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JOSS :
Journal of Social Science
ANALYSIS FACTORS RELATED TO THE INCIDENCE OF DIARRHEA IN
TODDLERS IN THE UPTD AREA OF THE EAST MARTAPURA HEALTH
CENTER, BANJAR REGENCY
Elisa Oktaviani Dewi Anggraeni
1
, Husaini
2
, Edi Hartoyo
3
, Meitria Syahdatina Noor
4
,
Erida Wydiamala
5
Universitas Lambung Mangkurat Kalimantan Selatan, Indonesia
Email : [email protected]
KEYWORDS
diarrhea, toddlers,
soap, latrines,
garbage.
ABSTRACT
Diarrhea is a disease that causes discharge of feces more than 3 times with
a liquid consistency, which may be accompanied by blood or mucus, and
the frequency is more frequent than normal (WHO, 2019). According to
WHO and UNICEF, there are around 2 billion cases of diarrhea and 1.9
million children under five die from diarrhea worldwide every year. The
2018 Basic Health Research stated that the prevalence of diarrhea for all age
groups was 8% and the prevalence rate for toddlers was 12.3%, while for
infants, the prevalence of diarrhea was 10.6%. The aim of the study was to
analyze the relationship between Hand Washing with Soap (CTPS), Latrine
Ownership, Garbage Securing and Diarrhea in the UPTD of the East
Martapura Health Center. The method used is Quantitative, the research was
conducted using a Cross Sectional study design, with a total sample of 89.
The instruments used were questionnaires and observation sheets.
Dependent variable: Incidence of diarrhea in toddlers, independent
variables: hand washing with soap, toilet ownership, and waste
management. The results of the study showed that there was a relationship
between washing hands with soap (p=0.000), toilet ownership (p=0.000)
and the incidence of diarrhea in toddlers. There is no relationship between
waste management (p=0.065) and the incidence of diarrhea in toddlers in
East Martapura. The most influential variable on the incidence of diarrhea
among toddlers in East Martapura was latrine ownership (p=0.000 Exp (B)
= 10.496).
INTRODUCTION
Diarrhea is a disease that causes the discharge of feces more than 3 times with a liquid
consistency can be accompanied by blood or lenders and the frequency is more frequent than
normal conditions. According to WHO and UNICEF, there are approximately 2 billion cases
of diarrhea and 1.9 million children under five die from diarrhea worldwide each year
(Organization, 2009). Of all these deaths, 78% occurred in developing countries, mainly in
Africa and Southeast Asia. Basic Health Research in 2018 stated the prevalence of diarrhea
for all age groups at 8% and the prevalence rate for toddlers at 12.3%, while in infants, the
prevalence of diarrhea was 10.6% [1]. The Ministry of Health in 2019 noted that the leading
cause of death in toddlers (aged 12-59 months) in Indonesia is diarrhea (RI, 2019). Diarrhea
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Analysis Factors Related To The Incidence Of Diarrhea In
Toddlers In The Uptd Area Of The East Martapura Health
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in Indonesia in 2018 showed a total of 4,165,789 diarrhea sufferers served in health facilities.
In 2018 there were 1,516,438 (37.88) diarrhea incidence in toddlers, and increased in 2019
the incidence of diarrhea in toddlers to 1,591,944 (40%) diarrhea incidence and recorded 314
deaths of toddlers due to diarrhea (RI, 2018).
Based on data from the South Kalimantan Provincial Health Office as of January 23,
2022, it released the incidence of diarrhea for 2020 in South Kalimantan of 35,092 cases
obtained from 13 regencies and cities in South Kalimantan Province. The highest incidence
of diarrhea is in Banjar Regency in the first place as many as 5516 cases. In 2020, the
incidence of diarrhea in Banjar Regency occurred more at the age of toddlers 12-59 months,
which was 2,906 cases, or around 52.67% of diarrhea cases of all ages. In 2022, the incidence
of diarrhea in toddlers in Banjar Regency tends to increase to 4,056 events, or around 53.90%
of the 7,524 targets for finding cases under five in Banjar Regency (Sopiyudin, 2014).
In 2022, UPTD Puskesmas Martapura Timur is in the first place in the incidence of
diarrhea in toddlers, recorded from 2,295 children under five in East Martapura, there was
diarrhea as many as 159 toddlers or 41.09% of the target of finding cases of 387 toddlers and
in 2022 there were two deaths of toddlers due to diarrhea. In the second place, in the UPTD
Puskesmas Sungai Tabuk 3 area, out of 1,836 toddlers, 115 diarrhea occurred in toddlers or
37.15% of the target of finding 310 cases under five. And in the third place in the UPTD
Martapura 1 Health Center, with a total of 6,894 toddlers, diarrhea occurred as many as 102
cases or 8.78% of the target of finding cases of 1,162 toddlers. Based on data from the East
Martapura Health Center in 2022 (Simatupang, 2022). Based on data from the East Martapura
Health Center in 2022 (Simatupang, 2022). Based on the data obtained, the classification that
is often experienced by toddlers in the East Martapura Health Center area is acute diarrhea
that lasts less than 14 days (Endra, 2015). Acute disease is a disease of short duration, which
is less than 6 months. Acute illness is a mild or possibly serious illness (Kemenkes, 2011).
Based on data obtained in the East Martapura Health Center area, in general,
community-based total sanitation in the area is not one hundred percent (Watulingas, 2021).
Based on riskesdas data in 2021, the percentage of families with access to proper sanitation
in the Banjar Regency area is 83.1% (Eldysta, 2022). Data for 2022 in the working area of the
East Martapura Village Health Center that implements community-based total sanitation in
the village category to stop open defecation is at a percentage of 74.19% of 9,479 households
that have access to proper sanitation (healthy latrines) (Eldysta, 2022). This will be a health
problem if a number of heads of families do not have permanent latrines and carry out
defecation activities in the open or anywhere (Dewi, 2020). According to the Ministry of
Health in 2011, diarrheal disease is an environment-based disease whose main factor of water
or fecal contamination accumulates with unhealthy human behavior (Carles, Amrivo V,
2017).
Waste security in the East Martapura Health Center area Based on information from
health officers from the environmental health department of the East Martapura Health
Center, not all residents dispose of waste by subscribing to the garbage collection officer.
Some residents still manage waste by burning, throwing garbage in rivers and throwing their
own garbage into garbage shelters (Budiarto, 2019). Poor waste security can have an impact
on health (Tuang, 2021). If the waste is not managed properly, the presence of the waste can
Analysis Factors Related To The Incidence Of Diarrhea In
Toddlers In The Uptd Area Of The East Martapura Health
Center, Banjar Regency
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invite flies (Aisyah, 2021). The results of this study are in line with the opinion expressed by
(Carles, Amrivo V, 2017) who said poor waste management behavior will cause waste to
become a breeding ground for disease vectors such as flies. Flies like damp and foul-smelling
places such as temporary shelters, foul odors that are in the trash, likely caused by organic
waste, such as fish pieces and inorganic waste collected in the same dump (Carles, Amrivo
V, 2017).
UPTD Puskesmas Martapura Timur is located in Banjar Regency, South Kalimantan.
UPTD Puskesmas Martapura Timur has 20 villages/villages. The total number of toddlers
aged 12-59 months in 2023 is 2,178 toddlers. From the background above, there are several
problems to be studied related to the relationship between the incidence of diarrhea in
toddlers., to prove this, it is necessary to conduct research on the analysis of factors related to
diarrhea in toddlers in the UPTD Puskesmas Martapura Timur Banjar Regency (Sopiyudin,
2014).
The main objective of this study was to identify and analyze risk factors associated
with the incidence of diarrhea in toddlers in UPTD East Martapura Health Center Area. This
study aims to explain how factors such as nutritional status, diet, vaccination, and
environmental sanitation can affect the incidence rate of diarrhea in this age group (Nisa et
al., 2023).
The theoretical framework in this study uses theories from John Gordon (1950) and
theories from (Sumampouw, 2017) which mention various factors associated with the
incidence of diarrhea in toddlers.
METHOD RESEARCH
This type of research is quantitative research, research is carried out using a cross
sectional study design. The use of cross sectional study design because in this study design
all variables are measured and observed at the same time. Researchers can collect all variables
at once at the same time. Several results can be researched at once. Prevalence for all factors
can be measured.
The research site was chosen, namely the UPTD Working Area, East Martapura Health
Center in Banjar Regency, South Kalimantan. The choice of location is based on several
considerations, based on riskesdas data in 2020, the highest incidence of diarrhea in South
Kalimantan Province is in Banjar Regency, and based on data obtained at the UPTD East
Martapura Health Center, the incidence of diarrhea in 2022 is mostly experienced by the
toddler age group. Data from UPTD Puskesmas Martapura Timur illustrates several problems
related to the incidence of diarrhea in toddlers. The research time is March-July 2023.
The population in this study was mothers who had children under five aged 1-5 years
in the Working Area of UPTD Puskesmas Martapura Timur, which was 2,178 mothers. The
sample size in this study uses the formula (Lemeshow, 1991), namely:
n =
The sampling technique used in this study is Purposive Sampling, which is research
determined by certain criteria set based on the research objectives. Inclusion criteria, namely
Z
2
1-a/2
P (1-P
d
2
Vol 2, No 9 September 2023
Analysis Factors Related To The Incidence Of Diarrhea In
Toddlers In The Uptd Area Of The East Martapura Health
Center, Banjar Regency
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mothers who have toddlers, live in the puskesmas area to be studied, mothers are in good
health and actively communicate and are willing to be research respondents. Exclusion
criteria, namely moving addresses outside the research area and not willing to be respondents.
The research instrument used questionnaires made by researchers and secondary data
obtained from the East Martapura Health Center. The variables that used the questionnaire
were hand washing with soap with 8 questions, while the secondary data were variables of
diarrhea incidence, latrine ownership and garbage security. Primary data were obtained by
filling out respondent identity data collection sheets, questionnaire sheets, and also conducted
direct interviews with mothers who have toddlers with diarrhea in the East Martapura health
center area. Secondary data in this study were obtained from data from the kertak hanyar
health center in 2022 and 2023, data from the Riskesdas of South Kalimantan province in
2020 regarding diarrhea in South Kalimantan and from journals related to several variables in
this study.
Primary data was obtained by filling out respondent identity data collection sheets,
questionnaire sheets, and also conducting direct interviews with mothers who have toddlers
with diarrhea in the East Martapura health center area. Secondary data in this study were
obtained from data from the kertak hanyar health center in 2022 and 2023, data from the
Riskesdas of South Kalimantan province in 2020 regarding diarrhea in South Kalimantan and
from journals related to several variables in this study.
RESULTS AND DISCUSSION
Descriptive Analysis of Respondent Characteristics
Descriptive analysis of respondents is describing respondents into several
characteristics of respondents.
Tabel 1
Analisis Deskriptif Karakteristik Responden
Variabel
Frekuensi
(n=89)
Persentase
(%)
Education
- No School
- SD
- SMP
- SMA
- Perguruan
Tinggi
5
29
55
5,6
32,6
61,8
Age of Toddler
- Under 1
year old
- 1-2 years
- 2-3 years
- 3-4 years
- 4-5 years
2
13
42
2,2
14,6
47,2
Analysis Factors Related To The Incidence Of Diarrhea In
Toddlers In The Uptd Area Of The East Martapura Health
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840
Variabel
Frekuensi
(n=89)
Persentase
(%)
26
6
29,2
6,7
Source. Research Processed Data, 2023
Based on the table, it is known that the age of respondents is mostly toddlers in the range
between 2-3 years as much as 47.2%, and respondents' education is mostly at the high school
education level as much as 61.8%.
Validity Test and Reliability Test
The validity and reliability test of the instrument in this study was conducted on 30
mothers who had toddlers by giving a questionnaire containing 16 questions. Each question
is said to be valid if the calculation result is found r count > r table (0.374).
Table 2
Uji validitas
Question
Item
Value
Validity
Information
CPTS 1 Ads
CPTS 2
CPTS 3
CPTS 4
CPTS 5
CPTS 6
CPTS 7
CPTS 8
Ownership of
Latrines 1
Ownership of
Latrines 2
Latrine
Ownership 3
Garbage
Security 1
Garbage
Security 2
Garbage
Security 3
Garbage
Security 4
,564
,608
,535
,512
,413
,526
,476
,661
,463
,839
,676
,847
,673
,580
,539
Valid
Valid
Valid
Valid
Valid
Valid
Valid
Valid
Valid
Valid
Valid
Valid
Valid
Valid
Valid
Vol 2, No 9 September 2023
Analysis Factors Related To The Incidence Of Diarrhea In
Toddlers In The Uptd Area Of The East Martapura Health
Center, Banjar Regency
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Source. Research Processed Data, 2023
The results of the reliability test of this study show that each variable has high and
medium reliability.
Univariate Analysis
Univariate analysis to describe the variables of handwashing with soap, ownership of
healthy latrines and waste security against the incidence of diaere in terms of frequency
distribution (n) and percentage (%) in 89 respondents.
Table 3
Univariate Analysis of Independent and Dependent Variables
Variable
Frequency (n=89)
Percentage (%)
Wash hands with soap
- Not Good (score 1-12)
- Good (score 13-24)
64
25
71,9
28,1
Ownership of healthy latrines
- Not having a healthy latrine
- Have a healthy latrine
56
33
62,9
37,1
Garbage security
- Not good
- Good
54
35
60,7
39,3
Incidence of diarrhea
- Diarrhea
- No diarrhea
55
34
61,8
38,2
Source. Research Processed Data, 2023
As a result, it was found that in the handwashing with soap variable as much as (71.9%)
64 of 89 respondents were included in the category of poor scores for the handwashing with
soap variable. For the variable ownership of healthy latrines, most (62.9%) 56 out of 89
respondents do not have healthy latrines. And for the variable of waste security, the majority
of respondents were included in the category of not good (60.7%), 54 of 89 respondents of
waste security were not good. And on the variable for the incidence of diarrhea, most
respondents (61.8%) have experienced toddler diarrhea in the last 6 months.
Bivariate analysis of the relationship between handwashing with soap, ownership of
healthy latrines and waste security with the incidence of diarrhea in toddlers
Table 4
The relationship between hand washing with soap, ownership of healthy latrines and
garbage security with the incidence of diarrhea in toddlers
incidence of diarrhea
variable
Diare
No Diare
Total
p-value
N
%
N
%
N
%
Analysis Factors Related To The Incidence Of Diarrhea In
Toddlers In The Uptd Area Of The East Martapura Health
Center, Banjar Regency
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Handwashing
with soap
relationship
Not good
good
48
7
53,9
7,9
16
18
18,0
20,2
64
25
100
100
0,000
Ownership of
healthy
latrines
Unhealthy
healthy
46
9
51,7
10,1
10
24
11,2
27,0
56
33
100
100
0,000
Garbage
safety
Not good
good
38
17
42,7
19,1
16
18
18,0
20,2
54
35
100
100
0,065
Total
55
61,8
34
38,2
89
100
Source. Research processed data, 2023
This analysis showed that 53.9% were not good at washing hands with soap
experiencing diarrhea and based on the results of statistical tests obtained a p-value of 0.000
which means that there is a relationship between handwashing with soap to the incidence of
diarrhea in toddlers. For the variable ownership of healthy latrines, 51.7% of unhealthy latrine
owners have experienced diarrhea in toddlers during the last 6 months and based on statistical
test results obtained a p-value of 0.000. This means that there is a relationship between healthy
latrine ownership and diarrhea incidence. And for the variable of waste security, 42.7% of
waste security is not good for diarrhea and based on the results of statistical tests, a p-value
of 0.065 was obtained. This means that there is no relationship between waste safety and
diarrhea in toddlers.
Multivariate analysis of the relationship between handwashing with soap and ownership
of healthy latrines on the incidence of diarrhea in toddlers.
The multivariate analysis used is multiple logistic regression analysis.
Tabel 5
Hasil Analisis Regresi Logistik Ganda
No
Variable
B
S.E
Wald
Sig
Exp
1
Wash hands
with soap
1,821
0,610
8,909
0,003
6,17
2
Ownership of
healthy latrines
2,351
0,561
17,561
0,000
10,49
Source. Research processed data, 2023
From the results of multivariate analysis in this study shows that ownership of healthy
latrines is the factor most associated with the incidence of diarrhea in toddlers with a value of
p = 0.000 and an Exp (B) value of 10.496. This means that the variable ownership of latrines
has a chance of experiencing diarrhea in toddlers by 10,496 times greater than the variable of
hand washing with soap.
Vol 2, No 9 September 2023
Analysis Factors Related To The Incidence Of Diarrhea In
Toddlers In The Uptd Area Of The East Martapura Health
Center, Banjar Regency
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Discussion
Based on descriptive analysis of respondent characteristics, it is known that the age of
respondents is mostly toddler age in the range between 2-3 years, where this age is included
in the characteristics of toddler use. Age is a variable that is always considered in
epidemiological investigations. Both morbidity and mortality rates, almost all conditions
show a relationship with age. Although diarrhea is capable and proven to attack the adult
human body, more cases are found in pediatric patients younger than 5 years.
As for the variable incidence of diarrhea, the findings in the field and processed in
univariate analysis that the incidence of diarrhea in toddlers in the East Martapura region can
be seen in table 4.2 the percentage of diarrhea incidence in toddlers in this study was 55
toddlers (61.8%) and no diarrhea as many as 34 toddlers (38.2%). That from the data obtained,
the incidence of diarrhea is more than toddlers who do not have diarrhea. There are several
factors that cause diarrhea in toddlers such as the quality of latrines, drinking water sources,
hand washing habits, habits of feeding toddlers, breastfeeding in toddlers, toddler age, toddler
gender, toddler nutritional status, mother's education level and family income
There is a relationship between hand washing with soap to the incidence of diarrhea in
toddlers. There is a relationship between hand washing with soap and the incidence of diarrhea
in this study because most mothers of toddlers who are not good in terms of washing hands
with soap which results in toddlers can experience diare.
There is a relationship between healthy latrine ownership and diarrhea incidence. The
relationship between healthy latrine ownership and diarrhea incidence in this study found that
as many as 56 latrines still did not meet the criteria for healthy latrines. Most latrines in the
latrine are not maintained clean, some latrines have latrine buildings but do not have closets,
some latrines do not have roof houses, latrine floors are slippery and the latrine floor and
walls are not tight so that it can allow insects And disease-transmitting animals can enter the
cubluk / infiltration and cause odor.
There is no relationship between waste safety and diarrhea in toddlers. As many as
70.8% of respondents did not separate decomposing and non-decomposing waste, and as
much as 30% of secured waste did not use closed covers or bins. Although 70.8 respondents
did not sort organic and non-organic waste, this was not related to the incidence of diarrhea
in toddlers, because the transmission of diarrheal diseases through the oral fecal route that
occurs through polluted water, either polluted from the source, polluted during the journey to
homes, or polluted when stored at home.
CONCLUSION
Based on the results of this study, it can be concluded that there is a relationship between
hand washing with soap to the incidence of diarrhea in toddlers. There is a relationship
between healthy latrine ownership and the incidence of diarrhea in toddlers. There is no
relationship between waste safety and diarrhea in toddlers. While the variable most related
to the incidence of diarrhea is the ownership of healthy latrines.
Based on the results of this study, it is hoped that health policy holders, namely the
Banjar District Health Office, can conduct counseling and health information more
intensively and regularly to puskesmas or people's homes in Banjar Regency to overcome the
Analysis Factors Related To The Incidence Of Diarrhea In
Toddlers In The Uptd Area Of The East Martapura Health
Center, Banjar Regency
Vol 2, No 9 September 2023
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problem of washing hands with soap, and having healthy latrines. In addition, it is expected
for each puskesmas to improve health promotion to prevent diarrhea in toddlers. It is expected
that puskesmas officers must intensively and continuously provide health counseling about
factors related to the incidence of diarrhea in toddlers, especially regarding the ownership of
healthy latrines and the habit of washing hands with soap.
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Analysis Factors Related To The Incidence Of Diarrhea In
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