Jurnal Publikasi Kesehatan Masyarakat Indonesia, Vol. 9 No. 2, April 2022 97
Analytical Study of Household Environmental Sanitation and Food Sanitation With Incidence of Diarrhea
Adhyatma Alimin, Andi Alim, Nur Inah
Faculty of Public Health, University of Pejuang Republic Indonesia Correspondence email: [email protected]
ABSTRACT
Bad environmental conditions are one of the factors increasing the incidence of diarrhea. Where environmental health includes several factors including housing, sewage disposal, clean water supply, and waste water drainage. South Panggilian Environment, South Benteng Sub-District, Benteng District, and Selayar Islands Regency, is an area that still has poor environmental sanitation or does not require health standards. In this case, especially the problem of sewerage that still does not follow health sanitation requirements. If left unchecked, it will become one of the risk factors for increasing disease, especially diarrheal diseases. The purpose of this study was to determine the relationship between sanitation and the incidence of diarrhea in the South Panggilian Environment, South Benteng Sub- District, Benteng District, and Selayar Islands Regency. This research is a type of research in the form of an observational survey with a cross-sectional approach with a population of 238 families. To determine the sample size, the slovin formula was used to obtain a total sample of 77 families. This research was conducted in October - November 2021. In collecting data using a questionnaire to the selected respondents, the data was then processed and displayed in tabular form. Based on the results of the study, it was found that there was a relationship between clean water facilities (p-value = 0.02), drinking water facilities (p-value = 0.00), feces/latrine disposal facilities (p-value = 0.00), sewage facilities wastewater (p-value=0.02), waste disposal facilities (p-value=0.00) and food sanitation (p-value=0.00) with the incidence of diarrhea. Based on the results of the study, it was suggested that the respondents make a means for disposing of wastewater at home and outside the home so that they do not interfere with each other, causing a very pungent odor seen from flood-prone areas.
Keywords: Clean water, latrines, trash cans, food sanitation, diarrhea
INTRODUCTION
Environmental sanitation is a state or condition that can affect health, especially regarding human waste and infections that are specifically related to drainage, and disposal of sewage and garbage from households (1). Sanitation is closely related to environmental health which can affect the degree of public health. This is due to the prevalence of poor sanitation, poor control of environmental conditions, and inadequate supply of clean water (2).
Basic sanitation is a minimum environmental health requirement that must be owned by every family to meet their daily needs. Basic house sanitation is a public health effort that focuses on monitoring various environmental factors that affect or may affect the degree of human health. The housing environment is very influential in the occurrence and spread of diarrhea. The impact of the low level of sanitation coverage can reduce the quality of the community's environment, pollute the source of drinking water for the community, and increase the transmission of environment-based diseases such as diarrhea (3).
Poor environmental conditions are one of the factors that increase the incidence of diarrhea. Where environmental health includes several factors where the first factor is housing, sewage disposal, clean water supply, and wastewater disposal. This can cause various environmental health problems because it can cause outbreaks of diarrheal diseases and affect public health conditions (4).
Diarrhea is more common in developing countries than in developed countries. This is caused by several factors, including the lack of adequate drinking water, lack of awareness of hygiene and sanitation as well as poor nutritional status and public health status. It is estimated that around 2.5 billion people still have inadequate sanitation facilities and 1 billion people do not have access to safe drinking water (5).
Jurnal Publikasi Kesehatan Masyarakat Indonesia, Vol. 9 No. 2, April 2022 98 Diarrhea can be caused by clean water facilities, where water is needed in daily life such as bathing, washing, toilet, and for consumption. Clean water facilities must meet the requirements so that the air is not polluted. Clean water facilities that meet the requirements are protected water sources which include Regional Drinking Water Companies, pumping wells, dug wells, and protected springs (6). Management issues that can hurt health are also related to the behaviour of defecating and the uneven use of defecation facilities, achieving a clean environment and achieving community sanitation.
In Indonesia, diarrhea is an endemic disease and also a disease that has the potential to become an Extraordinary Event and is often accompanied by death. In 2016 there were 3 outbreaks of diarrheal disease spread across 3 provinces, and 3 districts, with a total of 198 sufferers with a mortality rate of 6 people (CFR 3.04%). Recapitulation of diarrhea outbreaks from 2008 to 2016 can be seen from the CFR when outbreaks were still quite high (> 1%) except in 2011 the CFR when outbreaks were 0.40%, whereas in 2016 CFR outbreaks of diarrhea when outbreaks increased to 3.04 %. The target coverage for diarrhea sufferers who come to health facilities and health cadres is 10% of the estimated number of diarrhea sufferers (the incidence of diarrhea is multiplied by the number of residents in one work area in one year). The national diarrhea incidence rate from the 2014 Diarrhea Morbidity Survey was 270/1,000 people. It is estimated that the number of diarrhea sufferers in health facilities in 2016 was 6,897,463 people, while the number of diarrhea sufferers reported being treated at health facilities was 3,198,411 people or 46.4 % of targets ( 7 )
The incidence of diarrhea in the Benteng Community Health Center area, Benteng District, Selayar regency, diarrhea ranks second among the 10 biggest diseases, namely, in 2020 the incidence of diarrhea is 303 people while in 2021 the incidence of diarrhea is 412 people while in 2022 it is assumed that the incidence of diarrhea is 642 or 63% (8). This is assumed to be inadequate environmental sanitation such as the provision of clean water, utilization of family latrines, provision of trash bins, wastewater management, and food sanitation, especially in the South Panggilian Environment, South Benteng Sub-District, Benteng District, and Selayar Islands Regency.
With the incidence of diarrhea in the South Panggilian Environment, researchers were interested in knowing how the relationship between environmental sanitation and the incidence of diarrhea in the South Panggilian Environment, South Benteng Sub-District, Benteng District, and Selayar Islands Regency.
METHODS
This research includes research in the form of an observational survey with a cross- sectional approach, namely research conducted by observing for a moment or a certain period, and each subject is only observed once during the study. The population in this study were all households in the South Panggilian Environment, South Benteng Sub-District, Benteng District, Selayar Islands Regency, totalling 238 families. The sample in this study was several households in the South Panggilian Environment which were selected as samples. To determine the sample size, the Slovin formula was used to obtain a total sample of 70 families. So, the number of samples in the research to be conducted is 70 respondents. However, to avoid dropping out of this study, the sample was added 10% of the calculation results so that the number of respondents was 77 families.
Data were obtained through distributing questionnaires adopted from 2018 Basic Health Research data to respondents accompanied by observations by researchers directly regarding clean water facilities, waste/latrine disposal facilities, waste disposal facilities, Wastewater Disposal Facilities (SPAL), drainage channels, and food sanitation (9). Test the validity of this research questionnaire using a feasibility test by asking for expert opinion (expert judgment) from the field of environmental health. Based on the research objective, namely to determine whether there is a relationship between environmental sanitation and the incidence of diarrhea, a hypothesis test was carried out using the Chi-Square Test method at a significance level ()
= 0.05 and degrees of freedom (df) = 1.
Jurnal Publikasi Kesehatan Masyarakat Indonesia, Vol. 9 No. 2, April 2022 99 RESULT AND DISCUSSION
Table 1. General Characteristics of Respondents in the South Panggilian Environment, South Benteng Sub-District, Benteng District, Selayar Islands Regency in 2021
Characteristics of Respondents n %
Age (Years)
20 – 30 18 23.4
31 – 40 22 28.6
41 – 50 10 13.0
51 – 60 13 16.9
61 – 70 14 18.2
Gender
Man 17 22.1
Woman 60 77.9
Occupation
Unemployed 3 3.9
Pensionary 3 3.9
Housewife 31 40.3
Fisherman 5 6.5
Private employees 19 24.7
civil servant 7 9.1
Laborer 3 3.9
Other 6 7.8
Education
Never School 2 2.6
Elementary School Graduated 2 2.6
Junior High School Graduated 21 27.3
Senior High School Graduated 29 37.7
Diploma 10 13.0
Bachelor 13 16.9
Amount 77 100
Source: Primary Data, 2021
Based on Table 1 above, from the results of distributing the questionnaire to respondents in the South Panggilian Environment, it can be seen that the characteristics of the respondents consist of age, gender, occupation, and education of the respondents. The most age group of respondents was in the age group of 31-40 years, namely 22 respondents (28.6%), while the age group of the fewest respondents was in the age group of 41-50 years, namely 10 respondents (13.0%). For the characteristics of respondents based on gender, there were 60 respondents (77.9%) who were female, while the respondents who were male were 17 respondents (22.1%). The table above also shows the characteristics of respondents based on work which shows that most of the respondents' jobs are housewives with 31 respondents (40.3%), while the least job of respondents is laborers with 3 respondents (3.9). %). As for the educational characteristics of the respondents, it was shown that most of the education respondents met were high school graduates, namely 29 respondents (37.7%), while the education of the respondents was at least elementary school graduates or had never attended school, as many as 2 respondents (2.6%).
Table. 2 Distribution of Respondents based on Clean Water Facilities, Drinking Water Facilities, Ownership of Feces/Latrine Disposal Facilities, Wastewater Disposal Facilities, Types of Trash and Food Sanitation Facilities in the South Panggilian Environment in 2021.
Research variable n %
Clean Water Facilities
Unqualify 39 50.6
Qualify 38 49.4
Jurnal Publikasi Kesehatan Masyarakat Indonesia, Vol. 9 No. 2, April 2022 100
Research variable n %
Drinking Water Facilities
Unqualify 39 50.6
Qualify 38 49.4
Latrine ownership
Unqualify 40 51.9
Qualify 37 48.1
Waste Water Sewer
Unqualify 46 59.7
Qualify 31 40.3
Trash can
Unqualify 42 54.5
Qualify 35 45.5
Food Sanitation
Unqualify 39 50.6
Qualify 38 49.4
Diarrhea incidence
No Diarrhea 54 70.1
Diarrhea 23 29.9
Total 77 100
Source: Primary Data, 2021
Based on table 2 above shows that the majority of respondents have clean water facilities which are categorized as not meeting the requirements, namely 39 respondents (50.6%). For the distribution of respondents based on the availability of drinking water facilities, 39 respondents (50.6%) have drinking water facilities in the category that do not meet the requirements. The distribution of respondents based on latrine ownership shows that the majority of respondents based on ownership of latrine facilities are categorized as not meeting the requirements, namely 40 respondents (51.9%). As for the distribution of respondents based on the Wastewater Disposal Channel, it can be seen that most of the wastewater disposal facilities are in the category of not meeting the requirements of 46 respondents (59.7%). Table 2 above also shows that 42 respondents (54.5%) have a category of non-eligible trash bin facilities. For the distribution of food sanitation, it can be seen that most of the categories of food sanitation did not meet the requirements, namely 39 respondents (50.6%), while for the distribution with the incidence of diarrhea in respondents, there were 23 respondents (29.9%).
Table.3 Relationship Between Sanitation of Clean Water Facilities, Sanitation of Drinking Water Facilities, Sanitation of Final Disposal Facilities, Sanitation of Wastewater Disposal Facilities, Sanitation of Trash Facilities and Food Sanitation with Diarrhea.
Research Variable
Diarrhea incidence
Total No Diarrhea Diarrhea p
n % n % n %
Clean Water Facilities
Unqualify 21 53.8 18 46.2 39 100
0,002
Qualify 33 86.8 5 13.2 38 100
Drinking Water Facilities
Unqualify 19 48.7 20 51.3 39 100
0,000
Qualify 35 92.1 3 7.9 38 100
Latrine ownership
Unqualify 21 52.5 19 47.5 40 100
0,000
Qualify 33 89.2 4 10.8 37 100
Waste Water Sewer
Unqualify 26 56.5 20 43.5 46 100
0,002
Qualify 28 90.3 3 9.7 31 100
Trash can
Unqualify 22 52.4 20 47.6 42 100 0,000
Jurnal Publikasi Kesehatan Masyarakat Indonesia, Vol. 9 No. 2, April 2022 101 Research Variable
Diarrhea incidence
Total No Diarrhea Diarrhea p
n % n % n %
Qualify 32 91.4 3 8.6 35 100
Food Sanitation
Unqualify 18 46.2 21 53.8 39 100
0,000
Qualify 36 94.7 2 5.3 38 100
Total 54 70.1 23 29.9 77 100
Source: Primary Data, 2021
Sources of clean water are water used by the community for daily needs such as cooking, bathing, and washing. Based on Table 3, it can be seen that of the 39 respondents who had clean water facilities that did not meet the requirements, 21 respondents (53.8%) did not experience diarrhea and 18 respondents (46.2%) experienced diarrhea. Based on the chi-square test, the p-value was 0.002 <0.05. This indicates that there is a significant relationship between clean water facilities and the incidence of diarrhea. This research is in line with research conducted by Praptiwi (2011), in two villages, namely Purwodadi Village, Tembarak District and Tepusan Village, Kaloran District, Temanggung Regency, that there is a significant relationship between the supply of clean water and the incidence of diarrhea in the community (10). The clean water used by respondents is still classified as a poor clean water facility with the largest number using unprotected water sources, namely 39 households. Of the 77 respondents, the presence of unprotected water sources caused diarrhea in 18 respondents. Based on the results of field observations it can be explained that the poor sanitation conditions of the clean water facilities were directly used by the respondents, there were no clean water facilities used for washing and bathing purposes, but from the results of the analysis, there was no relationship with the incidence of diarrhea.
In this study, it can be seen that there is a relationship between the variable sources of clean water and the incidence of diarrhea, this is because the clean water facilities used are water that is included in the bad unprotected category. There are several reasons for this to occur, first because the chi-square analysis correlates variables with the incidence of diarrhea where out of 77 respondents who experienced diarrhea there were 23 respondents. So that in the analysis there is a relationship because the category of clean water facilities used is in a bad category. According to the Ministry of Health of the Republic of Indonesia, (2016), the Diarrhea Management Guidelines show that people who are reached by clean water supply have a smaller risk of suffering compared to people who do not get clean water, people can reduce the risk of diarrhea attacks by using clean water and protect water. from contamination from the source to storage at home (11).
Table 3 above can also be seen that of the 39 respondents who had drinking water facilities that did not meet the requirements, 19 respondents (48.7%) did not experience diarrhea and 20 respondents (51.3%) experienced diarrhea. Based on the chi-square test, the p-value was 0.000 <0.05, which means that there is a significant relationship between drinking water facilities and the incidence of diarrhea. According to Basic Health Research (2018), the sources of water used by households in Indonesia as drinking water are protected dug wells (24.7%), tap water (14.2%), drilled wells/pumps (14.0%), and Water Depot water Drinking (13.8%). Based on the place of residence, both in urban and rural areas the main source of water for drinking varies quite a lot, in urban areas households use water from boreholes/pumps (32.9%), and tap water/Regional Water Supply Companies (28.6), while in rural areas more use of protected dug wells (9). The national need for water at the household level in Indonesia reaches 2 litres/day and can even be 100 litres/day (12).
Regarding the quality of clean water owned by the respondents, most of the respondents had poor water quality and several respondents had poor physical water quality. Poor physical quality of water is odorless, tasteless, turbid, and coloured. According to the Indonesian Ministry of Health (1995), one of the efforts to determine the quality of clean water supply facilities is to monitor or examine the physical quality of water sources (13). The purpose of this inspection is to identify potential sources of pollution. As for the distance between clean
Jurnal Publikasi Kesehatan Masyarakat Indonesia, Vol. 9 No. 2, April 2022 102 water facilities and pollutant sources, household use of river water is considered zero.
According to Marjuki in Dahyuniar (2018), each clean water sanitation facility has different requirements, however, of each existing requirement, the main requirement that must be considered is the distance from the source of clean water to the disposal site for feces/other pollutant sources. not less than 10 meters (2). Most of the respondents did not have a water reservoir and the percentage of respondents who did not have a water reservoir was 96.1%, the rest used a container with a lid and good water. Respondents did not use shelters because of their habit of only taking water directly from the tap.
Analysis of the relationship between the source of drinking water and the incidence of diarrhea used the chi-square test with a bivariate test. The results showed that there was a relationship between drinking water sanitation facilities and the incidence of diarrhea where p- value = 0.000 (p <0.05). The results of this study are in line with research conducted by Nugraheni (2012), there is a relationship between drinking water facilities and the incidence of diarrhea in North Semarang District, Semarang City, p = 0.009 (p <0.05) drinking with the incidence of diarrhea (14). The results of Sutomo's research (2019) state that there is a relationship between the source of drinking water consumed in rural homes and respondents who use clean water having a lower tendency to suffer from diarrhea (15). On the other hand, respondents who do not use clean water tend to suffer from diarrhea. Data on sources of drinking water used by respondents are still classified as poor drinking water facilities with the highest percentage using retail/purchase tap drinking water and most of the respondents in this study did not process drinking water before consumption by those who did not process drinking water before consumption. The drinking water facility consumed by the respondents is a good drinking water facility, but most of the respondents do not treat drinking water by cooking, such as boiling/boiling it. Respondents who used refilled water were only a small proportion of the respondents who had been examined as well as those who boiled drinking water facilities.
Water treatment before consumption in this study is something that has not been applied to the respondents. Boiling water is the best way to purify water at home. For the purification process to be more effective, the water is allowed to boil between 5-10 minutes. This is so that all germs, spores, cysts, and eggs die so that the water is sterile. In addition, the boiling process can also reduce hardness because in the boiling process CO2 evaporation occurs and CaCO3 precipitation occurs (16). The main source of drinking water is one of the sanitation facilities associated with the incidence of diarrhea. Some of the germs that cause diarrhea are transmitted by the faecal-oral route. They can be transmitted by ingesting liquids or objects contaminated with feces, for example drinking water, fingers, and food prepared in pans washed with contaminated water (17).
From the research results obtained information that the water consumed is mostly retail tap water. Tap water was not pretreated by the respondents, only cooled down in a closed container and was consumed immediately. Most of the reasons for respondents not treating water or buying bottled drinking water such as gallons of water are because they easily get sick if they consume boiled or gallons of water. However, several respondents were not in line with this idea, respondents processed drinking water by boiling it and then storing it in a closed container, and the rest chose to use refilled drinking water. The physical quality of drinking water from the results of this study is mostly of good physical quality and some respondents have a physical quality of smelly water. Consuming refilled drinking water that is more than 2 hours old must be boiled first, this is one of the efforts to prevent diseases that may arise due to unhealthy water (Sandra in Jayadisastra, (2013)) (18).
According to the Director General of P2PL (2010), drinking water must be treated first and the water container must be clean and closed (19). Water that is not managed according to the Household Drinking Water Treatment (PAM-RT) standards can cause disease. One form of household drinking water treatment that is simple and often used is cooking. Cooking is the process of killing microorganisms (viruses, bacteria, bacterial spores, fungi, protozoa) that cause disease by heating (20).
Feces/latrine disposal facilities are a must in every household because by providing toilet disposal facilities that have good sanitation, humans can avoid the transmission of infectious
Jurnal Publikasi Kesehatan Masyarakat Indonesia, Vol. 9 No. 2, April 2022 103 diseases such as diarrhea. Based on Table 3, it can be seen that of the 40 respondents who had faecal/latrine disposal facilities that did not meet the requirements, 21 respondents (52.5%) did not experience diarrhea and 19 respondents (47.5%) experienced diarrhea.
Analysis of the relationship between faecal/latrine disposal facilities and the incidence of diarrhea using the chi-square test with a bivariate test showed that there was a relationship between the feces/latrine disposal facilities and the incidence of diarrhea where p = 0.000 (p
<0.05). The results of research that are in line with this research are the results of Octorina's research (2012) conducted in Sialang Buah Village, Teluk Mengkudu District, Serdang Bedagai Regency that there is a significant relationship between faecal/latrine disposal facilities and the incidence of diarrhea with a value of p = 0.005 (p < 0.05) (21). Data from the research shows that most of the respondents already have household latrines and some respondents do not yet have latrines. Based on the research results above, most people understand the importance of having a latrine to improve sanitation. Sanitation is one of the main aspects of realizing a strong and healthy building. The importance of awareness of making sanitation by hygiene quality standards is an awareness that must be applied to every family.
According to Notoatmodjo (2013), the requirements for waste disposal that meet health standards are not to contaminate the surface of the surrounding soil, not to contaminate the surrounding surface water, not to contaminate the surrounding groundwater, and not to open sewage so that it cannot be occupied by vectors to lay eggs and reproduce (22). Facilities for the disposal of feces/latrines are one of the supports for environmental sanitation which is very important to note. Several areas pay little attention to feces/latrine disposal facilities, thus making these areas with poor sanitation. Research by Yulisetyaningrum (2015) states that the habit of open defecation is a person's behaviour related to the activity of disposing of feces in places that are not by health regulations (latrines), so it is carried out in rivers, on grass and others (23). The thing that causes residents to defecate openly is the unavailability of private and public bathing, washing, and toilet facilities.
According to Entjang (2000), there are 8 types of latrines, namely pit latrines, water latrines, gooseneck latrines, drill latrines, basket latrines, trench latrines, pool latrines, and chemical latrines. However, only goose-neck latrines are suitable for healthy latrines and meet the requirements (24). And currently, the type of latrine that is most widely used by the community is the gooseneck latrine. In this study, the types of latrines were divided into 2 gooseneck latrines and plunge latrines. The cemplung type of latrine is a type of latrine that only digs a hole in the ground and provides support for both feet. The type of plunge latrine in this study was also found in swamps/small rivers around people's houses. This can harm neighbours and the respondent himself and also contaminate surface water so that the germs contained in it can spread everywhere with water which can cause containers. While the gooseneck latrines are the most widely used and meet the requirements. Therefore, this method of sewage disposal is recommended. In this outhouse, the toilet is in the shape of a swan's neck, so it will always be filled with water. The function of this water is as a plug so that the pitted odour does not smell in the toilet. According to Sukarni in Farkhati (2021), it is stated that gooseneck latrines have advantages such as being safe for children and can be made at home because they do not cause odour (25).
Wastewater is all water/liquid substances that are no longer used, even though their quality is getting better. Wastewater includes all wastewater originating from housing (bathrooms, toilets, and also from the kitchen) originating from industry and rainwater (26).
Table 3 above also shows that of the 46 respondents who had wastewater disposal facilities that did not meet the requirements, 26 respondents (56.5%) did not experience diarrhea and 20 respondents (43.5%) experienced diarrhea. Analysis of the relationship between the variables of wastewater disposal facilities and the incidence of diarrhea using the chi-square test with a bivariate test showed that there was a relationship between the sanitation of wastewater disposal facilities and the incidence of diarrhea where p-value = 0.002 (p <0.05).
The results of this study are in line with the results of research on individual factors and the condition of household wastewater disposal with the incidence of diarrhea in RT 01 RW 09
Jurnal Publikasi Kesehatan Masyarakat Indonesia, Vol. 9 No. 2, April 2022 104 Siejang Village, Bukit Bestari District, Tanjungpinang City with a value of p = 0.000 (p <0.05) (27).
Data on wastewater disposal facilities used by respondents were not classified as good wastewater disposal facilities with the highest percentage of respondents with bad sanitation at 59.7%. From 77 respondents, the presence of wastewater disposal facilities in this bad category caused diarrhea in 20 respondents. Based on the results of field observations, it can be explained that the condition of the wastewater disposal facilities is not good, that is, they do not have a good sewerage channel that only drains water directly into the sewer and in open yards in the yard of the house. In this study, it can be seen that there is a relationship between the variables of wastewater disposal facilities and the incidence of diarrhea. In this study, the household wastewater disposal facilities in this study were mostly channeled directly into the sewer, and some people prefer to dispose of it directly in an open shelter in the yard of the house. According to Sapei et al. (2011), it is feared that without domestic wastewater disposal facilities, public health will decline and affect the productivity of the local community (28). The availability of a centralized domestic wastewater treatment system is expected to reduce river water pollution levels and improve environmental quality which has implications for improving public health. The occurrence of floods every year in Kelurahan Serpong Selatan is very concerning for the local community, floods often occur with water levels as high as half a knee for adults.
Garbage is a source of disease and a breeding ground for disease vectors such as flies, cockroaches, and so on. Based on Table 3, it can be seen that of the 42 respondents who had garbage disposal facilities that did not meet the requirements, 22 respondents (52.4%) did not experience diarrhea and 20 respondents (47.6%) experienced diarrhea. Analysis of the relationship between the variables of garbage disposal facilities and the incidence of diarrhea by using the chi-square test with a bivariate test, it is known that there is a relationship between the sanitation of garbage disposal facilities and the incidence of diarrhea where the value of p
= 0.000 (p <0.05). Research that is in line with this research is the result of research conducted by Soamole (2018) at the Siko Community Health Center, Ternate City, which has a relationship between garbage disposal facilities and the incidence of diarrhea p = 0.000 (p
<0.05) (29). Data on the waste disposal facilities used by respondents were not classified as good waste disposal facilities with the highest percentage of respondents with bad waste disposal facilities at 54.5%. Of the 77 respondents, the existence of poor waste disposal facilities caused diarrhea in 20 respondents. Based on the results of field observations it can be explained that the condition of the waste disposal facilities is not good, namely, they do not have family trash cans and only dispose of them around the home environment.
Based on the results of the study, it was found that 54.5% of respondents did not have trash cans, and people who did not have trash bins could choose to dispose of them around their home environment. The results of this study indicate that the consequences of improper waste disposal are bad and will hurt indiscriminate waste disposal. Littering is one of the ethical violations that is often encountered, there are lots of negative impacts arising from litterings, such as floods, and disease outbreaks such as diarrheal diseases (30). People who have a habit of throwing garbage on the banks of rivers and around their yards disturb their eyesight and pollute the surrounding environment.
Food sanitation is an effort aimed at food hygiene and safety so as not to pose a danger of poisoning and disease to humans. The real goal of food sanitation efforts is to ensure food safety and hygiene, prevent transmission of disease outbreaks and reduce the level of damage or spoilage in food (31). Table 3 shows that of the 39 respondents who had food sanitation that did not meet the requirements, 18 respondents (46.2%) did not experience diarrhea and 21 respondents (53.8%) experienced diarrhea. Analysis of the relationship between food sanitation and the incidence of diarrhea using the chi-square test with a bivariate test showed that there was a relationship where the value of p = 0.000 (p <0.05). The results of the research are in line with this research, namely research by Widiastuti (2012) which was conducted in the working area of the Gatak Community Health Center, Sukoharjo Regency, that food processing is related to the incidence of diarrhea with a p-value = 0.016 (p <0.05) (32).
Jurnal Publikasi Kesehatan Masyarakat Indonesia, Vol. 9 No. 2, April 2022 105 Food sanitation data used by respondents were not classified as bad food sanitation with the highest percentage of respondents with bad food sanitation at 50.6%. Of the 77 respondents, the presence of food sanitation caused diarrhea in 21 respondents. Based on the results of field observations it can be explained that the sanitary condition of the food is not good when the food is placed on the floor without a cover and the processing is not good before cooking because of the respondent's assumption that food ingredients are unnecessary. to be washed with clean, running water because the food still wants to be cooked. Food sanitation is one of the behaviours of the community to prevent food from being released from all hazards that can interfere with health, from before it is processed to before it is consumed. From the results of the study only a small proportion of respondents took the first action before being processed such as washing food ingredients, the results can be said that people process food poorly because they do not wash food ingredients first and most respondents do not wash food ingredients first and some respondents sometimes wash food before processing. According to the respondents who have been interviewed, washing food is not very important and does not have much impact because respondents think that food will be cooked so that germs or bacteria will die.
Food sanitation is also needed after processing, food after processing must be handled as if it were stored in a safe place. From the results of the study, most of the respondents had stored processed food in a good place, such as in a closed cupboard/refrigerator. Respondents also chose to keep it on the table and close it. the rest prefer to store only processed foods on the floor and open and in uncovered cupboards. In the results of the study, there were still respondents who stored food without a cover which would result in contamination of the food by the growth of microorganisms in the food which plays an important role in the formation of compounds that produce unpleasant odours and cause food to rot and become unfit for eating.
Some microorganisms that contaminate food can pose a danger to consumers (33). Food sanitation also needs attention, because food is one of the causes of diarrhea. Food sanitation can be a factor in the occurrence of diarrhea if the food is contaminated, stale, toxic, too much fat, raw (vegetables), and undercooked. Contaminated food is much more likely to cause diarrhea (34).
CONCLUSION
Based on the results of the study, it was found that there was a relationship between environmental sanitation based on clean water facilities, drinking water facilities, faecal/latrine disposal facilities, household waste water disposal facilities, household waste disposal facilities and food sanitation with the incidence of diarrhea. Based on the results of the study, it was suggested that respondents make facilities for disposing of household and outdoor wastewater so that they do not interfere with each other, causing a very pungent smell to be seen from flood-prone areas, so respondents should make a means for disposing of healthy family wastewater.
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