Water, Sanitation, and Maternal Behavioral Factors Associated with Diarrhea Risk in Children 10–59 Months: An Epidemiological Analysis
Abstract
Purpose of the study: This study examines the relationship between clean water sanitation facilities and maternal health behaviors in relation to the incidence of diarrhea among toddlers aged 10–59 months, a persistent public health problem in many developing regions. Despite ongoing improvements in water and sanitation infrastructure, diarrhea remains a leading cause of morbidity in early childhood, suggesting that behavioral factors may play a crucial mediating role.
Methodology: This research employed a quantitative cross-sectional design involving 90 toddlers, with data collected through structured interviews with mothers and direct household observations to capture both environmental sanitation conditions and daily hygiene practices.
Main Findings: The results of the study showed that 35.6% experienced diarrhea and 64.4% did not experience diarrhea. Then, from the bivariate results with α 5%, two variables were found to be related to the incidence of diarrhea in toddlers, namely the use of latrines with a p-value of 0.024 and handwashing habits with a p-value of 0.050. Meanwhile, the variables of clean water sanitation facilities (pv 0.082) and boiling water (pv 1.000) did not have a significant relationship with diarrhea.
Novelty/Originality of this study: The novelty of this study lies in its integrated analysis of environmental sanitation and maternal practices, demonstrating that behavior-related factors may exert a stronger influence on diarrhea prevention than infrastructure alone. By highlighting the interaction between sanitation access and maternal behavior, this study provides new empirical evidence to support community-based health interventions that prioritize behavioral change communication alongside sanitation development.
References
W. M. Manetu, S. M’masi, and C. W. Recha, “Diarrhea disease among children under 5 years of age: A global systematic review,” Open J. Epidemiol., vol. 11, no. 03, pp. 207–221, 2021, doi: 10.4236/ojepi.2021.113018.
A. L. Cohen et al., “Aetiology and incidence of diarrhoea requiring hospitalisation in children under 5 years of age in 28 low-income and middle-income countries: Findings from the Global Pediatric Diarrhea Surveillance network,” BMJ Glob. Heal., vol. 7, no. 9, pp. 1–12, 2022, doi: 10.1136/bmjgh-2022-009548.
G. Singh, E. W. Tucker, and U. K. Rohlwink, “Infection in the developing brain: The role of unique systemic immune vulnerabilities,” Front. Neurol., vol. 12, pp. 1–17, 2022, doi: 10.3389/fneur.2021.805643.
N. Fauziah, J. K. Aviani, Y. N. Agrianfanny, and S. N. Fatimah, “Intestinal parasitic infection and nutritional status in children under five years old: A systematic review,” Trop. Med. Infect. Dis., vol. 7, no. 11, pp. 1–26, 2022, doi: 10.3390/tropicalmed7110371.
A. Baye, M. Adane, T. Sisay, and H. S. Hailemeskel, “Priorities for intervention to prevent diarrhea among children aged 0–23 months in northeastern Ethiopia: a matched case-control study,” BMC Pediatr., vol. 21, no. 1, pp. 1–11, 2021, doi: 10.1186/s12887-021-02592-5.
T. Syahlidin, K. Rohadi, and H. BZ, “Analysis of the implementation of health promotion programs on diarrhea disease control at Kuala Public Health Center, Bireuen Regency,” Int. Arch. Med. Sci. Public Heal., vol. 2, no. 1, pp. 44–56, 2020, doi: 10.53806/iamsph.v2i1.155.
C. D. Meki, E. J. Ncube, and K. Voyi, “Frameworks for mitigating the risk of waterborne diarrheal diseases: A scoping review,” PLoS One, vol. 17, no. 12, pp. 1–21, 2022, doi: 10.1371/journal.pone.0278184.
J. Azanaw, A. Malede, H. F. Yalew, and E. A. Worede, “Determinants of diarrhoeal diseases among under-five children in Africa (2013–2023): a comprehensive systematic review highlighting geographic variances, socioeconomic influences, and environmental factors,” BMC Public Health, vol. 24, no. 1, pp. 1–18, 2024, doi: 10.1186/s12889-024-19962-0.
A. Rahman and M. M. Hossain, “Prevalence and determinants of fever, ARI and diarrhea among children aged 6–59 months in Bangladesh,” BMC Pediatr., vol. 22, no. 1, pp. 1–12, 2022, doi: 10.1186/s12887-022-03166-9.
S. Adil, M. Nadeem, and I. Malik, “Exploring the important determinants of access to safe drinking water and improved sanitation in Punjab, Pakistan,” Water Policy, vol. 23, no. 4, pp. 970–984, 2021, doi: 10.2166/wp.2021.001.
C. E. Morgan, J. M. Bowling, J. Bartram, and G. L. Kayser, “Attributes of drinking water, sanitation, and hygiene associated with microbiological water quality in stored drinking water in rural Mozambiquan and Ugandan schools,” Int. J. Hyg. Environ. Health, vol. 236, pp. 1–17, 2021, doi: 10.1016/j.ijheh.2021.113804.
N. Mwaura J., “Preventive measures for diarrhea in communities lacking clean water supply: A scientific review,” Res. Invent. J. Biol. Appl. Sci., vol. 4, no. 3, pp. 39–43, 2024, doi: 10.59298/rijbas/2024/433943.
E. P. Moniz, D. R. M. U. Fernandes, I. Belo, A. S. dos Santos, and M. Carvalho, “Risk factors affecting the incidence of diarrhea in children aged 12-59 months,” Int. J. Innov. Sci. Res. Technol., vol. 10, no. 7, pp. 3134–3140, 2025, doi: 10.29406/jkmk.v12i1.7313.
N. Kawarazuka, F. Ibrahim, E. H. M. S. Rahaman, and G. Prain, “The roles of community nutrition scholars in changing mothers’ child feeding, food preparation, and hygiene practices in southern Bangladesh,” Front. Public Heal., vol. 11, no. 1, pp. 1–12, 2023, doi: 10.3389/fpubh.2023.1135214.
Z. Sharmin, K. F. Mumu, F. A. Tura, S. M. A. Huda, and S. Dutta, “Influence of food hygiene practices on diarrheal incidence among children of working mothers in Gazipur District Bangladesh,” Asia Pacific J. Surg. Adv., vol. 2, no. 1, pp. 63–71, 2025, doi: 10.70818/apjsa.2025.v02i01.022.
H. A. Teshome, W. W. Yallew, J. A. Mulualem, G. T. Engdaw, and A. M. Zeleke, “Complementary food feeding hygiene practice and associated factors among mothers with children aged 6–24 months in Tegedie District, Northwest Ethiopia: Community-Based Cross-Sectional Study,” Hygiene, vol. 2, no. 2, pp. 72–84, 2022, doi: 10.3390/hygiene2020006.
Y. E. Cha, Y. Z. Fu, and W. Yao, “Knowledge, practice of personal hygiene, school sanitation, and risk factors of contracting diarrhea among rural students from five western provinces in China,” Int. J. Environ. Res. Public Health, vol. 18, no. 18, pp. 1–13, 2021, doi: 10.3390/ijerph18189505.
J. M. Challa et al., “Inadequate hand washing, lack of clean drinking water and latrines as major determinants of cholera outbreak in Somali Region, Ethiopia in 2019,” Front. Public Heal., vol. 10, pp. 1–11, 2022, doi: 10.3389/fpubh.2022.845057.
F. Firdaus, W. H. Santy, E. Setiyowati, R. A. Putri, and S. Damawiyah, “Analysis of social demography, behavioral hygiene, breast milk, and nutritional status in children with diarrhea in Surabaya City,” Rev. Gest. Soc. e Ambient., vol. 18, no. 5, pp. 1–17, 2024, doi: 10.24857/rgsa.v18n5-066.
T. K. Soe, W. Laohasiriwong, K. Sornlorm, and R. K. Mahato, “Hygiene practice and diarrhea prevalence among underfive children in Myanmar: a cross-sectional study,” BMC Pediatr., vol. 24, no. 1, pp. 1–12, 2024, doi: 10.1186/s12887-024-05158-3.
J. At Thobari et al., “Direct and indirect costs of acute diarrhea in children under five years of age in Indonesia: Health facilities and community survey,” Lancet Reg. Heal.-West. Pacific, vol. 19, pp. 1–13, 2022, doi: 10.1016/j.lanwpc.2021.100333.
C. Chu et al., “Trends in epidemiological characteristics and etiologies of diarrheal disease in children under five: an ecological study based on Global Burden of Disease study 2021,” Sci. One Heal., vol. 3, pp. 100086, 2024, doi: 10.1016/j.soh.2024.100086.
C. M. George et al., “Diarrhea prevalence and child growth faltering are associated with subsequent adverse child developmental outcomes in Bangladesh (CHoBI7 Program),” Am. J. Trop. Med. Hyg., vol. 106, no. 1, pp. 233–238, 2022, doi: 10.4269/ajtmh.21-0767.
D. Nasrin et al., “Moderate-To-Severe diarrhea and stunting among children younger than 5 years: Findings from the vaccine impact on diarrhea in Africa (VIDA) Study,” Clin. Infect. Dis., vol. 76, no. Suppl 1, pp. S41–S48, 2023, doi: 10.1093/cid/ciac945.
S. Biswas, B. Dandapat, A. Alam, and L. Satpati, “India’s achievement towards sustainable Development Goal 6 (Ensure availability and sustainable management of water and sanitation for all) in the 2030 Agenda,” BMC Public Health, vol. 22, no. 1, pp. 1–16, 2022, doi: 10.1186/s12889-022-14316-0.
Y. O. Crystal et al., “A scoping review of the links between early childhood caries and clean water and sanitation: the Sustainable Development Goal 6,” BMC Oral Health, vol. 24, no. 1, pp. 1–12, 2024, doi: 10.1186/s12903-024-04535-9.
M. W. Merid et al., “Impact of access to improved water and sanitation on diarrhea reduction among rural under-five children in low and middle-income countries: a propensity score matched analysis,” Trop. Med. Health, vol. 51, no. 1, pp. 1–10, 2023, doi: 10.1186/s41182-023-00525-9.
A. Nehaluddin and G. Lilienthal, “Right to Water as a Human Right: A Critical Overview of International Instruments,” Environ. Policy Law, vol. 50, no. 4–5, pp. 299–308, 2021, doi: 10.3233/EPL-200232.
E. Atangana and P. J. Oberholster, “Assessment of water, sanitation, and hygiene target and theoretical modeling to determine sanitation success in sub-Saharan Africa,” Environ. Dev. Sustain., vol. 25, no. 11, pp. 13353–13377, Nov. 2023, doi: 10.1007/s10668-022-02620-z.
E. U. Alum, E. I. Obeagu, and O. P. C. Ugwu, “Enhancing quality water, good sanitation, and proper hygiene is the panacea to diarrhea control and the attainment of some related sustainable development goals A review,” vol. 103, no. 38, 2024. doi: 10.1097/MD.0000000000039578.
S. Novianti and A. Nurjaman, “The relationship of environmental factors and a history of diarrhea to the incidence of stunting in baduta aged 6-23 months,” Int. J. Heal. Sci. Med. Res., vol. 1, no. 2, pp. 62–72, 2022.
D. P. Kurniawati, S. Y. Arini, I. Awwalina, and N. A. Pramesti, “Poor basic sanitation impact on diarrhea cases in toddlers,” J. Kesehat. Lingkung., vol. 13, no. 1, pp. 41–47, 2021, doi: 10.20473/jkl.v13i1.2021.41-47.
S. Mebrahtom, A. Worku, and D. J. Gage, “The risk of water, sanitation and hygiene on diarrhea-related infant mortality in eastern Ethiopia: a population-based nested case-control,” BMC Public Health, vol. 22, no. 1, pp. 1–14, 2022, doi: 10.1186/s12889-022-12735-7.
M. Girma, A. Hussein, T. Norris, T. Genye, M. Tessema, A. Bossuyt, M. Hadist, C. van Zyl, K. Goyol, and A. Samuel, “Progress in Water, Sanitation and Hygiene (WASH) coverage and potential contribution to the decline in diarrhea and stunting in Ethiopia,” Matern. Child Nutr., vol. 20, no. S5, pp. 1–13, 2024, doi: 10.1111/mcn.13280.
S. Ginja, S. Gallagher, and M. Keenan, “Water, Sanitation and Hygiene (WASH) behaviour change research: why an analysis of contingencies of reinforcement is needed,” Int. J. Environ. Health Res., vol. 31, no. 6, pp. 715–728, 2021, doi: 10.1080/09603123.2019.1682127.
C. Maier, J. B. Thatcher, V. Grover, and Y. K. Dwivedi, “Cross-sectional research: A critical perspective, use cases, and recommendations for IS research,” Int. J. Inf. Manage., vol. 70, pp. 102625, 2023, doi: 10.1016/j.ijinfomgt.2023.102625.
S. Hunziker and M. Blankenagel, “Cross-Sectional research design,” in Research Design in Business and Management, Wiesbaden: Springer Fachmedien Wiesbaden, 2024, pp. 187–199. doi: 10.1007/978-3-658-42739-9_10.
S. G. Gebremichael, E. Yismaw, B. D. Tsegaw, and A. D. Shibeshi, “Determinants of water source use, quality of water, sanitation and hygiene perceptions among urban households in North-West Ethiopia: A cross-sectional study,” PLoS One, vol. 16, no. 4, 2021, pp. 1–20, 2021, doi: 10.1371/journal.pone.0239502.
M. M. Ravsanjanie, A. S. Pawitra, K. C. Diyanah, Z. A. Zakaria, and N. H. B. T. E. Marmaya, “Utilization of clean water, personal hygiene of toddler caregivers, and smoking behavior of family members as risk factors for cases of stunting toddlers,” J. Kesehat. Lingkung., vol. 13, no. 1, pp. 48–56, 2021, doi: 10.20473/jkl.v13i1.2021.48-56.
I. Irin and A. Kurniadi, “The relationship of mother’s knowledge, attitude, and behavior regarding diarrhea with the number of diarrhea toddlers taken to the health facility,” J. Urban Heal. Res., vol. 1, no. 1, pp. 38–46, 2022, doi: 10.25170/juhr.v1i1.3850.
M. R. Islam, M. F. Al Fidah, S. J. Bashar, R. Amin, S. Paul, C. A. Kawser, T. Ahmed, and S. Nuzhat “Qualitative approach to assess maternal knowledge, attitude and practice regarding oral rehydration solution preparation and administration among under-5 children suffering from diarrhoea in Dhaka, Bangladesh,” BMJ Paediatr. Open, vol. 9, no. 1, pp. 1–11, 2025, doi: 10.1136/bmjpo-2025-003577.
Y. Zulfiana, Nurul Fatmawati, and Yopi Suryatim Pratiwi, “Exclusive breastfeeding behavior and clean water facilities with the incidence of diarrhea in toddlers,” J. Qual. Public Heal., vol. 7, no. 2, pp. 163–168, 2024, doi: 10.30994/jqph.v7i2.494.
A. K. Daba, K. Abegaz, A. Muleta, and B. B. Desalegn, “Hand washing practice and food insecurity are associated with undernutrition of breastfeeding mothers in Rural Ethiopia: A Cross-sectional Study,” Environ. Health Insights, vol. 18, pp. 1–19, 2024, doi: 10.1177/11786302241231708.
N. I. Rahayu, M. Muktiarni, and Y. Hidayat, “An application of statistical testing: A guide to basic parametric statistics in educational research using SPSS,” ASEAN J. Sci. Eng., vol. 4, no. 3, pp. 569–582, 2024, doi: 10.17509/ajse.v4i3.76092.
A. Ghanad, “An overview of quantitative research methods,” Int. J. Multidiscip. Res. Anal., vol. 06, no. 08, pp. 3794–3803, 2023, doi: 10.47191/ijmra/v6-i8-52.
F. Bolikulov, R. Nasimov, A. Rashidov, F. Akhmedov, and Y. I. Cho, “Effective methods of categorical data encoding for artificial intelligence algorithms,” Mathematics, vol. 12, no. 16, pp. 1–21, 2024, doi: 10.3390/math12162553.
M. Vishwakarma and N. Kesswani, “A new two-phase intrusion detection system with Naïve Bayes machine learning for data classification and elliptic envelop method for anomaly detection,” Decis. Anal. J., vol. 7, pp. 100233, 2023, doi: 10.1016/j.dajour.2023.100233.
C. Teng, Q. Yang, Z. Xiong, N. Ye, and X. Li, “Multivariate analysis and validation of the prognostic factors for skull base chordoma,” Front. Surg., vol. 8, pp. 1–14, 2021, doi: 10.3389/fsurg.2021.764329.
A. R. Jazieh, H. C. Onal, D. S. W. Tan, R. A. Soo, K. Prabhash, A. Kumar, R. Huggenberger, S. Robb, and B. C. Cho, “Real-world treatment patterns and clinical outcomes in patients with stage III NSCLC: results of KINDLE, a multicountry observational study,” J. Thorac. Oncol., vol. 16, no. 10, pp. 1733–1744, 2021, doi: 10.1016/j.jtho.2021.05.003.
S. Rahman, A. M. Munam, A. Hossain, A. S. M. D. Hossain, and R. A. Bhuiya, “Socio-economic factors affecting the academic performance of private university students in Bangladesh: a cross-sectional bivariate and multivariate analysis,” SN Soc. Sci., vol. 3, no. 2, pp. 1–21, 2023, doi: 10.1007/s43545-023-00614-w.
D. N. Khasanah, “The risk factors of hypertension in Indonesia (Data study of Indonesian family life survey 5),” J. Public Heal. Res. Community Heal. Dev., vol. 5, no. 2, pp. 80–89, 2022, doi: 10.20473/jphrecode.v5i2.27923.
S. Kwak, “Are only p-values less than 0.05 significant? a p-value greater than 0.05 is also significant!,” J. Lipid Atheroscler., vol. 12, no. 2, pp. 89–95, 2023, doi: 10.12997/jla.2023.12.2.89.
A. Vaidyanathan, “Significance of hypothesis and P value,” J. Indian Prosthodont. Soc., vol. 23, no. 2, pp. 103–104, 2023, doi: 10.4103/jips.jips_131_23.
A. Maftouh, O. El Fatni, M. Fayiah, R. K. Liew, S. S. Lam, T. Bahaj, and M. H. Butt, “The application of water–energy nexus in the Middle East and North Africa (MENA) region: A structured review,” Appl. Water Sci., vol. 12, no. 5, pp. 1–21, 2022, doi: 10.1007/s13201-022-01613-7.
R. K. Mishra, “Fresh water availability and It’s global challenge,” J. Mar. Sci. Res., vol. 2, no. 1, pp. 01–03, 2023, doi: 10.58489/2836-5933/004.
G. Berihun, M. Abebe, S. Hassen, A. Gizeyatu, L. Berhanu, D. Teshome, Z. Walle, B. Desye, & A. Keleb, “Drinking water contamination potential and associated factors among households with under-five children in rural areas of Dessie Zuria District, Northeast Ethiopia,” Front. Public Heal., vol. 11, pp. 1–12, 2023, doi: 10.3389/fpubh.2023.1199314.
B. M. J. K. Balasooriya, J. Rajapakse, and C. Gallage, “A review of drinking water quality issues in remote and indigenous communities in rich nations with special emphasis on Australia,” Sci. Total Environ., vol. 903, pp. 166559, 2023, doi: 10.1016/j.scitotenv.2023.166559.
M. E. Adede, A. J. Barde, B. M. Eniola, M. T. Hassan, and O. A. Aanuoluwapo, “Public health challenges and solutions in urban areas of Nigeria,” Int. J. Heal. Pharm. Res., vol. 9, no. 3, pp. 39–52, 2024, doi: 10.56201/ijhpr.v9.no3.2024.pg39.52.
B. Shehu and F. Nazim, “Clean water and sanitation for all: Study on SDGs 6.1 and 6.2 targets with state policies and interventions in Nigeria,” Environ. Sci. Proc., vol. 15, no. 71, pp. 1–12, 2022, doi: 10.3390/environsciproc2022015071.
F. Mills, T. Foster, C. Moe, N. Amin, P. Liu, M. Rahman, B. Evans, and J. Willetts, “Unsafe containment: Public health risks of septic tanks discharging to drains in Dhaka Bangladesh,” PLOS Water, vol. 3, no. 12, pp. 1–18, 2024, doi: 10.1371/journal.pwat.0000325.
S. S. N. Khairunnisa, R. Yanidar, S. M. P. Marendra, A. D. Astuti, and H. M. Taki, “The study of septic tank proximity on coliform, E. Coli, and organic contamination in shallow groundwater: A case study of DKI Jakarta,” J. Community Based Environ. Eng. Manag., vol. 9, no. 1, pp. 53–62, 2025, doi: 10.23969/jcbeem.v9i1.21644.
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