunei Darussalam, Gadong, Brunei-Muara, Brunei Darussalam;
and Community Health, Ministry of Health, Brunei-Muara, Brunei
Darussalam
Linda Lai: Child Health Services, Department of Health Services,
Ministry of Health, Brunei-Muara, Brunei Darussalam
Dk Haryanti Petra: Department of Environment, Parks and Recreation,
Ministry of Development, Brunei-Muara, Brunei Darussalam
Justin Wong: Public Health, Ministry of Health, Brunei-Muara, Brunei
Darussalam; and Health Promotion Centre, Ministry of Health,
Brunei-Muara, Brunei Darussalam
Siti Rosemawati Yussof: Health Promotion Centre, Ministry of
Health, Brunei-Muara, Brunei Darussalam
Rev Environ Health 2020; aop
over an area of 5765 km2, over four districts: Brunei-Muara,
which is the smallest but most densely populated where
the capital city, Bandar Seri Begawan, is located; Tem-
burong, the least populated district and home to pristine
rainforests; Tutong, with a heavy concentration of Brunei’s
ethnic groups; and Kuala Belait, the main production base
of oil and gas – major export commodities of Brunei. About
72% of Brunei’s land area is covered by forests. Under
Brunei Vision 2035, Brunei strives to diversify its economy
by attracting foreign direct investments across multi-sec-
tors. Brunei is an Association of Southeast Asian Nations
(ASEAN) member state since 7 January 1984 (1). Brunei
Darussalam’s peaceful and stable socioeconomic climate
has enabled its people to enjoy a high standard of living
and well-being as reflected in the national vital statistics.
Brunei is a high-income country (2).
Demography and vital statistics
The population of Brunei is 421,300 (year 2017), with an
annual population growth rate of 1.0% (3). Males and
females constitute 51.4% and 48.6% of the population,
respectively. Brunei has a relatively high average life
expectancy of 77.4  years (average global life expectancy
is 72 years), with women having a higher life expectancy
at birth than men (76.3  years for men and 78.3  years for
women) (4, 5). In 2017, 21.8% of the population was below
15 years of age (world average: 25.9%); 17.8% comprises 15-
to 24-year-olds, 46.5% falls between 25–54 years and 13.9%
of the population was over 55 years old (5, 6). Figure 1 shows
the population pyramid of Brunei Darussalam. The Malays
(Brunei-Malay, Belait, Bisaya, Dusun, Kedayan, Murut
and Tutong) are the largest ethnic group of the country,
comprising 66% of the population; the Chinese make up
10% of the population, and other ethnicities constitute the
remaining 24% of the population (5). In 2015, the adult lit-
eracy rate for Brunei Darussalam was 96.7% (7).
National statistics reported that the crude death rate
was four per 1000 population and the crude birth rate
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 2      Lee et al.: Brunei Darussalam: Country Report on children’s environmental health

85+
80–84
75–79 Male Female
70–74
65–69
60–64
Age-groups, years

55–59
50–54
45–49
40–44
35–39
30–34
25–29
20–24
15–19
10–14
5–9
0–4
6 4 2 0 2 4 6
Distribution, %

Key:
Total population in 2011
Total population in 2017

Figure 1: Population pyramid of Brunei Darussalam (2017).

was 15.3 per 1000 population in 2017. The mortality rate
for children under 5 stands at 11.5 per thousand live births
and the total fertility rate is 1.8 per woman. The maternal
mortality ratio (MMR) is 62 per 100,000 live births, whereas
the infant mortality rate (IMR) stands at 9.5 per 1000 live
births. The MMR in Brunei Darussalam has declined
rapidly since the 1960s – from 487.2 per 100,000 live births
in 1960 to 0.0 per 100,000 live births in 1990. Since then,
the MMR has shown minor fluctuations with consistently
low MMR. In 2017, four maternal deaths were registered (62
per 100,000 live births). Brunei Darussalam’s small popu-
lation and relatively low live births (around 7000 annually)
render calculation of MMR sensitive to small fluctuations,
resulting in significant rise in MMR. The very low MMR
can be attributed to the high access to reproductive health
care, immunization programs, as well as high percentage
of deliveries in hospitals by skilled health personnel. All
deliveries were attended to by trained health personnel
from 2015 to 2017 (5). Greater than 99.9% of the population
has access to clean water and improved sanitation.
Under the national long-term development plan
(Vision 2035), Brunei strives to be recognized for: (i) quality
of life that is among the top 10 nations in the world, (ii) the
accomplishments of its well-educated and highly skilled
people as measured by the highest international stand-
ards, and (iii) dynamic and sustainable economy with
income per capita among the top countries in the world (8).
The population pyramid shows percentage distri-
bution of population by gender and age-groups. For
example, the 0–4 age-group represented 6.7% of the total
population in which 3.5% and 3.2% constitute males and
females, respectively. Children made up to 21.8% of the
population of Brunei in 2017 [figure retrieved from (5)].
Health care setting in Brunei
Brunei Darussalam has a strong public health infra-
structure system in place. Healthcare services are deliv-
ered through an extensive network of health centers and
health clinics. Under the government medical services (as
of 2018), there are four main hospitals, 14 health centers,
three health clinics, four maternal and child health clinics,
three travelling health clinics and two flying medical ser-
vices. Dental services and private health services also
provide comprehensive health care to all residents (5).
Health care services for children in Brunei Darussalam
are free of charge for citizens and permanent residents
or subsidized by the government. The recently launched
Women and Children’s Block (in 2016), located at the main
tertiary hospital, provides a comprehensive and special-
ized service for women’s health and children’s health. The
annual budget allocated to the Ministry of Health in 2019 is
BND$ 386.8 million (approximately USD$ 282 million) (3).
The Maternal and Child Health (MCH) service provides
high-quality antenatal, postnatal and child health (for
0–5 years) services to all residents of Brunei Darussalam
(citizens and non-citizens) at government health centers
nationwide. Child health services at the MCH clinics cover

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 Lee et al.: Brunei Darussalam: Country Report on children’s environmental health      3
a broad range of care from home nursing assessment of
newborns in the community, routine child developmen-
tal and physical assessments from 0 to 5 years of age, and
administration and surveillance of childhood immuniza-
tions according to the National Childhood Immunization
Programme schedule.
Brunei Darussalam has a well-established, compre-
hensive National Childhood Immunization Programme
which has been successful in protecting children against
vaccine-preventable diseases. The immunization cover-
age rate for all childhood vaccinations has remained con-
sistently high at above 95% over the last 5 years (5) and
the country is World Health Organization (WHO)-verified
as polio-free (2010), measles-free (2015) and rubella-free
(2018). For children beyond 5  years of age, the school
health services carry out a general health screening for
all school children attending public and private schools
in the country. This health screening is provided at year
1 (age 5–6 years old), year 4 (age 9–10 years old) and year
7 (age 12–13  years old). The school health service also
ensures school children’s immunization status are up to
date and identifies any missed vaccinations.
Brunei Darussalam’s health status
in relation to the UN’s Sustainable
Development Goals
The Millennium Development Goals (MDGs) reached the
end of their term in 2015. On the 25th of September 2015,
the United Nations (UN) General Assembly adopted the
new development agenda “Transforming our world: the
2030 agenda for sustainable development”. The post-
2015 agenda comprises 17 Sustainable Development Goals
(SDGs) and 169 targets, including one specific goal for
health with 13 targets.
Under Brunei’s law (Children and Young Persons Act),
a “child” means a person who has not attained the age
of 14  years (9). Children’s health remains one of the key
indicators for Brunei Darussalam in monitoring progress
toward achieving the SDGs of 2030. IMR has declined from
36.7 per 1000 live births in 1967 to 9.5 per 1000 live births
in 2017. Statistics from 2013 to 2017  showed that a high
proportion of the IMR was attributed to congenital abnor-
malities and perinatal conditions (partly due to abor-
tion being illegal in the country, unless when a pregnant
woman’s life is at risk). The under-5 mortality rate (U5MR)
has also decreased from 20 per 1000 live births in 1980 to
11.5 per 1000 live births in 2017 (in 2017, 82.4% of the total
deaths in U5MR were due to infant mortalities) (5).
Mortality in Bruneian children
In 2015, more than a quarter of the 5.9 million deaths of chil-
dren under 5 years could have been prevented by reducing
environmental hazards globally (10). Children are more
vulnerable to environmental hazards as they breathe
more air, consume more food and drink more water than
adults do, in proportion to their weight. In addition, their
immature and developing nervous, immune, reproductive
and digestive systems are more prone to environmental
toxins. Their behavior also results in different patterns of
exposure to dust and chemicals (crawling exposes them
to dust and chemicals on floors and soils). They also have
less control over their environment, are unaware of risks
and unable to make choices which limits the ability to
protect their health (11).
Table 1 illustrates the leading causes of under-5 mor-
tality in Brunei (5). These include certain conditions origi-
nating in the perinatal period, congenital malformations,
deformations and chromosomal abnormalities, cancer
(leukemia and cancer of the nervous system), septicemia,
heart diseases (including rheumatic fever), and diarrhea
and gastroenteritis of presumed infectious origin.
Leading causes of morbidity in
Bruneian children
Gastroenteritis of infectious origins is a leading cause of
morbidity in Bruneian children under 5. Respiratory disor-
ders including asthma, influenza and pneumonia – lower
respiratory tract infections of both viral and bacterial eti-
ology – are also prevalent among children in Brunei. Out-
breaks of hand, foot and mouth disease (HMFD) are also
common in Brunei.
The 2nd National Health and Nutritional Status Survey
(NHANSS): Phase 1 (NHANSS report, 2012) showed that
19.7% of children aged 0–5 years were moderately stunted
and 4.8% were severely stunted. The survey showed a
prevalence of moderate wasting (2.9%) and severe wasting
of 0.4% for 0- to 5-year-olds. The NHANSS has also shown
a prevalence for overweight in 0-to 5-year-old children
at 8.8%, and obesity in 0- to 5-year-old children at 3.3%.
Data collected through routine school health services’
anthropometric screening showed a prevalence of 12.6%
of obese year 1 (aged 5–6 years) schoolchildren and 18.8%
of obese year 4 (aged 9–10 years) schoolchildren in 2011.
In 2017, the figures increased to 13.2% for year 1  school-
children and 22.7% for year 4 schoolchildren. These data
suggest that malnutrition is prevalent in younger children
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4      Lee et al.: Brunei Darussalam: Country Report on children’s environmental health

Table 1: Leading causes of under-5 mortality in Brunei (2013–2017).

Leading causes of under-5 mortality in Brunei

  2013   2014   2015   2016   2017

1   Certain conditions   Certain conditions  Certain conditions   Certain conditions   Certain conditions
originating in the originating in the originating in the originating in the originating in the
perinatal period perinatal period perinatal period perinatal period perinatal period
  (26)   (24)   (27)   (29)   (34)
2   Congenital   Congenital   Congenital   Congenital   Congenital
malformations, malformations, malformations, malformations, malformations,
deformations and deformations and deformations and deformations and deformations and
chromosomal chromosomal chromosomal chromosomal chromosomal
abnormalities abnormalities abnormalities abnormalities abnormalities
  (15)   (17)   (26)   (13)   (19)
3   Cancer   Septicemia   Heart diseases   Cancer   Heart diseases
  (3)   (2)   (2)   (7)   (3)
4   Transport accidents   Diarrhea and   Accidental drowning  Septicemia   Cancer
gastroenteritis and submersion
of presumed
infectious origin
  (3)   (1)   (2)   (4)   (2)
5   Heart diseases   Other intestinal   Cancer   Heart diseases   Accidental
infectious drowning and
diseases submersion
  (2)   (1)   (1)   (2)   (2)
6   Septicemia   Cancer   Exposure to smoke,   Influenza and   Influenza and
fire and flames pneumonia pneumonia
  (1)   (1)   (1)   (1)   (2)
7   Influenza and   Anemias     Bronchitis, chronic   Diarrhea and
pneumonia and unspecified gastroenteritis
emphysema and of presumed
asthma infectious origin
  (1)   (1)     (1)   (1)
8   Unspecified acute lower   Heart diseases     Transport   Septicemia
respiratory infection accidents
  (1)   (1)     (1)   (1)
Othersa   (13)   (12)   (8)   (9)   (10)
Total   (65)   (60)   (67)   (67)   (74)

Remainders; Numbers in brackets () represent the number of cases per condition contributing to U5MR for the respective year.
a

(0–5  years) whereas obesity is a concern among older
­children in Brunei (above 5 years old).
Challenges related to children’s
infections in children younger than 5 years (5,939,000) and
asthma in children (651,000) (12). Maternal exposure to
second-hand smoke during pregnancy has been associated
with delayed mental developmental in early childhood (13).
Outdoor air quality is not a major problem in Brunei,
based on the Pollutant Standards Index (PSI) readings

environmental health in Brunei in accordance with the US Environmental Protection

Indoor and outdoor air pollution
Globally, exposure to passive smoke was estimated to
have caused 165,000 deaths from lower respiratory infec-
tions, 36,900 from asthma and 21,400 from lung cancer.
The largest disease burdens were from lower respiratory
Agency (EPA), European Union and the WHO standards.
However, according to the 2nd NHANSS: Phase 1, house-
hold smoking prevalence indicates that children in Brunei
were exposed to high levels of passive smoke where 50.2%
fathers and 2.1% mothers were current smokers, and 32%
of households surveyed have other family members who
smoke. In addition, despite existing legislations/tobacco
sale ban and smoking cessation programs to restrict

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 Lee et al.: Brunei Darussalam: Country Report on children’s environmental health      5
use, a recent nation-wide survey has shown high exist-
ing tobacco smokers among the population (19.9%), with
daily tobacco users at 13.3% (5). The Global Youth Tobacco
Survey has shown that in Brunei, tobacco use among ado-
lescents stands at 11.1% (16.3% of boys and 5.6% of girls)
(n = 917  students, 13–15  years old). Therefore, tobacco
use, and the resulting passive smoke, remains a risk for
children.
Occasionally, Brunei experiences haze periods from
bush and forest fires. The most recent episode occurred
in September this year (2019), with PSI readings reach-
ing >100. This may result in minor health conditions such
as cough, eye irritation and runny nose. Children with
asthma, lung and heart diseases may also be more vulner-
able to haze-associated health conditions.
A recent meta-analysis reported an associated
between benzene exposure (from traffic-related con-
taminants) and the increased risk of childhood leukemia
(14). In Brunei, the number of private car owners is high,
and fuel is subsidized by the government of Brunei, with
unleaded petrol (ULP) being the most common fuel type
in Brunei. In terms of public transport infrastructure,
there are franchised taxis and a public bus system which
services limited area. However, public transport usage is
low. Outdoor air pollution and, in particular, exposure
to contaminants released by motorized traffic, therefore
remains a potential environmental threat.
Studies have shown that young individuals are more
susceptible to air pollution-induced neurotoxicity, which
negatively affects their neuropsychological development
(15–17). The increasing prevalence of learning disabilities
and neurodevelopmental conditions in Brunei suggests the
need to further understand the link between neurodevelop-
mental disorders and environmental threats with measures
to monitor and limit exposure to these toxic pollutants.
House dust mites grow well in a warm and humid
climate. Brunei has a tropical climate that favors per-
manent exposure to mite allergens (18). It has also
been reported that mites constitute the most important
cause of respiratory allergy in tropical settings (19).
This is reflected in the high levels of sensitization to
house dust mites among Bruneian children (20). House
dust mites have been shown to be important sources
of indoor allergens associated with asthma and other
allergic conditions (21).
Notifiable diseases
Notification of infectious diseases is required by Brunei
law under the Infectious Diseases Act. A total of 57
infectious diseases are listed as notifiable in the country.
All notifications are reported to the Disease Control Divi-
sion at the Ministry of Health (5).
A recent systematic analysis for the Global Burden of
Disease Study 2015 to estimate the global, regional, and
national morbidity, mortality and etiologies of diarrheal
diseases has shown that Brunei is one of countries with
the lowest under-5 deaths from diarrhea (22). However,
diarrhea/gastroenteritis remains common in Bruneian
children. Therefore, improving hygiene awareness, sur-
veillance and management of outbreak remains a key
priority.
HFMD is an endemic disease in Brunei. Brunei Darus-
salam experienced its first major reported outbreak of the
EV71 strain of HFMD between February and August 2006.
More than 1681 children were affected, with three deaths
resulting from severe neurological disease. EV71 was iso-
lated in samples from 34 of at least 100 patients diagnosed
with HFMD or herpangina (HA), including two patients
who died as a result of severe neurological complications
(personal communication).
Since then, HFMD has become an important public
health disease due to its tendency to cause large out-
breaks (mainly self-limiting) among children and infants.
Disease patterns are cyclical and in temperate, countries
most cases occur in the summer and fall. In Brunei Darus-
salam, disease surveillance over the past few years indi-
cates peak activity starting from February lasting until
late-May/early-June. As of 31st April 2019, 2561 HFMD
cases have been reported in Brunei (personal communi-
cation). The large nuclear family system in Brunei means
that it is common for multi-generation family members
to live in close proximity (under the same roof), which
may partially explain the ease of spreading infection.
The national HFMD guidelines ensure that the Ministry of
Health along with schools and childcare centers remain
vigilant on HFMD surveillance and reporting.
Nutrition and physical activity
Key concerns related to diet and nutrition among chil-
dren in Brunei from the NHANSS: Phase 2 (2013) include
short duration of exclusive breastfeeding and sustenance
of breastfeeding up to 24 months; consumption of sugary
drinks; consumption of salty snacks; very low fruits and
vegetables contributing to low fiber intake; the high
proportion of children consuming more than the recom-
mended amounts of energy from fats and the majority of
children consuming more than the recommendation of
10% of energy from saturated fats. Stunting and wasting
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6      Lee et al.: Brunei Darussalam: Country Report on children’s environmental health
among 0- to 5-year-old children and obesity in older
­children are challenges to address.
Waste management
Landfill is the main waste disposal method in Brunei
Darussalam. It was estimated that 222,766 tons of waste
were generated in Brunei in 2018, an increase of 18% since
2005 (189,000 tons).
In Brunei Darussalam, the main issue and challenge
is the lack of comprehensive legislation and enforcements
of the laws and regulations regarding municipal wastes.
It is thus necessary for the government to formulate
­legislations and laws to protect the environment in-line
with international or global standards. For instance, the
government can also enforce stricter waste management
laws such as only allowing non-recyclable materials into
the landfills, mandatory waste segregation at source for
recycling and implementing recycling bins in government
buildings including schools (23).
Currently, there are two laws pertaining to the manage-
ment of hazardous wastes in Brunei Darussalam, namely
the Environmental Protection and Management Order
2016 (EPMO) and the Hazardous Waste (Control of Export,
Import and Transit) Order 2013 (HWO). Whilst the HWO
only looks into the transboundary movement of hazard-
ous wastes between countries, there are no comprehen-
sive provisions under the EPMO that deal with the holistic
management of hazardous wastes in the country. There is
presently no waste classification system in Brunei, apart
from the occasional arrangements for special disposal
of hazardous wastes. Due to the limited capability and
number of facilities dealing with the disposal of hazard-
ous wastes in the country, hazardous wastes generated
are sent overseas for proper treatment and disposal/recov-
ery through the procedures of the Basel Convention on the
Control of Transboundary Hazardous Movements of Haz-
ardous Wastes and their Disposal (Basel Convention).
The existing waste management system and control
of toxic chemicals is inadequate to deal with hazard-
ous waste generated by polluting industries that utilize
chemicals, especially toxic chemicals, in their production
process. This is of particular concern as Brunei intends
to diversify the oil and gas industry through the develop-
ment of downstream activities such as oil refinery and
export-oriented petrochemical industry, as well as expan-
sion into the industrial, agriculture and fishery sectors.
The US-based EPA estimates that as much as 60 million
metric tons of electronic waste (e-waste) enter landfills
every year with toxic heavy metals such as beryllium,
cadmium, mercury and lead, potentially ­leeching into
soil and water supply (24). It is estimated that the average
inhabitant generates 18.1 kg of e-waste in Brunei (25).
Therefore, there is a dire need to enhance public
awareness regarding safe handling and disposal of wastes
and install comprehensive legislations for industries and
various sectors to ensure environmental sustainability to
minimize health hazards associated with environmental
threats.
Existing strategies related to
children’s environmental health
Air quality control
Tobacco-control measures in the country have been in
place since the mid-1970s. These include voluntary ban of
cigarette advertisements on television, radio and cinemas
in 1976; mandatory health warnings on cigarette packs in
1991; all government buildings declared smoke-free; and
a 200% increase in tobacco tax in 1994 and smoke-free
schools in 2002. In 2004, Brunei ratified the WHO Frame-
work Convention on Tobacco Control (FCTC) and the reli-
gious authorities also declared a “fatwa” (religious edict)
that categorizes smoking as “haram” (inappropriate for
Muslims). This was followed by the enforcement of WHO
FCTC and the enactment of the Tobacco Order and estab-
lishment of smoking cessation clinics in 2005 followed by
Tobacco Regulation in 2007.
Continuous effort to sustain the ban on public
smoking was enforced on June 1, 2008, with the estab-
lishment of the Tobacco Control Unit in 2008 to oversee
enforcement activities, the formation of the National Com-
mittee on Tobacco Control in 2009, and most recently the
increase in tax and pricing in 2010. In 2011, a consultative
“Workshop for the Development of the National Tobacco
Control Plan” was conducted to outline the national plan
of actions for a tobacco-free initiative in the country,
which included further research on tobacco use. Through
this research, there would be updated data on preva-
lence, smoking trends and assessment of effectiveness of
current measures. One of the main strategic themes of the
National Tobacco Control Plan is to reduce current prev-
alence of tobacco use by 50% in males 15  years old and
above by 2018.
Climate change remains a threat globally, and Brunei
is not exempted. On 22 April 2016, Brunei Darussalam
signed the Paris Agreement, which aims to strengthen the
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 Lee et al.: Brunei Darussalam: Country Report on children’s environmental health      7
global response to the threat of climate change by keeping
a global temperature rise this century well below 2°C
above pre-industrial levels and to pursue efforts to limit
the temperature increase even further to 1.5°C, and Brunei
Darussalam is one of the first countries among the ASEAN
member states to deposit the Instruments of Ratification
of the Paris Agreement on 21 September 2016.
Brunei is also a member of “The Heart of Borneo
(HoB) Initiative” – a transboundary effort between
Brunei, ­Indonesia and Malaysia to enable conservation
and ­sustainable development that improves the welfare of
those living on the island while minimizing deforestation,
forest degradation and the associated loss of biodiversity
and ecosystem services (26).
Access to clean water and improved
sanitation
Drinking water is systematically and regularly monitored
at various sources (source water, water treatment plants,
reservoirs and distribution system) to ensure safe drink-
ing standards (27). One hundred percent of the population
have access to safe, clean water and 93% have access to
improved sanitation in Brunei (28).
Water pollution is not a major problem in this
country. The Prevention of Pollution of the Sea Order,
2005 gave effect to the International Convention for
the Prevention of Pollution from Ships, 1973 and to
other international agreements relating to the preven-
tion, reduction and control of pollution on the sea and
­pollution from ships (23).
Disease surveillance and outbreak measures
The legal and regulatory framework underpinning the
surveillance of communicable diseases of public health
concern in Brunei Darussalam is the Infectious Disease
Act, Chapter 204. HFMD is a notifiable disease under this
Act, and clinicians have the responsibility for notifying
cases of HFMD to the Director General of Health ­Services
or a delegated division. Operationally, the Disease
Control Division, Ministry of Health, Brunei is responsi-
ble for the collation, analysis and dissemination of HFMD
­surveillance data and produces weekly surveillance report
for HFMD cases in Brunei Darussalam, and supports the
implementation of control measures when an outbreak is
identified.
Gastroenteritis, pneumonia and influenza are also
common pediatric diseases. Under the Infectious Disease
Act, surveillance and measures to control outbreak to
prevent the spread of transmission and control infection
are in place. Infection control guidelines are also in place
for schools and childcare centers.
Nutritional and physical activity guidelines
for children
The 2nd NHANSS: Phase 2 (2013) reported a national rate
of 26.7% of exclusively breastfed infants (0–6 months of
age). Routine clinic data collection of babies attending the
MCH clinics for regular developmental assessments have
shown that exclusive breastfeeding rates have increased
steadily to 46% in 2018. Brunei Darussalam endorsed its
first National Strategy for Maternal, Infant, and Young
Children Nutrition (MIYCN, 2014–2020) in 2014. Under
this strategy, efforts to protect, support and promote
breastfeeding in the country have been continuous and
strengthened from time to time.
A high-level Multisectoral Taskforce for Health was
established in 2017 which identified two specific focus on
nutrition: (i) to improve Brunei’s food environment and
(ii) giving every child the best start in life. These aim to
promote and support production and access to healthier
foods and to generate and drive the demand for health-
ier food choices. A number of policies and strategies are
currently put in place including nutrition education in
the school curriculum, Food-based Dietary Guidelines,
Healthy School Canteen Programme, School Garden-
ing Programme and introduction of excise tax on sugar-
sweetened beverages. Other new developments in the
near future include implementing the Nutrition and Phys-
ical Activity Guidelines for Childcare Centers (for 0- to
5-year-olds), and strengthening Health-Promoting School
Initiatives. Such initiatives which focus on giving every
child the best start in life, are included in the Ministry of
Health’s 5-year strategic plan for 2019–2023. The Health
Promotion Centre at the Ministry of Health, Brunei is also
working on guidelines on marketing of food and beverage
to children, in alignment with the WHO’s SDGs.
Waste management
Daily collection of wastes is done through various
methods: (1) private collection and/or door-to-door collec-
tion by registered vendors; (2) collection at the roadside
public waste collection centers for domestic wastes; and
(3) self-hauling of wastes to landfills. With regard to waste
disposal, Brunei has committed itself to an engineered or
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8      Lee et al.: Brunei Darussalam: Country Report on children’s environmental health
sanitary landfill (built to the toughest U.S. EPA standards)
which includes a $66.5  million modern waste manage-
ment facility covering an area of 110  hectares at Sungai
Paku in Tutong district since 2012. Testing of surface water,
groundwater quality, ambient air quality and landfill
gases is conducted at the Sungai Paku engineered landfill
site on a monthly basis. Brunei practices a multi-bin col-
lection system for certain educational institutions, offices,
retail establishments and in public places for recovering
recyclable cans, bottles and paper. However, there are no
policies to waste segregation at the point of collection par-
ticularly at the household level (29).
There are several recycling companies in Brunei which
offer cash incentives for scrap metals, used papers, com-
puters, plastics and used motorcar batteries and export
to countries including Indonesia, Malaysia, Thailand
and Japan for recycling processes, with regulated export/
import permit in accordance with the Basel Convention.
Relevant government agencies are responsible for
enforcing environmental protection efforts for the rain-
forest, agriculture, wildlife, air, water, climate and ocean.
One of the government agencies responsible is the Depart-
ment of Environment, Parks and Recreation (JASTRe) at
the Ministry of Development, which has established Envi-
ronmental Acts and Guidelines, Pollution Control Guide-
lines for Industrial Development, and recycling guidelines
(Recycle 123 Handbook) for the general public.
JASTRe also engages with the public through road-
shows, education, campaign, social media, non-govern-
mental organizations (NGOs) and government agencies
to raise awareness about environmental protection.
Brunei has existing bilateral cooperation (memorandum
of understanding) with the Ministry of the Environment
and Water Resources, Singapore to enhance cooperation
between both parties in the field of environmental protec-
tion and sustainable development.
Internationally, Brunei Darussalam has been party to
several United Nations Conventions namely: the Vienna
Convention on the substances that deplete the Ozone
Layers signed on the 26th of July 1990; the Montreal Pro-
tocol signed on the 27th of May 1993 and its Amendments
since 2009. Though not a full member of the Stockholm
Convention on Persistent Organic Pollutants, Brunei
Darussalam had the opportunity to receive technical
assistance for implementing the project “Evaluation of
National Dioxin and Furan Inventories” in December 2002
(30). Brunei is also a participating member of the Asian
Network for Prevention of Illegal Transboundary Move-
ment of Hazardous Wastes (Asian NT) since 2004 (31).
In 2002, the Pollution Control Guidelines for the Indus-
trial Development in Brunei Darussalam was adopted for
the control of emissions, effluents and discharge from
various development and construction activities. The
Environmental Impact Assessment Guidelines for Brunei
Darussalam were also established to complement the Pol-
lution Control Guidelines for the Industrial Development
in Brunei Darussalam.
The Environmental Impact Assessment Guidelines
for Brunei Darussalam serve as guidelines for project
proponents to survey, predict and assess environmental
impacts and study possible environmental protection
measures relating to prescribed activities in the follow-
ing areas: agriculture, airport, drainage and construction,
land reclamation, fisheries, forestry, housing, industrial,
infrastructure, ports, mining, petroleum, power genera-
tion and transmission, quarries, railways, transportation,
resort and recreational development, waste treatment and
disposal, and water supply (32).
In addition, the HWO 2013 (Control of Export, Import
and Transit) and the EPMO 2016 are also in place to better
regulate environmental threats associated with hazardous
reagents.
The oil and gas industry as the major large-scale
industry in the country is a significant generator of “haz-
ardous wastes” which include oily sludge, waste oils,
emulsions, waste drilling mud, produced waters, mercury,
oxazolidone, spent catalyst, contaminated sludge and
washings. Produced water is a major byproduct of oil and
gas companies. Produced water contains hydrocarbons,
production chemicals and heavy metals (33). Oil and gas
sectors in Brunei adhere to sustainability principles, with
systems to manage environmental risks and impacts.
Continuous engagement with the community to
improve health literacy and raising awareness about the
risks of environmental hazards remain the way forward.
The Government of Brunei Darussalam is fully committed
to the concept of sustainable development as central to
socioeconomic development. Eight strategies, including
environmental strategy, have been identified in the Tenth
National Development Plan Year 2012–2017 to ensure the
proper conservation of our natural environment and cul-
tural habitat to provide health and safety in line with the
highest international practices.
To help accomplish conservation and protection of
the ecosystem of Brunei Darussalam, the government is
also working with businesses and non-profit organiza-
tions by undertaking several initiatives including the pro-
vision of recycling services, conducting environmental
awareness programs and activities such as “No Plastic Bag
Everyday” from 31st of December 2018, car-free Sundays
during “Bandarku Ceria”, participating in Earth Hour,
reducing the use of styrofoam, as well as establishing
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 Lee et al.: Brunei Darussalam: Country Report on children’s environmental health      9
environmental clubs such as Beach Bunch, Green Brunei
and Panaga Natural History Society among others (34).
There is no recycling facility in Brunei currently,
but plastic and metal wastes are being collected and
exported as “valuable waste”. Waste segregation (for
non-hazardous waste) at the household level is another
strategy moving forward. A national control system for
hazardous waste management is required, incorporating
the following components: (i) legislation and regulation;
(ii) proper implementation and enforcement procedures;
(iii) provision of adequate facilities for hazardous waste
recycling, treatment, disposal and measures to encour-
age their use; and (iv) adequate training for enforcement
officers, plant operators and public awareness educa-
tional programs. In addition, collection of high-quality
data on present quantities of the types of waste collected
and on current practices of waste management is essen-
tial to identify priorities for development of a national
strategy for hazardous waste management and planning
for the provision of facilities (35).
CBRN risk mitigation
Brunei engages with the European Union’s CBRN (Chemi-
cal, Biological, Radiological and Nuclear) Centres of
Excellence initiative, to revise and update the national
action plan toward CBRN risk mitigation (36). A Radia-
tion Protection Order has been gazetted earlier this year,
with the newly created Safety, Health and Environment
National Authority (SHENA) responsible for its implemen-
tation (37).
Social welfare
There are existing legislations and guidelines to protect
the social well-being of children. These include the Chil-
dren and Young Persons Act (2006) and most recently the
National Strategy Framework for Child Online Protection
(2015). Children under the age of 18 may only work under
parental consent with the approval of the Labour Commis-
sion. The law in Brunei prohibits employment of children
under the age of 16. There are no reports of violations of
these child labor laws (38).
Reproductive health issues among adolescents are
among the social issues identified in Brunei Darussalam
in particular teenage pregnancy and sexually transmit-
ted infections (STIs). Between 2005 and 2010, female
adolescents consistently made up around 6% of preg-
nant patients registered in government antenatal clinics
throughout the country. Since then, this proportion
has gradually declined; in 2018, only 3.5% of pregnant
patients were adolescents. Between 2005 and 2018, the
number of pregnant adolescents dropped by more than
50%. Adolescent birth rate similarly shows a downward
trend from 19.6 per 1000 (women between 15 and 19)
in 2005 to 9.3 per 1000 in 2017. The Ministry of Health,
however, reported between 70 and 80 cases of STIs among
adolescents aged 10–19 years old between 2008 and 2012.
Since then, the number of cases has decreased to 50% in
2014 and has shown further decline from 36 cases in 2015
to 13 cases in 2018.
Recognizing the gap in the services for adolescents in
the country, the Ministry of Health has identified adoles-
cent health service as one of the main initiatives under its
5-year strategic plan for 2019–2023. Under this initiative,
an adolescent-friendly health center will be introduced in
the community, and TeenBuddy System in school settings
will be established whilst also strengthening sexual and
reproductive health awareness and prevention programs
for the general public and adolescents, in particular.
Country needs and strategy
moving forward
There is a need to constantly review children’s environ-
mental exposures in order to understand disease trends
and mortality. Although the framework for protecting
children’s health is in place, a multisectoral approach to
hazard identification, risk assessment and communica-
tion is essential in order to more effectively implement
these measures. These include enforcing legislations,
developing/refining framework and guidelines to raising
public awareness, and managing exposure and disease
risks to decrease disease burden from environmen-
tal hazards in children. Gap analysis, capacity train-
ing (particularly in environmental and health impact
assessments), strengthening research and collabora-
tion, and continuous engagement with the community
to improve health literacy in alignment with the UN SDG
may also lead to improved protection of this vulnerable
population.
Acknowledgment: Contributors from the Ministry of
Health and Universiti Brunei Darussalam: Dk. Haryanti
Binti Pengiran Hj Petra [Department of Environment,
Parks and Recreation (JASTRe)], Dr. Hjh Rafidah binti Haji
Gharif and Dr. Linda Lai (Primary Health Care ­Services), Dr.
Justin Wong (Public Health Services), Dr. Siti Rosemawati,
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10      Lee et al.: Brunei Darussalam: Country Report on children’s environmental health
Rusydiah Binti Sudin and Dr Hjh Norol Ehsan Binti Hj Abd
Hamid (Health Promotion Centre), Dr. Mohamad Hussein
Abdullah, Muhammad Ali Hamzah Kasmat and Dr. Nurul
Hayati Azrina Binti Hj Jaman (Environmental Health
Services), Dr. Anni @ Nik Ani Afiqah binti Hj Mohamad
Tuah (Universiti Brunei Darussalam), Associate Professor
Dr. Anne Cunningham (Universiti Brunei Darussalam),
Distinguished Professor David Koh (Universiti Brunei
Darussalam).
Research funding: None declared.
Conflict of interest: None declared.
Informed consent: Not applicable.
Ethical approval: The conducted research is not related to
either human or animal use.
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