Multilevel Analysis on the Contextual Effects of Hygiene, Environmental Sanitation, and Diarrhea Prevention in Elementary School Students in Ngawi, East Java


  • Dian Surya Kartika Masters Program in Public Health, Universitas Sebelas Maret
  • Setyo Sri Rahardjo Faculty of Medicine, Universitas Sebelas Maret
  • Bhisma Murti Masters Program in Public Health, Universitas Sebelas Maret


Background: Clean and healthy behavior in school is an important factor to prevent diarrhea and improve the health status of school children. This study aimed to determine the effects of hygiene and school environmental sanitation on diarrhea prevention behavior.

Subjects and Method: This was an analytic observational study with a cross-sectional design. This study was conducted in Ngawi, East Java, in October 2018. A sample of 225 elementary school students was selected randomly from 25 elementary high schools in Ngawi. The dependent variable was diarrhea prevention. The independent variables were the student



Cairncross S, Bartram J, Cumming O, Brocklehurst C (2010). Water, sanitation and hygiene for the prevention of diarrhea. International journal of epidemiology, 39(1), i193-205.

Cairncross S, Bartram J, Cumming O, Brocklehurst C (2010). Hygiene, sanitation, and water: what needs to be done?. PLoS medicine. 7 (11), e1000365. doi: 10.1371/journal.pmed.1000365.

Cronin AA, Gnilo ME, Odagiri M, Wijesekera S. (2017). Equity Implications for Sanitation from Recent Health and Nutrition Evidence. International Journal for Equity in Health, 16(1), 211. doi: 10.1186/s1293901707095.

Darlan DM, Tala ZZ, Amanta C, Warli SM, Arrasyid NK (2017). Correlation between Soil Transmitted Helminth Infection and Eosinophil Levels among Primary School Children in Medan. Open Access Macedonian Journal of Medical Sciences, 5(2), 142-146.

Das JK, Bhutta ZA (2016). Global Challenges in Acute Diarrhea. Current Opinion in Gastroenterology, 32(1), 18-23.

Departemen Kesehatan Republik Indonesia (2009). Seri Perilaku Hidup bersih dan Sehat di Rumah Tangga: Menggunakan Jamban Sehat. Jakarta: Departemen Kesehatan Republik Indonesia Pusat Promosi Kesehatan.

Desta BK, Assimamaw NT, Ashenafi TD (2017). Knowledge, practice, and associated factors of homebased management of diarrhea among caregivers of children attending underfive clinic in Fagita Lekoma District, Awi Zone, Amhara Regional State, Northwest Ethiopia. Nursing Research and Practice, 8084548(8). doi: 10.1155/2017/8084548

Dinas Kesehatan Provinsi Jawa Timur (2016). Profil Kesehatan Provinsi Jawa Timur Tahun 2016.

Ding Z, Zhai Y, Wu C, Wu H, Lu Q, Lin J, He F (2017). Infectious diarrheal disease caused by contaminated well water in Chinese schools: a syste-matic review and meta-Analysis. Journal of Epidemiology, 27(6), 274-281.

Duijster D, Monse B, DimaisipNabuab J, Djuharnoko P, HeinrichWeltzien R, Hobdell M, KromeyerHauschild K, Kunthearith Y, et al. (2017). Fit for schoola schoolbased water, sanitation and hygiene programme to improve child health: results from a longitudinal study in Cambodia, Indonesia and Lao PDR. BMC Public Health, 17(1), 302. doi: 10.1186/s1288901742031.

Ejemot-Nwadiaro RI, Ehiri JE, Arikpo D, Meremikwu MM, Critchley JA (2015). Hand washing promotion for prevent-ing diarrhea. Cochrane Database of Systematic Reviews, 9. doi: 10.1002-/14651858. CD004265.pub3.

Freeman MC, Meredith E, Oliver S, Aurelie C, Julian J, Higgins PT, Wolf J, Pr

Garn JV, Brumback BA, DrewsBotsch CD, Lash TL, Kramer MR, Freeman MC (2016). Estimating the effect of school water, sanitation and hygiene improvements on Pupil health outcomes. Wolters Kluwer Health, 27(5): 752-60.doi: 10.1097/ede.0000000000000522

Greene LE, Freeman MC, Akoko D, Saboori S, Moe C, Rheingans R (2012). Impact of a school-based hygiene promotion and sanitation intervention on pupil hand contamination in Western Kenya: a cluster randomized trial. Am J Trop Med Hyg, 87(3), 385-93. doi: 10.4269/ajtmh.2012.110633.

Hasan MM, Richardson A (2017). How sustainable household environment and knowledge of healthy practices relate to childhood morbidity in South Asia: analysis of survey data from Bangladesh, Nepal and Pakistan. BMJ open, 7(6), e015019. doi:10.1136/bmjopen2016015019.

Jordanova T, Cronk R, Obando W, Medina OZ, Kinoshita R, Bartram J (2015). Water, sanitation, and hygiene in schools in low socioeconomic regionn Nicaragua: A cross-sectional survey. Int. J. Environ. Res. Public Health, 12, 61976217; doi: 10. 3390/ ijerph120606197

Kamara JK, Galukande M Maeda F, Luboga S, Renzaho AMN (2017). Understanding the challenges of improving sanitation and hygiene outcomes in a community-based intervention: a cross-sectional study in rural Tanzania. International Journal of Environmental Research and Public Health, 14(6), E602. doi: 10.3390/ijerph14060602.

Karon AJ, Cronin AA, Cronk R, Hendrawan R (2017). Improving water, sanitation, and hygiene in schools in Indonesia: A cross-sectional assessment on sustaining infrastructural and behavioral interventions. International Journal of Hygiene and Environmental Health. 220(3): 539-550. doi: 10.1016/j.ijheh.2017.02.001.

Kementerian Pendidikan dan Kebudayaan (2017). Peta jalan sanitasi sekolah dalam kerangka UKS. Kementerian Pendidikan dan Kebudayaan.

Kementerian Pendidikan dan Kebudayaan Republik Indonesia (2017). Statistik sekolah dasar (SD) 2016/2017. Jakarta: Sekretariat Jenderal Pusat Data Dan Statistik Pendidikan Dan Kebudayaan.

Keusch GT, Walker CF, Das JK, Horton S, Habte D (2016). Diarrheal diseases. In: Black RE, Laxminarayan R, Temmerman M, Walker N, editors. Source Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities. Washington (DC): The International Bank for Reconstruction and Development/ The World Bank, 3(2). doi: 10.1596/9781464803482_ch9

Khatoon R, Sachan B, Khan MA, Srivastava JP (2017). Impact of school health education program on personal hygiene among school children of Lucknow district. J Family Med Prim Care. 6(1), 97100. doi: 10.4103/22494863.214973.

Komarulzaman A, Smits J, de Jong E (2017). Clean water, sanitation and diarrhea in Indonesia: Effects of Household and Community Factors. Global Public Health, 12(9), 1141-1155. doi: 10.1080/17441692.2015.1127985.

La Con G, Schilling K, Harris J, Person B, Owuor M, Ogange L, Faith S, Quick R (2017). Evaluation of student handwashing practices during a schoolbased hygiene program in rural Western Kenya. International Quarterly of Community Health Education, 37(2), 121-128. doi: 10.1111/cobi.12263.

Mbakaya BC, Lee PH, Lee RL (2017). Hand hygiene intervention strategies to reduce diarrhoea and respiratory infections among school children in developing countries: A systematic review. International Journal of Environmental Research and Public Health, 14(4), E371. doi: 10.3390/ijerph14040371.

Mbuya MN, Humphrey JH (2016). Preventing Environmental Enteric Dysfunction Through Improved Water, Sanitation and Hygiene: An Opportunity for Stunting Reduction in Developing Countries. Maternal & Child Nutrition, 12(1), 106-120. doi: 10.1111/mcn.12220.

Mokomane M, Kasvosve I, de Melo E, Pernica JM, Goldfarb DM (2018). The Global Problem of Childhood Diarrheal Diseases: Emerging Strategies in Prevention and Management. Therapeutic Advances in Infectious Disease, 5(1), 29-43. doi: 10.1177/2049936117744429.

Mumtaz Y, Zafar M, Mumtaz Z (2014). Knowledge attitude and practices of mothers about diarrhea in children under 5 years. J Dow Uni Health Sci, 8(1), 3-6. doi: 10.15226/25764802/2/1/00111.

Park MJ, Clements AC, Gray DJ, Sadler R, Laksono B, Stewart DE (2016). Quantifying accessibility and use of improved sanitation: Towards a comprehensive indicator of the need for sanitation interventions. Scientific Reports, 6, 30299. doi: 10.1038/srep30299.

Perlroth NH, Castelo Branco CW (2017). Current knowledge of environmental exposure in children during the sensitive developmental periods. Jornal de Pediatria (Rio J). 93(1), 17-27. doi: 10.1016/j.jped.2016.07.002.

Prendergast AJ, Kelly P (2016). Interactions between Intestinal Pathogens, Enteropathy and Malnutrition in Developing Countries. Current Opinion in Infectious Diseases, 29(3), 229-236. doi: 10.1016/j.ebiom.2016.07.030.

Seguin M, Ni

Seimetz E, Slekiene J, Friedrich M, Mosler HJ (2017). Identifying behavioural determinants for interventions to increase handwashing practices among primary school children in rural Burundi and urban Zimbabwe. BMC research notes, 10(1), 280. doi:10.1186/s1310401725994

Shrestha RM, Miyaguchi M, Shibanuma A, Khanal A, Yasuoka J, Jimba M (2016). A School Health Project Can Uplift the Health Status of School Children in Nepal. PloS one, 11(11), e0166001. doi:10.1371/journal.pone.0166001

Sibiya JE, Gumbo JR (2013). Knowledge, attitude and practices (KAP) survey on water, sanitation and hygiene in selected schools in Vhembe District, Limpopo, South Africa. International journal of environmental research and public health, 10(6), 2282-2295. doi:10.3390/ijerph10062282

Slekiene J, Mosler HJ (2017). Does Depression Moderate Handwashing in Children?. BMC Public Health, 18(1), 82. doi: 10.1186/s1288901746384.

Weaver ER, Agius PA, Veale H, Dorning K, Hlang TT, Aung PP, Fowkes FJ, Hellard ME (2016). Water, Sanitation, and Hygiene Facilities and Hygiene Practices Associated with Diarrhea and Vomiting in Monastic Schools, Myanmar. American Journal of Tropical Medicine and Hygiene, 95(2), 278-287. doi: 10.4269/ajtmh.150290.




How to Cite

Kartika, D. S., Rahardjo, S. S., & Murti, B. (2017). Multilevel Analysis on the Contextual Effects of Hygiene, Environmental Sanitation, and Diarrhea Prevention in Elementary School Students in Ngawi, East Java. Journal of Epidemiology and Public Health, 4(2), 97–108. Retrieved from




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