Volume 84, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



We characterized the relationship of the presence of an improved latrine with diarrhea and under-five child mortality in Indonesia. The proportion of rural and urban families, respectively, without an improved latrine was 52.1% and 16.2%, with a child with a history of diarrhea in the last 7 days was 8.2% and 9.7%, and with a history of under-five child mortality was 11.1% and 8.5%. Among rural and urban families, respectively, lack of an improved latrine was associated with a child history of diarrhea in the last 7 days (odds ratio [OR] = 1.23, 95% confidence interval [CI] = 1.18–1.29, < 0.0001; OR = 1.20, 95% CI = 1.13–1.27, < 0.0001) and under-five child mortality (OR = 1.29, 95% CI = 1.25–1.31, < 0.0001; OR = 1.22, 95% CI = 1.12–1.32, < 0.0001) in separate multivariable logistic regression models adjusting for covariates. The lack of a household improved latrine is associated with diarrhea and under-five child mortality in Indonesia.


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  1. World Health Organization, 2010. Progress on Sanitation and Drinking Water: 2010 Update. Geneva: World Health Organization.
  2. Prüss-Üstün A, Bos R, Gore F, Bartram J, , 2008. Safer Water, Better Health: Costs, Benefits, and Sustainability of Interventions to Protect and Promote Health. Geneva: World Health Organization.
  3. Lanata CF, Black RE, Semba RD, Bloem MW, , 2008. Diarrheal diseases. , eds. Nutrition and Health in Developing Countries. Second edition. Totowa, NJ: Humana Press, 139178.[Crossref]
  4. Fagundes Neto U, Martins MC, Lima FL, Patricio FR, Toledo MR, , 1994. Asymptomatic environmental enteropathy among slum-dwelling infants. J Am Coll Nutr 13: 5156.[Crossref]
  5. Steiner TS, Lima AA, Nataro JP, Guerrant RL, , 1998. Enteroaggregative Escherichia coli produce intestinal inflammation and growth impairment and cause interleukin-8 release from intestinal epithelial cells. J Infect Dis 177: 8896.[Crossref]
  6. Humphrey JH, , 2009. Child undernutrition, tropical enteropathy, toilets, and handwashing. Lancet 374: 10321035.[Crossref]
  7. Berkman DS, Lescano AG, Gilman RH, Lopes SL, Black MM, , 2002. Effects of stunting, diarrhoeal disease, and parasitic infection during infancy on cognition in late childhood: a follow-up study. Lancet 359: 564571.[Crossref]
  8. Waddington H, Snilstveit B, White H, Fewtrell L, , 2009. Water, Sanitation and Hyiene Interventions to Combat Childhood Diarrhoea in Developing Countries. New Delhi: International Initiative for Impact Evaluation.
  9. Fewtrell L, Kaufmann RB, Kay D, Enanoria W, Haller L, Colford JM, Jr, 2005. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis. Lancet Infect Dis 5: 4252.[Crossref]
  10. Daniels DL, Cousens SN, Makoae LN, Feachem RG, , 1991. A study of the association between improved sanitation facilities and children's height in Lesotho. Eur J Clin Nutr 45: 2332.
  11. United Nations Children's Fund (UNICEF), 2009. The State of the World's Children 2010: Celebrating 20 Years of the Convention on the Rights of the Child. New York: UNICEF.
  12. de Pee S, Bloem MW, Sari M, Kiess L, Yip R, Kosen S, , 2002. High prevalence of low hemoglobin concentration among Indonesian infants aged 3–5 months is related to maternal anemia. J Nutr 132: 22152221.
  13. Bloem MW, Moench-Pfanner R, Panagides D, , eds., 2003. Health & Nutritional Surveillance for Development. Singapore: Helen Keller Worldwide.
  14. de Pee S, Bloem MW, Semba RD, Bloem MW, , 2001. Assessing and communicating impact of nutrition and health programs. , eds. Nutrition and Health in Developing Countries. Totowa, NJ: Humana Press, 483506.[Crossref]
  15. Mason JB, Habicht JP, Tabatabai H, Valverde V, , 1984. Nutritional Surveillance. Geneva: World Health Organization.
  16. Bank of Canada, Exchange rates: monthly average rates: 10-year look-up. Available at: http://www.bankofcanada.ca/en/rates/exchange-avg.html. Accessed December 18, 2005.
  17. Campbell AA, Thorne-Lyman A, Sun K, de Pee S, Kraemer K, Moench-Pfanner R, Sari M, Akhter N, Bloem MW, Semba RD, , 2008. Greater household expenditures on fruits and vegetables but not animal source foods are associated with decreased risk of under-five child mortality among families in rural Indonesia. J Nutr 138: 22442249.
  18. World Medical Association, 2001. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. Bull World Health Organ 79: 373374.
  19. Semba RD, de Pee S, Sari M, Ahkter N, Bloem MW, , 2008. Effect of parental formal education on risk of child stunting in Indonesia and Bangladesh: a cross-sectional study. Lancet 371: 322328.[Crossref]
  20. Macassa G, Ghilagaber G, Berhardt E, Burstrom B, , 2004. Contribution of household environmental factors to urban childhood mortality in Mozambique. East Afr Med J 81: 408414.[Crossref]
  21. Woldemicael G, , 2000. The effects of water supply and sanitation on childhood mortality in urban Eritrea. J Biosoc Sci 32: 207227.[Crossref]
  22. Hoque BA, Chakraborty J, Chowdhury JT, Chowdhury UK, Ali M, el Arifeen S, Sack RB, , 1999. Effects of environmental factors on child survival in Bangladesh: a case control study, 1999. Public Health 113: 5764.
  23. Norman G, Pedley S, Takkouche B, , 2010. Effects of sewerage on diarrhoea and enteric infections: a systematic review and meta-analysis. Lancet Infect Dis 2010: 536544.[Crossref]
  24. Olsen A, Samuelsen H, Onyango-Ouma W, , 2001. A study of the risk factors for intestinal helminth infections using epidemiological and anthropological approaches. J Biosoc Sci 33: 569584.[Crossref]
  25. Berger SG, de Pee S, Bloem MW, Halati S, Semba RD, , 2007. High malnutrition and morbidity among children who are missed by periodic vitamin A capsule distribution for child survival in rural Indonesia. J Nutr 137: 13281333.
  26. Semba RD, de Pee S, Sun K, Best C, Sari Y, Bloem MW, , 2008. Paternal smoking and increased risk of infant and under-five child mortality among families in Indonesia. Am J Public Health 98: 18241826.[Crossref]
  27. Semba RD, de Pee S, Hess SY, Sun K, Sari M, Bloem MW, , 2008. Child malnutrition and mortality among families not utilizing adequately iodized salt in Indonesia. Am J Clin Nutr 87: 438444.
  28. Gascon J, Vargas M, Schellenberg D, Urassa H, Casals C, Kahigwa E, Aponte JJ, Mshinda H, Vila J, , 2000. Diarrhea in children under 5 years of age from Ifakara Tanzania: a case-control study. J Clin Microbiol 38: 44594462.
  29. Azurin JC, Alvero M, , 1974. Field evaluation of environmental sanitation measures against cholera. Bull World Health Organ 51: 1926.
  30. Daniels DL, Cousen SN, Makoae LN, Feachem RG, , 1990. A case-control study of the impact of improved sanitation on diarrhoea morbidity in Lesotho. Bull World Health Organ 68: 455463.
  31. Aziz KM, Hoque BA, Hasan KZ, Patwary MY, Huttly SR, Rahaman MM, Feachem RG, , 1990. Reduction in diarrhoeal diseases in children in rural Bangladesh by environmental and behavioural modifications. Trans R Soc Trop Med Hyg 84: 433438.[Crossref]
  32. Emerson PM, Lindsay SW, Alexander N, Bah M, Dibba SM, Faal HB, Lowe KO, McAdam KP, Ratcliffe AA, Walraven GE, Bailey RL, , 2004. Role of flies and provision of latrines in trachoma control: cluster-randomised controlled trial. Lancet 363: 10831098.[Crossref]
  33. Motariemi Y, Käferstein F, Moy G, Quevedo F, , 1993. Contaminated weaning food: a major risk factor for diarrhoea and associated malnutrition. Bull World Health Organ 71: 7992.
  34. Andersson M, Takkouche B, Egli I, Allen HE, de Benoist B, , 2005. Global iodine status and progress over the last decade towards the elimination of iodine deficiency. Bull World Health Organ 83: 518525.
  35. Best CM, Sun K, de Pee S, Sari M, Bloem MW, Semba RD, , 2008. Paternal smoking and increased risk of child malnutrition among families in rural Indonesia. Tob Control 17: 3845.[Crossref]
  36. United Nations Development Programme, 2004. Indonesia Progress Report on the Millennium Development Goals. Available at: http://www.undp.or.id/pubs/imdg2004/. Accessed November 30, 2009.
  37. Hutton G, Haller L, Bartram J, , 2007. Global cost-benefit analysis of water supply and sanitation interventions. J Water Health 5: 481502.[Crossref]
  38. Haller L, Hutton G, Bartram J, , 2007. Estimating the costs and health benefits of water and sanitation improvements at global level. J Water Health 5: 467480.[Crossref]
  39. Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Guiligiani E, Haider BA, Kirkwood B, Morris SS, Sachdev HP, Shekar M, , Maternal and Child Undernutrition Study Group, 2008. What works? Interventions for maternal and child undernutrition and survival. Lancet 371: 417440.[Crossref]

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  • Received : 29 Apr 2010
  • Accepted : 01 Dec 2010

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