Determinants of Diarrhea in Toddlers at Post-Declaration Open-Defecation-Free Area

Arum Siwiendrayanti(1), Inda Zumalat Dawil Maulidah(2),

(1) Environmental Health Division, Public Health Department, Universitas Negeri Semarang, Indonesia
(2) Environmental Health Division, Public Health Department, Universitas Negeri Semarang, Indonesia


Kudus District Health Office in 2020 reported that diarrhea was still the main cause of post-neonatal and toddler mortality even though Kudus District had become an Open Defecation Free (ODF) District in 2019. The highest case finding was in the working area of the Gondosari Health Center at 22.9% in 2020 and an increase of 20.8% compared to the previous year. Aim: to find out the determinants of the incidence diarrhea in toddler after ODF declaration in the work area of the Gondosari Health Center, Kudus Regency. Method: this type of research is an analytic observational study with a cross-sectional design and was obtained in December 2021. The number of samples was 71 samples with the purposive sampling technique. The research instrument used a questionnaire sheet and an observation sheet. Data analysis used Chi-Square and Fisher tests. Result: the results showed the quality of latrine facilities (RP=1.9 and p=0.112), PAMRT (RP=1.0 and p=1,000), PLCRT (RP=3.1 and p=0.001), drinking water sources (RP= 1.1 and p=0.986, water microbiological quality (RP=4.0 and p=0.026). Conclusion: there is a relationship between PLCRT and water microbiological quality with the incidence of diarrhea in children under five after the ODF declaration in the Gondosari Health Center working area. It is hoped that the government will seek a better water source development program for the community and regular monitoring of ODF areas.


Diarrhea; Toddler; ODF

Full Text:



Ayalew, A.M., Mekonnen, W.T., Abaya, S.W., & Mekonnen, Z.A., 2018. Assessment of Diarrhea and Its Associated Factors in Under-Five Children Among Open Defecation and Open Defecation-Free Rural Settings of Dangla District, Northwest Ethiopia. Journal of Environmental and Public Health, 2018, pp.1–8.

Bain, R., Cronk, R., Hossain, R., Bonjour, S., Onda, K., Wright, J., Yang, H., Slaymaker, T., Hunter, P., Pruss-Ustun, A., & Bartram, J., 2014. Global Assessment of Exposure to Faecal Contamination Through Drinking Water Based on a Systematic Review. Tropical Medicine and International Health, 19(8), pp.917–927.

Barrantes, K., Chacon, L., Morales, E., Rivera-Montero, L., Pino, M., Jimenez, A.G., Mora, D.C., Jimenez, P.S., Silva, B., & Romero-Esquivel, L.G., 2022. Occurrence of Pathogenic Microorganisms in Small Drinking-Water Systems in Costa Rica. Journal of Water and Health, 20(2), pp.344–355.

Bhar, D., Bhattacherjee, S., Mukherjee, A., Sarkar, T.K., & Dasgupta, S., 2017. Utilization of Safe Drinking Water and Sanitary Facilities in Slum Households of Siliguri, West Bengal. Indian Journal of Public Health, 61(4), pp.248–253.

Cameron, L., Chase, C., Haque, S., Joseph, G., Pinto, R., & Wang, Q., 2021. Childhood Stunting and Cognitive Effects of Water and Sanitation in Indonesia. Economics and Human Biology, 40, pp.100944.

Dimitrova, A., McElroy, S., Levy, M., Gershunov, A., & Benmarhnia, T., 2022. Precipitation Variability and Risk of Infectious Disease in Children Under 5 Years for 32 Countries: A Global Analysis Using Demographic and Health Survey Data. The Lancet Planetary Health, 6(2), pp.e147–e155.

Dinas Kesehatan Kabupaten Kudus., 2020a. Laporan Studi Environmental Health Risk Assessment (EHRA). Kudus.

Dinas Kesehatan Kabupaten Kudus., 2020b. Profil Kesehatan Kabupaten Kudus 2020. Kudus.

GBD 2016., 2018. Estimates of the Global, Regional, and National Morbidity, Mortality, and Aetiologies of Diarrhoea in 195 Countries: A Systematic Analysis for the Global Burden of Disease Study 2016. The Lancet Infectious Diseases, 18(11), pp.1211–1228.

Getahun, W., & Adane, M., 2021. Prevalence of Acute Diarrhea and Water, Sanitation, and Hygiene (WASH) Associated Factors Among Children Under Five in Woldia Town, Amhara Region, Northeastern Ethiopia. BMC Pediatrics, 21(1), pp.1–15.

Grady, C.A., Kipkorir, E.C., Nguyen, K., & Blatchley, E.R., 2015. Microbial Quality of Improved Drinking Water Sources: Evidence from Western Kenya and Southern Vietnam. Journal of Water and Health, 13(2), pp.607–612.

Hashi, A., Kumie, A., & Gasana, J., 2017. Hand Washing with Soap and WASH Educational Intervention Reduces Under-Five Childhood Diarrhoea Incidence in Jigjiga District, Eastern Ethiopia: A Community-Based Cluster Randomized Controlled Trial. Preventive Medicine Reports, 6, pp.361–368.

Ko, S.H., & Sakai, H., 2022. Water Sanitation, Hygiene and the Prevalence of Diarrhea in the Rural Areas of the Delta Region of Myanmar. Journal of Water and Health, 20(1), pp.149–156.

Magdalena, I., Rantetampang, A.L., Pongtiku, A., & Mallongi, A., 2019. The Risk Factors Environment and Behavior Influence Diarrhea Incidence to Child in Abepura Hospital Jayapura City. International Journal of Science and Healthcare Research, 4(1), pp.171–180.

Majorin, F., Torondel, B., Chan, G.K.S.C., & Clasen, T., 2019. Interventions to Improve Disposal of Child Faeces for Preventing Diarrhoea and Soil-Transmitted Helminth Infection. Cochrane Database of Systematic Reviews, 2019.

Mcclelland, P.H., Kenney, C.T., Palacardo, F., Roberts, N.L.S., Luhende, N., Chua, J., Huang, J., Patel, P., Sanchez, L.A., Kim, W.J., Kwon, J., Christos, P.J., & Finkel, M.L., 2022. Improved Water and Waste Management Practices Reduce Diarrhea Risk in Children under Age Five in Rural Tanzania : A Community-Based , Cross-Sectional Analysis. International Journal of Environmental Research and Public Health, 19(4218), pp.1–18.

Mebrahtom, S., Worku, A., & Gage, D.J., 2022. The Risk of Water, Sanitation and Hygiene on Diarrhea-Related Infant Mortality in Eastern Ethiopia: A Population-Based Nested Case-Control. BMC Public Health, 22(1), pp.1–14.

Meki, C.D., Ncube, E.J., & Voyi, K., 2022. Community-Level Interventions for Mitigating the Risk of Waterborne Diarrheal Diseases: A Systematic Review. Systematic Reviews, 11(1), pp.1–12.

Mengistie, B., Gobena, T., Admassu, D., Assefa, N., Ayele, D.M., Mengistu, D.A., Worku, A., Kumie, A., Terfa, W., Bikila, Z., & Azage, M., 2022. Seasonal Variability Influence on the Prevalence of Diarrhoea among Under-Five-Year-old Children in Kersa District, Eastern Ethiopia: A Community-Based Longitudinal Study. Environmental Health Insights, 16, pp.1–11.

Mernie, G., Kloos, H., & Adane, M., 2022. Prevalence of and Factors Associated with Acute Diarrhea Among Children Under Five in Rural Areas in Ethiopia with and without Implementation of Community-Led Total Sanitation and Hygiene. BMC Pediatrics, 22(1), pp.1–16.

Moyo, T.M., Juru, T.P., Sibanda, E., Marape, G., Gombe, N.T., Govha, E., & Tshimanga, M., 2022. Risk Factors for Contracting Watery Diarrhoea in Mzilikazi, Bulawayo City, Zimbabwe, 2020: a Case Control Study. Pan African Medical Journal, 41(145), pp.1–13.

Natnael, T., Lingerew, M., & Adane, M., 2021. Prevalence of Acute Diarrhea and Associated Factors Among Children Under Five in Semi-Urban Areas of Northeastern Ethiopia. BMC Pediatrics, 21(1), pp.1–11.

Peraturan Menteri Kesehatan RI., 2010. Peraturan Menteri Kesehatan Republik Indonesia Nomor 492/Menkes/Per/IV/2010 Tentang Persyaratan Kualitas Air Minum, Kemenkes RI.

Rakesh, P., Samiksha, K., Harmanpreet, K., Mansi, R., Vijay, K., & Amit, G., 2022. Qualitative and Quantitative Enumeration of Coliform Bacteria in Song River Water in Rural Area of Dehradun. Journal of Medical Pharmaceutical and Allied Sciences, 11(2), pp.4534–4538.

Sembiring, W.S.R., Annida H., & A, R.F., 2022. Diarrhea Incidence in Tanah Bumbu, South Kalimantan, Under A Spatial Approach. Jurnal Kesehatan Masyarakat, 17(4), pp.526–534.

Sidhi, A.N., Raharjo, M., & Dewanti, N.A.Y., 2016. Hubungan Kualitas Sanitasi Lingkungan dan Bakteriologis Air Bersih Terhadap Kejadian Diare Pada Balita di Wilayah Kerja Puskesmas Adiwerna kabupaten Tegal. Jurnal Kesehatan Masyarakat, 4(3), pp.665–676.

Soboksa, N.E., Hailu, A.B., Gari, S.R., & Alemu, B.M., 2019. Water Supply, Sanitation and Hygiene Interventions and Childhood Diarrhea in Kersa and Omo Nada districts of Jimma Zone, Ethiopia: A Comparative Cross-Sectional Study. Journal of Health, Population and Nutrition, 38(1), pp.1–14.

Tafere, Y., Abate, B.A., Enyew, H.D., & Mekonnen, A.B., 2020. Diarrheal Diseases in Under-Five Children and Associated Factors among Farta District Rural Community, Amhara Regional State, North Central Ethiopia: A Comparative Cross-Sectional Study. Journal of Environmental and Public Health, 2020, pp.3–9.

Tutuanita, N.Y.Z., 2019. Sanitation, Open Defecation, and Diarrhea in Tangerang, Banten, Indonesia, in early 2017: A Cross-Sectional Epidemiological Study. Journal of International Dental and Medical Research, 12(1), pp.368–371.

Wagari, S., Girma, H., & Geremew, A., 2022. Water, Sanitation, and Hygiene Service Ladders and Childhood Diarrhea in Haramaya Demographic and Health Surveillance Site, Eastern Ethiopia. Environmental Health Insights, 16, pp.1–13.

Wani, H., Smeets, P., & Shrivastava, S., 2022. Evaluation of WASH Indicators Associated with Diarrhoeal Disease Among Under-Five Children in an Urban Slum Pocket, Mumbai City, India: A Community-Based Repeated Cross-Sectional Study. Journal of Water Sanitation and Hygiene for Development, 12(4), pp.359–374.

Wolf, J., Hunter, P.R., Freeman, M.C., Cumming, O., Clasen, T., Bartram, J., Higgins, J.P.T., Johnston, R., Medlicott, K., Boisson, S., & Prüss-Ustün, A., 2018. Impact of Drinking Water, Sanitation and Handwashing With Soap on Childhood Diarrhoeal Disease: Updated Meta-Analysis and Meta-Regression. Tropical Medicine and International Health, 23(5), pp.508–525.

Yaya, S., Hudani, A., Udenigwe, O., Shah, V., Ekholuenetale, M., & Bishwajit, G., 2018. Improving Water, Sanitation and Hygiene Practices, and Housing Quality to Prevent Diarrhea Among Under-Five Children in Nigeria. Tropical Medicine and Infectious Disease, 3(2), pp.1–11.


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.