Risk Factors for Undernutrition and Diarrhea Prevalence in an Urban Slum in Indonesia: Focus on Water, Sanitation, and Hygiene

Yumiko Otsuka Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan;

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Lina Agestika Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan;

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Widyarani Research Unit for Clean Technology (LPTB), Indonesian Institute of Sciences (LIPI), Bandung, Indonesia;

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Neni Sintawardani Research Unit for Clean Technology (LPTB), Indonesian Institute of Sciences (LIPI), Bandung, Indonesia;

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Taro Yamauchi Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan;
Research Institute for Humanity and Nature, Kyoto, Japan

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Unsafe drinking water and poor sanitation and hygiene lead to deterioration of the child health condition in low- and middle-income countries. This study aimed to evaluate the nutritional and health status of children living in an urban slum and to clarify the factors contributing to undernutrition and diarrhea prevalence by focusing on water, sanitation, and hygiene from three viewpoints: household environments, child personal hygiene practices, and knowledge and awareness. The study was conducted at a preschool and two elementary schools in the densely populated area of Bandung, Indonesia. Participants were 228 pairs of children and their caretakers. The survey involved 1) anthropometric measurements (height and weight), 2) handwashing observation using a checklist, and 3) questionnaires. On multivariate logistic regression analysis, not using a towel for handwashing practices (adjusted odds ratio [AOR] = 2.37; 95% confidence interval [CI] = 1.13–4.96) was significantly associated with an increased risk of stunting. Regarding household environments, children from households using tap water as drinking water were significantly associated with an increased risk of stunting and thinness compared with households using tank water (AOR = 2.26; 95% CI = 1.03–4.93; and AOR = 2.88; 95% CI = 1.13–7.35, respectively). Moreover, children from households using open containers for water storage were significantly associated with an increased risk of diarrhea (AOR = 5.01; 95% CI = 1.08–23.15). Therefore, drinking water management at home and proper personal hygiene practices of children are important for maintaining and promoting child health in urban Indonesian slums.

Author Notes

Address correspondence to Taro Yamauchi, Graduate School of Health Sciences, Hokkaido University, N-12, W-5, Kita-ku, Sapporo 060-0812, Hokkaido, Japan. E-mail: taroy@med.hokudai.ac.jp

Authors’ addresses: Yumiko Otsuka, Lina Agestika, and Taro Yamauchi, Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan, E-mails: yumiko-otsuka@eis.hokudai.ac.jp, linaagestika@yahoo.com, and taroy@med.hokudai.ac.jp. Widyarani and Neni Sintawardani, Research Unit for Clean Technology (LPTB), Indonesian Institute of Sciences (LIPI), Bandung, Indonesia, E-mails: widyrani@lipi.go.id and neni.sintawardani@lipi.go.id.

  • 1.

    World Health Organization and the United Nations Children’s Fund (UNICEF), 2017. Progress on Drinking Water, Sanitation and Hygiene: 2017 Update and SDG Baselines .Geneva, Switzerland: WHO and the United Nations Children’s Fund (UNICEF).

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    United Nations, 2015. Transforming Our World: The 2030 Agenda for Sustainable Development. New York, NY: United Nations.

  • 3.

    World Health Organization, United Nations Children’s Fund, and United States Agency for International Development, 2015. Improving Nutrition Outcomes with Better Water, Sanitation and Hygiene: Practical Solutions for Policy and Programmes. Geneva, Switzerland: WHO, United Nations Children’s Fund, and United States Agency for International Development.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Jee HR, Aidan AC, Bhupendra B, Victor MA, Suzanne C, Sarah A, 2015. Household sanitation and personal hygiene practices are associated with child stunting in rural India: a cross-sectional analysis of surveys. BMJ Open 5: e005180.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Fink G, Günther I, Hill K, 2011. The effect of water and sanitation on child health: evidence from the demographic and health surveys 1986–2007. Int J Epidemiol 40: 11961204.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    United Nations Human Settlements Programme (UN-HABITAT), 2006. The State of the World’s Cities Report 2006/2007. Nairobi, Kenya: United Nations Human Settlements Programme (UN-HABITAT).

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Fink G, Günther I, Hill K, 2014. Slum residence and child health in developing countries. Demography 51: 11751197.

  • 8.

    Torlesse H, Cronin AA, Sebayang SK, Nandy R, 2016. Determinants of stunting in Indonesian children: evidence from a cross-sectional survey indicate a prominent role for the water, sanitation and hygiene sector in stunting reduction. BMC Public Health 16: 669.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Komarulzaman A, Smits J, de Jong E, 2017. Clean water, sanitation and diarrhea in Indonesia: effects of household and community factors. Glob Public Health 12: 11411155.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Hirai M, Graham JP, Mattson KD, Kelsey A, Mukherji S, Cronin AA, 2016. Exploring determinants of handwashing with soap in Indonesia: a quantitative analysis. Int J Environ Res Public Health 13: E868.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    World Health Organization, 2009. WHO AnthroPlus for Personal Computers Manual: Software for Assessing Growth of the World’s Children and Adolescents. Geneva, Switzerland: WHO.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    World Health Organization Multicentre Growth Reference Study Group, 2006. WHO Child Growth Standards: Length/height-for-Age, Weight-for-Age, Weight-for-Length, Weight-for-Height and Body Mass Index-for-Age: Methods and Development. Geneva, Switzerland: WHO.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J, 2007. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 85: 660667.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    World Health Organization, 2018. Growth Reference 5–19 Years: BMI-for-Age (5–19 Years). Available at: http://www.who.int/growthref/who2007_bmi_for_age/en/. Accessed April 9, 2018.

    • PubMed
    • Export Citation
  • 15.

    World Health Organization, 2009. WHO Guidelines on Hand Hygiene in Health Care .Geneva, Switzerland: WHO.

  • 16.

    Centers for Disease Control and Prevention, 2016. Handwashing: Clean Hands Save Lives. Available at: https://www.cdc.gov/handwashing/. Accessed December 31, 2017.

    • PubMed
    • Export Citation
  • 17.

    World Health Organization, 2005. The Treatment of Diarrhoea: A Manual for Physicians and Other Senior Health Workers .Geneva, Switzerland: WHO.

  • 18.

    Sandjaja S et al. 2013. Food consumption and nutritional and biochemical status of 0.5–12-year-old Indonesian children: the SEANUTS study. Br J Nutr 110 (Suppl 3): S11S20.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Gebregyorgis T, Tadesse T, Atenafu A, 2016. Prevalence of thinness and stunting and associated factors among adolescent school girls in Adwa town, north Ethiopia. Int J Food Sci 2016: 8323982.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Altare C, Delbiso TD, Mutwiri GM, Kopplow R, Guha-Sapir D, 2016. Factors associated with stunting among pre-school children in southern highlands of Tanzania. J Trop Pediatr 62: 390408.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Anindrya N, Barti SM, Dwina R, Arief S, Meijerink SV, Smits AJM, 2017. Coping with poor water supply in peri-urban Bandung, Indonesia: towards a framework for understanding risks and aversion behaviours. Environ Urbanization 29: 6988.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Alemayehu M, Tinsae F, Haileslassie K, Seid O, Gebregziabher G, Yebyo H, 2015. Undernutrition status and associated factors in under-5 children, in Tigray, northern Ethiopia. Nutrition 31: 964970.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Fuller JA, Eisenberg JN, 2016. Herd protection from drinking water, sanitation, and hygiene interventions. Am J Trop Med Hyg 95: 12011210.

  • 24.

    Larsen DA, Grisham T, Slawsky E, Narine L, 2017. An individual-level meta-analysis assessing the impact of community-level sanitation access on child stunting, anemia, and diarrhea: evidence from DHS and MICS surveys. PLoS Negl Trop Dis 11: e0005591.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Harris M, Alzua ML, Osbert N, Pickering A, 2017. Community-level sanitation coverage more strongly associated with child growth and household drinking water quality than access to a private toilet in rural Mali. Environ Sci Technol 51: 72197227.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    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, Switzerland: WHO.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Curtis V, Cairncross S, Yonli R, 2000. Domestic hygiene and diarrhea-pinpointing the problem. Trop Med Int Health 5: 2232.

  • 28.

    Friedrich MN, Julian TR, Kappler A, Nhiwatiwa T, Mosler HJ, 2017. Handwashing, but how? Microbial effectiveness of existing handwashing practices in high-density suburbs of Harare, Zimbabwe. Am J Infect Control 45: 228233.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Pinzón-Rondón ÁM, Zárate-Ardila C, Hoyos-Martínez A, Ruiz-Sternberg ÁM, Vélez-van-Meerbeke A, 2015. Country characteristics and acute diarrhea in children from developing nations: a multilevel study. BMC Public Health 15: 811.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Kunii O, Nakamura S, Abdur R, Wakai S, 2002. The impact on health and risk factors of the diarrhoea epidemics in the 1998 Bangladesh floods. Public Health 116: 6874.

  • 31.

    Heitzinger K, Rocha CA, Quick RE, Montano SM, Tilley DH Jr., Mock CN, Carrasco AJ, Cabrera RM, Hawes SE, 2015. “Improved” but not necessarily safe: an assessment of fecal contamination of household drinking water in rural Peru. Am J Trop Med Hyg 93: 501508.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Nigatu M, Tadesse A, 2015. Knowledge, perception, and management skills of mothers with under-five children about diarrhoeal disease in indigenous and resettlement communities in Assosa district, western Ethiopia. J Health Popul Nutr 33: 2030.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Srigley JA, Furness CD, Baker GR, Gardam M, 2014. Quantification of the Hawthorne effect in hand hygiene compliance monitoring using an electronic monitoring system: a retrospective cohort study. BMJ Qual Saf 23: 974980.

    • PubMed
    • Search Google Scholar
    • Export Citation
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