Clean water, sanitation and diarrhoea in Indonesia: Effects of household and community factors

Abstract

Diarrhoea is an important health issue in low-and middle-income countries, including Indonesia. We applied a multilevel regression analysis on the Indonesian Demographic and Health Survey to examine the effects of drinking water and sanitation facilities at the household and community level on diarrhoea prevalence among children under five (n = 33,339). The role of the circumstances was explored by studying interactions between the water and sanitation variables and other risk factors. Diarrhoea prevalence was reported by 4820 (14.4%) children, who on average were younger, poorer and were living in a poorer environment. At the household level, piped water was significantly associated with diarrhoea prevalence (OR = 0.797, 95% CI: 0.692-0.918), improved sanitation had no direct effect (OR = 0.992, 95% CI: 0.899-1.096) and water treatment was not related to diarrhoea incidence (OR = 1.106, 95% CI: 0.994-1.232). At the community level, improved water coverage had no direct effect (OR = 1.002, 95% CI: 0.950-1.057) but improved sanitation coverage was associated with lower diarrhoea prevalence (OR = 0.917, 95% CI: 0.843-0.998). Our interaction analysis showed that the protective effects of better sanitation at the community level were increased by better drinking water at the community level. This illustrates the importance of improving both drinking water and sanitation simultaneously. ARTICLE HISTORY

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

“…7 In Indonesia, untreated drinking water and unimproved sanitation were strong predictors of child stunting, 8 and use of piped water reduces the risk of diarrhea in children. 9 However, the relationship between WASH and child health in urban slums of Indonesia remains unclear.…”

Health Effects of Sanitation Facilities: A Bayesian Semiparametric Analysis of Compositional Data

“…Komarulzaman et al . () similarly used an adjusted logistic regression approach and Godfrey et al . () used a difference‐in‐differences method to estimate the effect of improved sanitation on the risk of diarrhoea at the household level.…”

“…Fan and Mahal (2011), Kumar and Vollmer (2013), Begum et al (2011) and Capuno et al (2015) used DHS (or similar household level survey) data and propensity score matching methods to compare households with 'improved sanitation' (typically improved latrines) with households with unimproved sanitation. Komarulzaman et al (2017) similarly used an adjusted logistic regression approach and Godfrey et al (2014) used a difference-indifferences method to estimate the effect of improved sanitation on the risk of diarrhoea at the household level. Aziz et al (1990), Garrett et al (2008), Moraes et al (2003) and Messou et al (1997) conducted non-experimental intervention studies and, with the exception of Moraes et al (2003), who used longitudinal data and reasonably comprehensive adjustment, all evaluated the effect of their interventions with crude before-after analyses of a diarrhoea risk ratio.…”

Pit Toilets (Latrines)

“…The relationship between use of pit toilets and decreased incidence of disease and helminth infection compared to open defecation has been addressed in the literature. Pit toilet usage can protect public health in two ways: 1) it can protect the health of the members of the household that uses the pit toilet (individual effect) or 2) it can protect the health of the community members surrounding the household that uses the pit toilet (community effect) (Komarulzaman et al, 2017;Jung et al, 2017;Oswald et al, 2017). It is unknown whether the individual effect or the community effect has greater influence.…”