Multilevel Analysis on Determinants of Diarrhea in Demak, Central Java


  • Aulia Noorvita Ramadani Masters Program in Public Health, Universitas Sebelas Maret
  • Setyo Sri Rahardjo Faculty of Medicine, Universitas Sebelas Maret
  • Bhisma Murti Masters Program in Public Health, Universitas Sebelas Maret


Background: Diarrhea is an infectious disease with high mortality in Indonesia. Diarrhea often occurs where risk factor control is weak, such as in rural area. This study aimed to examine the determinants of diarrhea in Demak, Central Java.

Subjects and Method: A case-control study was conducted in Demak, Central Java, in October to November 2018. A sample of 200 study subjects was selected by fixed disease sampling. The dependent variable was diarrhea. The independent variables were age, clean water supply, latrine availability, waste water management, waste management, hand wash behavior, family income, and education level. The data were collected by questionnaire and analyzed by a multilevel regression, run on Stata 13.

Results: Diarrhea increased with poor clean water supply (b= 1.45; 95% CI= 0.23 to 2.67; p= 0.020), latrine unavailable (b= 1.86; 95% CI= 0.66 to 3.06; p= 0.002), poor waste management (b= 2.71; 95% CI= 1.52 to 3.90; p<0.001), poor garbage management (b= 1.34; 95% CI= 0.17 to 2.50; p= 0.024), irregular hand washing with soap (b= 1.34; 95% CI= 0.12 to 2.40; p= 0.030). Diarrhea decreased with high family income (b= -1.56; 95% CI= -2.78 to -0.34; p= 0.012) and high education (b= -1.75; 95% CI= -2.95 to -0.565; p= 0.004). Diarrhea was negatively associated with age but it was statistically non-significant (b= -0.33; 95% CI= -1.51 to 0.844; p= 0.578). Village had contextual effect on the incidence of diarrhea (ICC= 13.9%).

Conclusion: Diarrhea increases with poor clean water supply, latrine unavailable, poor waste management, poor garbage management, irregular hand washing with soap. Diarrhea decreases with high family income and high education. Village has contextual effect on the incidence of diarrhea.

Keywords: diarrhea, water supply, hand wash behavior, waste management



Adane M, Mengistie B, Kloos H, Medhin G, Mulat W (2017). Sanitation facilities, hygienic conditions, and prevalence of acute diarrhea among under- five children in slums of Addis Ababa, Ethiopia: Baseline survey of a longitu-dinal study. PLoS ONE 12(8): e01-82783. 1

Akinyemi AI, Adeniyi FF, Elizabeth O, Ade-bayo SO, Agunbiade OM (2017). Diarrhea management practices and child health outcomes in Nigeria: Sub-National Analysis. Advances in Integrative Medicine. 5(1): 15-22.

Bitew BD, Woldu W, Gizaw Z (2017). Childhood diarrheal morbidity and sanitation predictors in a nomadic community. Ital J Pediatr. 43(91): 1

Dinkes Provinsi Jateng (2017). Profil Kese-hatan Provinsi Jawa Tengah Tahun 2016. Semarang.

Desta BK, Assimamaw NT, Ashenafi TD (2017). Knowledge, practice, and associated factors of home-based management of diarrhea among care-givers of children attending under-five clinic in Fagita Lekoma District, Awi Zone, Amhara Regional State, Northwest Ethiopia. Nursing Re-search and Practice. 10

Fauziah A, Ahmad LAI, Tina L (2016). Studi Komparatif Determinan Kejadian Diare Di Wilayah Pesisir (Puskesmas Abeli). https://www.neliti.-com/journals/jimkesmas 1

George CM, Perin J, Karen J, Calani ND, Norman WR, Perry H, Davis TP, Erik DL (2014). Risk Factors for Diarrhea in Children under Five Years of Age Residing in Peri-urban Communities in Cochabamba, Bolivia. Am J Trop Med Hyg. 91(6): 1190

Hasan M, Richardson A (2017). How sus-tainable household environment and knowledge of healthy practices relate to childhood morbidity in South Asia : analysis of survey data from Bangla-desh, Nepal and Pakistan. BMJ Open. 7(6):e015019. doi: 10.1136/bmjopen-2016-015019.

Imada KS, Muniz PT (2016). Socioeconomic, hygienic, and sanitation factors in reducing diarrhea in the Amazon. Rev Saude Publica. 50(77): 1

Kemenkes RI (2016). Profil Kesehatan Indonesia 2015. Jakarta

Kemenkes RI (2017). Data dan Informasi Kesehatan Profil Kesehatan Indonesia 2016. Jakarta.

Lowe B, Lohse A, Andresen V, Vettorazzi E, Rose M, Broicher W (2016). The Development of Irritable Bowel Syn-drome: A Prospective Community-Based Cohort Study. Am J Gastro-enterol. 111(9): 1320-9. oi: 10.1038/-ajg.2016.255.

Mengistie B, Berhane Y, Worku A (2013). Prevalence of diarrhea and associated risk factors among children under-five years of age in Eastern Ethiopia: A Prevalence of diarrhea and associated risk factors among children under-five years of age in Eastern Ethiopia: A cross-sectional study. Open Journal of Preventive Medicine. 3(7): 446-453. doi: 10.4236/ojpm.2013.37060.

Setiani DMW, Yusiana MA (2013). Lack of mother

Merga N, Alemayehu T (2015). Knowledge, perception, and management skills of mothers with under-five children about diarrhoeal disease in indigen-ous and resettlement communities in assosa district, western ethiopia. J Health Popul Nutr. 33(1): 20

Mohammed S, Tamiru D (2014). The burden of diarrheal diseases among children under five years of age in arba minch district, southern ethiopia and associated risk factors: a cross-sectional study. International Scholar-ly Research Notices. http://dx.doi.-org/10.1155/2014/654901.

Mukti DA, Raharjo M, Dewanti NAY (2016). Hubungan antara penerapan program sanitasi total berbasis masyarakat ( stbm ) dengan kejadian diare di wilayah kerja puskesmas. Jurnal Kesehatan Masyarakat. 4(3): 767-775. ISSN: 2356-3346.

Mumtaz Y, Zafar M, Mumtaz Z (2014). Knowledge attitude and practices of mothers about diarrhea in children under 5 years. Journal of Dow University of Health Sciences. 8(1): 3

Murti B (2017). Prinsip dan metode riset epidemiologi. Edisi kedua. Program Studi Ilmu Kesehatan Masyarakat Program Pascasarjana Universitas Sebelas Maret: Yuma Pustaka. ISBN: 978-602-71484-2-0.

Patil SR, Arnold BF, Salvatore AL, Briceno B, Ganguly S, John M, Paul JG (2014). The effect of india

Roman C, Solh T, Broadhurst M (2017). Infectious diarrhea. 2(2): 229

Samwel M, Eddison M, Faith N, Richard S, Elizabeth KM, Douglas N (2014). Determinants of diarrhea among young children under the age of five in Kenya, evidence from KDHS 2008-09. African Population Studies Etude de la Population Africaine. 28(2). Doi:

Thiam S, Aminata ND, Samuel F, Winkler MS, Ibrahima S, Jacques AN, Christian S, Penelope V, Utzinger J, Faye O, Cissee G (2017). Prevalence of diarrhoea and risk factors among children under five years old in mbour, senegal: a cross-sectional study. infectious diseases of poverty. Infect Dis Poverty. 1

Zeleke AT, Alemu ZA (2014). Determinants of under five childhood diarrhea in Kotebe health. 14(4). Global Journal of Medical Research: B Pharma, Drug Discovery, Toxicologgy and Medicine. 14 (4): 1-7.


How to Cite

Ramadani, A. N., Rahardjo, S. S., & Murti, B. (2019). Multilevel Analysis on Determinants of Diarrhea in Demak, Central Java. Journal of Epidemiology and Public Health, 4(2), 88–96. Retrieved from




Most read articles by the same author(s)

> >>