Maternal Preventive Behaviors and Six-Month Diarrhea Burden Among Under-Five Children in The Coastal City North Sulawesi, Indonesia: A Community-Based Cross-Sectional Survey

Oksfriani Jufri Sumampouw; Jeini Ester Nelwan; Marshanda Miraycly Syalomita Amazing Korompis; Mikha Christania Rondonuwu; Vennetia Ryckerens Danes; Ester Candrawati Musa

doi:10.70716/mohr.v4i3.814

Authors

Oksfriani Jufri Sumampouw Environmental Health Department, Faculty of Public Health, Sam Ratulangi University, Indonesia
Jeini Ester Nelwan Epidemiology Department, Faculty of Public Health, Sam Ratulangi University, Indonesia
Marshanda Miraycly Syalomita Amazing Korompis Environmental Health Department, Faculty of Public Health, Sam Ratulangi University, Indonesia
Mikha Christania Rondonuwu Environmental Health Department, Faculty of Public Health, Sam Ratulangi University, Indonesia
Vennetia Ryckerens Danes Physics Department, Faculty of Medicine, Sam Ratulangi University, Indonesia
Ester Candrawati Musa Nutrition Department, Faculty of Public Health, Sam Ratulangi University, Indonesia

DOI:

https://doi.org/10.70716/mohr.v4i3.814

Keywords:

childhood diarrhea, exclusive breastfeeding, handwashing, primary care, Indonesia

Abstract

This community-based cross-sectional survey described the six-month burden of diarrhea and two modifiable maternal preventive behaviors—exclusive breastfeeding and handwashing with soap at critical times—among mothers of under-five children in the Sagerat Public Health Center catchment area of Bitung City, North Sulawesi, Indonesia, from July to August 2025. Fifty mothers of children aged 9 months to 5 years were recruited by accidental sampling from a population of 3,122. Data were collected via interviewer-administered questionnaires and field observation. Exclusive breastfeeding was defined as breast milk only from birth through six months. Handwashing was classified as good only when all seven critical-time items were fulfilled; otherwise it was classified as poor. Diarrhea was defined as maternal report of at least three loose or watery stools in 24 hours during the preceding six months. Of the 50 children, 24 (48.0%; 95% confidence interval, 34.8%–61.5%) had experienced diarrhea. Thirty-three mothers (66.0%; 95% confidence interval, 52.2%–77.6%) had not exclusively breastfed for six months, while 31 (62.0%; 95% confidence interval, 48.2%–74.1%) demonstrated poor handwashing behavior. Most mothers were aged 26–35 years (56.0%) and were homemakers (74.0%); 62.0% of children were aged one to two years. A substantial diarrhea burden coexisted with major gaps in both preventive behaviors. Although causal associations cannot be inferred due to the descriptive design and non-probability sampling, these findings establish an actionable primary-care baseline for integrated breastfeeding support and hand-hygiene promotion and justify larger analytic studies using probability sampling and multivariable models.

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References

Adhiningsih, Y. R., Athiyyah, A. F., & Juniastuti, J. (2019). Diare akut pada balita di Puskesmas Tanah Kali Kedinding Surabaya. Jurnal Ilmiah Kesehatan, 1(2), 96–101. https://doi.org/10.36590/jika.v1i2.31

Alebel, A., Tesema, C., Temesgen, B., Gebrie, A., Petrucka, P., & Kibret, G. D. (2018). Prevalence and determinants of diarrhea among under-five children in Ethiopia: A systematic review and meta-analysis. PLOS ONE, 13(6), e0199684. https://doi.org/10.1371/journal.pone.0199684

Anwari, D. (2020). Hubungan pengetahuan dan kebiasaan mencuci tangan ibu dengan kejadian diare pada balita di Puskesmas Sungai Jingah tahun 2020 (Doctoral dissertation, Universitas Islam Kalimantan MAB).

Aydamo, A. A., Gari, S. R., & Mereta, S. T. (2024). The nexus between household water insecurity, mother's handwashing practices, and diarrheal diseases among under-five children. Journal of Water and Health, 22(8), 1357–1371. https://doi.org/10.2166/wh.2024.026

Cahyaningrum, D. (2015). Studi tentang diare dan faktor risiko pada balita umur 1–5 tahun di wilayah kerja Puskesmas Kalasan. Journal of Chemical Information and Modeling, 53(9), 1689–1699.

Delelegn, M. W., Endalamaw, A., & Belay, G. M. (2020). Determinants of acute diarrhea among children under-five in Northeast Ethiopia: Unmatched case–control study. Pediatric Health, Medicine and Therapeutics, 11, 323–333. https://doi.org/10.2147/PHMT.S256309

Fitriani, N., Darmawan, A., & Puspasari, A. (2021). Analisis faktor risiko terjadinya diare pada balita di wilayah kerja Puskesmas Pakuan Baru Kota Jambi. Medical Dedication (MEDIC): Jurnal Pengabdian kepada Masyarakat FKIK UNJA, 4(1), 154–164. https://doi.org/10.22437/medicaldedication.v4i1.13472

Ganbold, G., Farnaz, N., Scutts, T., Borg, B., & Mihrshahi, S. (2025). The association between exclusive breastfeeding and diarrhea morbidity in infants aged 0–6 months: A rapid review and meta-analysis. Maternal & Child Nutrition, 21(3), e70042. https://doi.org/10.1111/mcn.70042

Gemilang, S. W., & Werdani, K. E. (2020). Hubungan usia, pendidikan, dan pekerjaan dengan pemberian ASI eksklusif (Doctoral dissertation, Universitas Muhammadiyah Surakarta).

Hartati, S., & Nurazila. (2018). Faktor yang mempengaruhi kejadian diare pada balita di wilayah kerja Puskesmas Rejosari Pekanbaru. Jurnal Endurance, 3(2), 400–407.

Heranita, L., Lubis, N. L., & Moriza, T. (2019). Faktor yang Mempengaruhi Perilaku Keluarga dalam Pemanfaatan Jamban di Pemukiman Desa Air Pinang, Kecamatan Simeulue Timur, Kabupaten Simeulue Tahun 2018. Jurnal Kesehatan Cehadum, 1(3), 15-27.

Hutasuhut, M. S. (2018). Faktor lingkungan, karakteristik, perilaku, dan pengetahuan ibu balita penderita diare yang berobat di Puskesmas Padang Matinggi Kecamatan Padangsidimpuan Selatan Kota Padangsidimpuan tahun 2017 (Undergraduate thesis, Poltekkes Kemenkes Medan).

Irwan. (2017). Etika dan perilaku kesehatan. Yogyakarta, Indonesia: CV Absolute Media.

Kasim, S., & Rivai, A. (2020). Ketersediaan prasarana sanitasi di lingkungan permukiman kumuh (slum area) terhadap penyakit berbasis lingkungan di Kelurahan Bentenge Kota Bulukumba. Sulolipu: Media Komunikasi Sivitas Akademika dan Masyarakat, 20(2), 274–281. https://doi.org/10.32382/sulolipu.v2i20.1737

Kementerian Kesehatan Republik Indonesia. (2018). Riset kesehatan dasar 2018. Jakarta, Indonesia: Badan Penelitian dan Pengembangan Kesehatan.

Mahanani, S. (2020). Pemenuhan kebutuhan cairan dan elektrolit pada anak yang mengalami diare. Kediri, Indonesia: Pelita Medika.

Marissa, O. J. (2015). Hubungan sanitasi lingkungan, sosial ekonomi dan perilaku ibu terhadap kejadian diare dengan dehidrasi sedang pada balita di wilayah kerja Puskesmas Mangkang Kota Semarang tahun 2015 (Undergraduate thesis, Universitas Negeri Semarang).

Mulatu, T., Yimer, N. B., Alemnew, B., Linger, M., & Liben, M. L. (2021). Exclusive breastfeeding lowers the odds of childhood diarrhea and other medical conditions: Evidence from the 2016 Ethiopian demographic and health survey. Italian Journal of Pediatrics, 47, 166. https://doi.org/10.1186/s13052-021-01115-3

Noguchi, Y., Nonaka, D., Kounnavong, S., & Kobayashi, J. (2021). Effects of handwashing facilities with water and soap on diarrhea incidence among children under five years in Lao People's Democratic Republic: A cross-sectional study. International Journal of Environmental Research and Public Health, 18(2), 687. https://doi.org/10.3390/ijerph18020687

Notoatmodjo, S. (2018). Metodologi penelitian kesehatan. Jakarta, Indonesia: Rineka Cipta.

Novrianda, D., & Yeni, F. (2014). Hubungan karakteristik ibu dengan pengetahuan tentang penatalaksanaan diare pada balita. NERS Jurnal Keperawatan, 10(2), 159–165. https://doi.org/10.25077/njk.v10i2.321

Pakpahan, M., Siregar, D., Susilawaty, A., Tasnim, Mustar, Ramdany, R., ... Maisyarah, M. (2021). Promosi kesehatan & perilaku kesehatan. Medan, Indonesia: Yayasan Kita Menulis.

Prabaswara, D. (2019). Hubungan faktor keadaan lingkungan dengan kejadian diare pada anak balita di Desa Hajimena Kecamatan Natar wilayah kerja Puskesmas Hajimena Kabupaten Lampung Selatan tahun 2019 (Diploma thesis, Poltekkes Tanjungkarang).

Ragil, D. W. (2017). Hubungan antara pengetahuan dan kebiasaan mencuci tangan pengasuh dengan kejadian diare pada balita di Kelurahan Bandarharjo. Journal of Health Education, 2(1), 39–46. https://doi.org/10.15294/jhe.v2i1.13867

Rahmawati, A., Wiralodra, U., Ir, J., Km, H. J., & Indramayu, K. (2019). Pemberian ASI eksklusif dan status gizi serta hubungannya di Puskesmas Juntinyuat. Gema Wiralodra, 10(1), 105–114.

Rifai, R., Wahab, A., & Prabandari, Y. S. (2016). Kebiasaan cuci tangan ibu dan kejadian diare anak: Studi di Kutai Kartanegara. Berita Kedokteran Masyarakat, 32(11), 409–414.

Saktya Utama, S. Y. A., & Inayati, A. (2019). Hubungan kondisi jamban keluarga dan sarana air bersih dengan kejadian diare pada balita di wilayah kerja Puskesmas Arosbaya Bangkalan. Dinamika Kesehatan: Jurnal Kebidanan dan Keperawatan, 10(2), 820–832. https://doi.org/10.33859/dksm.v10i2.465

Sari, N. R., Yarmaliza, Y., Reynaldi, F., Husna, A., & Zakiyuddin, Z. (2022). Pengaruh personal hygiene ibu dengan kejadian diare pada balita di Desa Langung Kecamatan Meureubo Kabupaten Aceh Barat. Jurmakemas (Jurnal Mahasiswa Kesehatan Masyarakat), 2(1), 1–10. https://doi.org/10.35308/(jurmakemas).v2i1.5204

Saripah, S. (2020). Hubungan higienitas botol susu dengan kejadian diare pada balita di wilayah Puskesmas Astambul Kabupaten Banjar (Doctoral dissertation, Universitas Islam Kalimantan MAB).

Sarkar, M., Lahiri, S., Gupta, A., & Mukhopadhyay, P. (2024). Water sanitation and hygiene at households and its implications for diarrhea among under-five children in slums at the field practice area of a peripheral medical college of West Bengal. Journal of Family Medicine and Primary Care, 13(3), 911–918. https://doi.org/10.4103/jfmpc.jfmpc_1249_23

Solomon, E. T., Gari, S. R., Kloos, H., & Alemu, B. M. (2021). Handwashing effect on diarrheal incidence in children under 5 years old in rural eastern Ethiopia: A cluster randomized controlled trial. Tropical Medicine and Health, 49, 26. https://doi.org/10.1186/s41182-021-00315-1

Sumampouw, O. J. (2017). Diare balita: Suatu tinjauan dari bidang kesehatan masyarakat. Yogyakarta, Indonesia: Deepublish.

Sutandi, M. C. (2019). Penelitian air bersih di PT Summit Plast Cikarang. Jurnal Teknik Sipil, 8(2), 133–141. https://doi.org/10.28932/jts.v8i2.1363

Sutomo, O., Sukaedah, E., & Iswanti, T. (2020). Hubungan pemberian ASI eksklusif dengan kejadian diare pada bayi di wilayah kerja Puskesmas Cibadak Kabupaten Lebak tahun 2019. Jurnal Medikes (Media Informasi Kesehatan), 7(2), 403–410. https://doi.org/10.36743/medikes.v7i2.250

World Health Organization. (2019). Diarrhoea.

Wibowo, D., Hardiyanti, & Subhan. (2019). Hubungan dehidrasi dengan komplikasi kejang pada pasien diare usia 0–5 tahun di RSD Idaman Banjarbaru. Dinamika Kesehatan: Jurnal Kebidanan dan Keperawatan, 10(1), 112–125. https://doi.org/10.33859/dksm.v10i1.387

Widjaja, M. C. (2018). Mengatasi diare & keracunan pada balita. Jakarta, Indonesia: Kawan Pustaka.

Widyana, E. D., Toyibah, A., & Prani, L. P. M. E. (2015). Pola asuh anak dan pernikahan usia dini. Jurnal Pendidikan Kesehatan, 4(1), 33–39.

Wolf, J., Hubbard, S., Brauer, M., Ambelu, A., Arnold, B., Bain, R. E. S., ... Boisson, S. (2022). Effectiveness of interventions to improve drinking water, sanitation, and handwashing with soap on risk of diarrhoeal disease in children in low-income and middle-income settings: A systematic review and meta-analysis. The Lancet, 400(10345), 48–59. https://doi.org/10.1016/S0140-6736(22)00937-0