Intern
ati
o
n
a
l
Jo
urn
a
l
o
f
P
u
b
lic Hea
l
th Science (IJ
P
HS)
V
o
l.5
,
No
.2
,
Jun
e
2
016
, pp
. 15
8
~ 1
63
I
S
SN
: 225
2-8
8
0
6
1
58
Jo
urn
a
l
h
o
me
pa
ge
: h
ttp
://iaesjo
u
r
na
l.com/
o
n
lin
e/ind
e
x.ph
p
/
IJPHS
Employment, Knowledge and Latrine Ownership as Risk
Factors and Prediction Mo
del of Diarrhea Incidence
Irfan, Sulansi
Health
Poly
tech
nic MoH Kupa
n
g
, NTT Province, Indonesia
Article Info
A
B
STRAC
T
Article histo
r
y:
Received
Ja
n 27, 2016
Rev
i
sed
Mar
20
, 20
16
Accepted
May 10, 2016
Diarrhea
is
a l
eading c
a
us
e o
f
death rank
ed
3
rd
after Tuberculosis and
Pneumonia in In
donesia. Diarrhea cases
in NTT p
r
ovince
and also in Kupan
g
Cit
y
is still high
, with Pasir Panjang PHC in 2012 and 2013 ranked the top
three, while Oep
o
i PHC alway
s
the lowe
st rank. This research was conducted
to anal
yz
e the ri
s
k
factors
for the incid
e
nce of d
i
arrhe
a
and cre
a
t
e a m
odel
equation to predict th
e diarrh
ea inci
den
c
e. This observatio
nal analy
tic
research
using case control
design.
Sa
mple
s
with dia
rrhe
a
ca
se
s we
re
recorded in Janu
ar
y
- June 2015 in th
e register book Pasir Panjang PHC and
Oepoi PHC taken b
y
random sampli
ng to obtain samples for cases 62
childr
e
n of Diar
r
h
ea pa
ti
ent.
The
cont
rol samples
are 62
childr
e
n
who are not
register
ed as suf
f
ering from diar
rhea
in
th
e month of June 2015
,
close to
th
e
patient’s house, and h
e
r mother or pe
op
le wh
o responsible to
car
e thos
e
childr
e
n want as respondent. Data were
obtain
e
d b
y
interviews with the
mothers of cases and controls
using
questionnaires and direct observation
us
ing a che
c
kl
i
s
t. Data
were
anal
yz
ed using
univariate, bivariate
and
m
u
ltivari
a
te
logi
stic regr
ession.
There
are
thre
e
variab
les th
at si
gnific
a
n
t
l
y
affect to th
e diar
rhea in
ciden
c
e,
na
mely
emplo
y
ment, knowledg
e and latrin
e
ownership and the most dominant variab
le influ
e
nce that is kno
wledge (O
R
4.353). The model equation Y = -
2.048 +1.153 emplo
y
ment + 1.48
3
knowledge + 1
.
480 latrin
e ownership with a p
e
rcen
tag
e
accur
a
cy
of the
m
odel in
cl
assifying
observation
s
is 68.5%
.
Keyword:
Diarrhea
Em
pl
oym
ent
K
now
ledg
e
Latrin
e Own
e
rsh
i
p
Copyright ©
201
6 Institut
e
o
f
Ad
vanced
Engin
eer
ing and S
c
i
e
nce.
All rights re
se
rve
d
.
Co
rresp
ond
i
ng
Autho
r
:
Ir
fan
I
rfa
n,
Health
Po
lytech
n
i
c M
o
H
Kupan
g
,
N
TT Prov
in
ce,
In
don
esia.
Em
a
il: u
m
a1
9
7
1
kup
ang@g
m
ail.co
m
1.
INTRODUCTION
Diarrh
ea is still a g
l
o
b
a
l
proble
m
, esp
ecially fo
r d
e
v
e
lop
i
ng
cou
n
t
ries and
cau
s
e d
eat
h
,
esp
ecially i
n
childre
n less than 5 years as
many as
76%
of
deat
hs
d
u
e t
o
di
a
r
r
h
ea [
1
]
-
[
3
]
.
As m
a
ny
as 10%
o
f
chi
l
d
r
e
n wi
t
h
d
i
arrh
ea
will d
e
h
ydrate and
0.5
%
will d
i
e [2] an
d
abou
t 25% o
f
t
h
e d
i
fferen
ce in
g
r
o
w
t
h
d
i
sord
ers in
ch
ild
ren
i
n
de
vel
o
pi
ng
cou
n
t
r
i
e
s a
n
d
d
e
vel
o
ped
co
u
n
t
r
i
e
s can
be
at
t
r
i
but
e
d
due
t
o
di
arr
h
ea
[2]
D
i
arrh
ea and
o
t
h
e
r
g
a
stro
en
t
e
ritis rank
ed
fi
rst in
p
a
tien
t
s
in
ho
sp
itals in Indo
nesia 2008
is
8
.
2
3
%.
Diarrhoea is a
leading ca
use
of deat
h ranked 3rd becaus
e
of
infectious
di
sease a
f
ter t
ube
rc
ulosis
(T
B) and
pne
um
onia [4]. Inc
r
e
d
ible inci
dent
of
Diarrhe
a
always occ
u
r each year in
Indonesia with
a Case Fatality Rate
(CFR), wh
ich is still h
i
g
h
[4
]
Based
o
n
Basic Health
Re
search
20
13
, althou
gh
t
h
e
n
u
m
b
e
r of cases
o
f
d
i
arrh
ea
out
brea
k i
n
20
13
was
do
wn
com
p
ared t
o
t
h
e y
ear
20
1
2
,
fr
om
1,6
5
4
case
s
i
n
2
0
1
2
t
o
6
4
6
cases i
n
20
13
,
bu
t
the CFR
because of
out
brea
ks of
diar
rhea is
still higher tha
n
the
national t
a
rget
or still more
tha
n
1%
[1]
Lik
e
wise, m
o
rb
id
ity an
d
m
o
rtalit
y o
f
Diarrhea are still h
i
g
h
in
NTT Provin
ce and
h
a
d
the 5
t
h
h
i
gh
est
i
n
ci
denc
e of
di
arr
h
ea nat
i
o
nal
l
y
200
7 [
5
]
.
Whi
l
e
based
on
hi
s di
ag
n
o
si
s i
n
2
0
1
3
o
v
e
r
al
l
NTT IR
ra
nke
d 1
7
t
h
with
2
.
6
%
,
wh
ile th
e todd
ler was 4.6% [1] Diarrh
eal
d
i
seases cou
l
d po
ten
tially
caus
e
outbreaks
in NT
T
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Em
pl
oy
ment
,
K
now
l
e
d
g
e
a
n
d
L
a
t
r
i
n
e
Ow
n
e
rshi
p
as
Ri
sk
Fact
or
s
an
d P
r
edi
c
t
i
on
Mo
del
...
. (
I
rf
an)
15
9
Provi
n
ce, whe
r
e the second
hi
ghe
st fre
quenc
y
after DH
F.
NTT
was ra
nked second hi
ghest period
pre
v
alence
of
di
ar
r
h
ea (
1
0
.
9%
) i
n
2
0
1
3
a
f
t
e
r Pa
p
u
a
(1
4.
7%)
,
a
n
d
i
s
hi
g
h
er
t
h
a
n
t
h
e
na
t
i
onal
av
era
g
e
(7%
)
[1]
.
Diarrhea is a
n
endem
i
c disease in NT
T Provi
n
ce a
nd al
s
o
i
n
Ku
pa
ng
C
i
t
y
.
Diarrhea case
s
in Kupa
ng
C
i
t
y
i
n
20
1
2
a
nd
2
0
1
3
fel
l
co
m
p
ared t
o
2
0
1
1
,
but
di
a
r
r
h
eal
di
seases rem
a
in am
ong t
h
e t
o
p 1
0
o
f
Di
seas
e [6]
-
[8]. Base
d on t
h
e incidence
ra
te of
Diarrhea, Diarrhea
in Pa
sir
Panja
ng PH
C in
20
12
an
d
2
013
w
a
s r
a
n
k
ed
the
to
p
t
h
ree,
wh
il
e in
Oepo
i PHC always th
e l
o
west
ra
nk
, as
sho
w
n i
n
Ta
bl
e 1.
Tabl
e
1.
Inci
de
nce R
a
t
e
(
I
R
)
o
f
Di
a
r
r
h
ea
per
10
0,
0
0
0
P
o
p
u
l
a
t
i
on
by
P
ubl
i
c
Heal
t
h
C
e
nt
er
s i
n
Ku
pa
n
g
C
i
t
y
Subdistric
t
PH
C
IR 2012
IR 2013
Alak
Naioni 38.
71
31.
04
Alak 30.
56
29.
06
Maulaf
a
Siku
m
a
na 16.
76
18.
67
Penfui
36.
39
43.
59
Kota Raja
Bakunase
22.
45
19.
81
Oebobo
Oebobo
13.
59
15.
21
Oepoi 6.
31
7.
57
Kota La
m
a
Pasir
Panjang
44.
59
43.
01
Kupang Kota
27.
24
28.
28
Kelapa L
i
m
a
Oesapa
14.
9
16.
38
Pre
v
ention
Diarrhea ca
n be
done
for e
x
am
ple by br
eastfee
ding a
nd c
o
rre
ct com
p
le
m
e
ntary fee
d
ing,
the use
of clea
n
water,
was
h
i
n
g ha
nds
before pre
p
a
r
ing
food, defecation in
latrine,
dis
p
ose of feces ba
by
in
t
h
e t
o
i
l
e
t
and i
m
m
uni
zat
i
on agai
nst
m
easl
e
s [9]
.
Pre
v
ent
i
o
n of
Di
arr
h
ea
wo
ul
d
be
m
o
re
effect
i
v
e i
f
do
ne by
t
h
e go
ve
rnm
e
nt
t
oget
h
er
wi
t
h
t
h
e com
m
uni
ty
and st
ake
hol
ders a
nd i
f
ba
sed o
n
t
h
e k
n
o
wl
e
dge
of t
h
e ri
sk
factors of dia
r
rhea i
n
a re
gion. T
h
is resea
r
c
h
was c
o
nd
uct
e
d to a
n
alyze the ris
k
fact
or
for the inci
dence of
di
arr
h
ea a
n
d c
r
eat
e a m
odel
equat
i
o
n t
o
pre
d
i
c
t
the incide
nc
e of
diarrhea i
n
Kupa
ng City.
2.
R
E
SEARC
H M
ETHOD
This observati
onal analytic research
using
case c
ont
rol
st
udy
de
si
g
n
. R
e
search st
a
r
t
i
n
g fr
om
cases
and controls t
h
en
be
bac
k
to s
ee th
eir
risk facto
r
s. Th
e
p
opu
latio
n is a
ll patien
t
s of
D
i
ar
rh
ea i
n
Pasi
r
Pan
j
ang
PHC
(hi
gh
IR
) an
d
Oe
poi
P
H
C
(l
ow
IR
)
of
K
upa
n
g
C
i
t
y
. Sam
p
l
e
s wi
t
h
di
a
r
r
h
ea cas
es we
re rec
o
rd
ed i
n
Janu
ar
y -
Jun
e
2
015
in
th
e
r
e
gister
b
ook
as man
y
as 31
case
s
of
health ce
nters in Pasi
r Pa
nja
n
g health ce
nters
and
3
1
cases i
n
PHC
Oe
poi
t
a
ken
by
ra
nd
om
sam
p
l
i
ng. C
o
n
t
rol
sam
p
l
e
s are not
l
i
s
t
e
d as a chi
l
d
wi
t
h
di
arr
h
ea
in the m
onth
January - June 2015, t
h
eir
house cl
ose
t
o
the cases
’s
hous
e, a
n
d m
o
ther
or pe
ople
who
resp
o
n
si
bl
e t
o
t
a
ke care c
h
i
l
d
r
e
n wa
nt
t
o
be a
resp
o
nde
nt
, i
e
31
pe
opl
e i
n
P
a
si
r Pan
j
a
n
g
P
H
C
an
d
31
pe
o
p
l
e
i
n
Oep
o
i P
H
C.
The de
pe
nde
nt
vari
abl
e
was
t
h
e i
n
ci
dence
of di
arrhea and inde
pende
n
t variables are
education,
e
m
p
l
o
y
m
en
t,
k
nowledg
e, attitu
d
e
, b
e
h
a
v
i
or, latri
n
e
o
w
nersh
i
p
and
con
d
ition
o
f
la
trin
e. In
terv
iews
were
co
ndu
cted
t
o
respo
n
d
e
n
t
s u
s
i
n
g qu
estion
n
aires an
d
d
i
rect
o
b
s
erv
a
tio
n to
th
eir hou
se
physical co
nd
itio
n
u
s
i
ng
checkl
i
s
t
s
. The
dat
a
obt
ai
ne
d was pr
ocesse
d descri
pt
i
v
el
y
t
o
descri
be
t
h
e
fre
que
ncy
di
st
r
i
but
i
o
n of
t
h
e st
ud
y
v
a
riab
les an
d
an
alyzed
u
s
i
n
g
l
o
g
i
stic regressi
o
n
m
u
ltiv
aria
te to
see th
e effect o
f
in
d
e
p
e
nden
t
v
a
riab
les on
th
e
depe
n
d
ent
va
ri
abl
e
.
3.
R
E
SU
LTS AN
D ANA
LY
SIS
3.
1.
Results
Thi
s
st
u
d
y
f
o
u
nd t
h
at
t
h
e vas
t
m
a
jori
t
y
of c
a
ses an
d co
nt
r
o
l
s
al
ready
had
hi
g
h
sch
o
o
l
or
col
l
e
ge,
a
n
d
can
b
e
seen
com
p
le
tely
in
Tab
l
e 2
.
Tab
l
e 2 also
shows the k
nowledg
e an
d
attitu
d
e
s of respon
d
e
n
t
s
m
o
stl
y
unfa
vorable in the case as w
e
ll as on the c
ont
rol, wh
e
r
ea
s pre
v
ent
i
v
e ac
t
i
on di
ar
rhea r
e
sp
on
de
nt
had
alm
o
st
the sam
e
percentage. T
h
e study also fo
und
m
o
st o
f
th
e cases an
d
con
t
ro
l
s
h
a
v
e
th
ei
r own
latrin
es with
to
ilet
co
nd
itio
ns are elig
ib
le.Biv
ariate an
alysis resu
lts can
b
e
seen
i
n
Tab
l
e
3
,
were fou
nd fo
ur
v
a
riab
les v
a
lu
e
<0
.2
5
:
edu
catio
n, em
p
l
o
y
m
e
n
t,
k
now
ledg
e
an
d latr
in
e
own
e
r
s
h
i
p,
w
h
ich m
ean
s th
at only f
o
u
r
v
a
r
i
ab
l
e
s th
at
co
u
l
d
b
e
in
cl
ud
ed in
t
h
e m
u
ltiv
ariate an
alysi
s
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
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:
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252
-88
06
IJP
H
S V
o
l
.
5, No
. 2,
J
u
ne 2
0
1
6
:
15
8 – 1
6
3
16
0
Tabl
e
2.
U
n
i
v
a
r
i
a
t
e
A
n
al
y
s
i
s
of
R
e
searc
h
V
a
ri
abl
e
at
C
a
se
s an
d C
ont
rol
s
Gr
ou
ps
Variable
Cases Controls
Total
n %
n
%
n
%
E
ducation L
e
vel
≤
Secondar
y
School
19
30.
6
11
17.
7
30
24.
2
High School / College
43
69.
4
51
82.
3
94
75.
8
Em
ploy
m
e
nt
Housewife/Farm
er
/L
abor
er
39
62.
9
24
38.
7
63
50.
8
Civil ser
v
ant/self-
em
plo
y
ed
23
37.
1
38
61.
3
61
49.
2
Knowledge L
e
ss/E
nough
58
93.
5
47
75.
8
105
84.
7
Good
4
6.
5
15
24.
2
19
15.
3
Attitude Negative
51
82.3 49
79.0
100
80.6
Positive 11
17.7
13
21.0
24
19.4
Behavior
L
e
ss/E
nough
36
58.
1
35
56.
5
71
57.
3
Good
26
41.
9
27
43.
5
51
42.
7
Latrine
Ownership
Neighbor
/Public
13
21.
0
4
6.
5
17
13.
7
Pr
ivate 49
79.
0
58
93.
5
107
86.
3
L
a
tr
ine Condition
Not Sufficient
26
41.
9
27
43.
5
53
42.
7
Sufficient
36
58.
1
35
56.
5
71
57.
3
Total
62
100
62
100
124
100
Table
3. Bi
vari
ate Analysis
of Researc
h
Vari
abl
e
at
C
a
ses a
n
d
C
o
nt
r
o
l
s
Gr
ou
ps
Variables
P Value
OR
95%
CI
E
ducation L
e
vel
≤
Secondar
y
School
0.
092
2.
049
0.
879 – 4.
77
5
T
e
r
tiar
y
School /
Univer
sity
Em
ploy
m
e
nt
Housewife/Form
er
/L
abor
er
0.
007
2.
685
1.
299 – 5.
54
7
Civil Servant/Self-e
m
p
loyed
Knowledge L
e
ss/E
nough
0.
005
4.
628
1.
439 – 14.
8
8
2
Good
Attitude Negative
0.
649
1.
230
0.
503 – 3.
00
6
Positive
Behavior
L
e
ss/E
nough
0.
856
1.
068
0.
524 – 2.
17
6
Good
L
a
tr
ine Owner
ship
Neighbor
/Public
0.
016
3.
847
1.
178 – 12.
5
6
2
Private
Latrine Condition
Not Sufficient
0.
856
0.
936
0.
460 – 1.
90
7
Suf
f
i
cient
After an
alyzing
b
y
m
u
ltiv
ariate lo
g
i
stic regression
with
enter m
e
th
o
d
, th
i
s
research
d
i
sco
v
e
red
th
ree
v
a
riab
les th
at
sig
n
i
fican
tly affect to the in
cid
e
n
ce of dia
r
rhea
be
cause the
p-
valu
e < 0.05
,
n
a
m
e
l
y
em
pl
oym
ent
,
kn
o
w
l
e
d
g
e an
d l
a
t
r
i
n
e o
w
n
e
rshi
p, as s
h
o
w
n i
n
Tabl
e
4. T
h
e m
o
st
dom
i
n
ant
va
ri
abl
e
t
h
at
in
flu
e
n
ce th
e
Diarrh
ea in
ci
den
ce is kno
wl
ed
g
e
with
OR
4
.
3
5
3
,
with
t
h
e m
o
d
e
l eq
uatio
n
s
to
p
r
ed
i
c
t th
e
i
n
ci
denc
e o
f
di
arr
h
ea:
Y =
-
2.
04
8 +
1.
1
53
em
pl
oym
ent
+ 1.
48
0
k
n
o
w
l
e
dge +
1
.
4
8
3
l
a
t
r
i
n
e o
w
ners
hi
p. T
h
e
perce
n
tage
of accuracy in classi
fying observation m
odels is 68.5%,
or 124
obse
rvation there
are 85
obs
er
vat
i
o
n
s
pr
eci
se cl
assi
fi
cat
i
on
by
l
o
gi
st
i
c
re
gressi
on
m
odel
s
.
Tab
l
e
4
.
M
u
ltiv
ariate
An
alysi
s
of Research
Variab
les at C
a
ses and
C
o
n
t
ro
ls Gro
u
p
s
Variables in th
e
Equation
B
S.E.
Wald
Df
Sig
Exp(B)
95%
CI
Em
ploy
m
e
nt
1.
153
.
400
8.
321
1
.
004
3.
167
1.
447 – 6.
93
3
Knowledge
1.
480
.
616
5.
767
1
.
016
4.
392
1.
313 – 14.
6
9
3
Latrine Ownership
1.
483
.
647
5.
258
1
.
022
4.
404
1.
240 – 15.
6
3
9
Constant
-
2
.
048
.
634
10.
438
1
.
001
.
129
3.
2.
Discussion
Em
pl
oym
ent
,
kn
o
w
l
e
d
g
e a
n
d
l
a
t
r
i
n
e o
w
ners
hi
p a
r
e ri
s
k
facto
r
s o
f
Diarrh
ea
in
th
is research
, with
th
e
in
f
l
u
e
n
ce
of
these v
a
r
i
ab
les is 68
.5
%, an
d kn
ow
ledg
e is
the m
o
st in
flu
e
n
tial v
a
riab
le h
e
re. So
h
e
re th
ere are
still
3
1
.
5
%
in
fl
u
e
n
ce
o
f
o
t
h
e
r
facto
r
s o
u
t
si
d
e
o
f
em
p
l
o
y
m
e
n
t, kn
owledg
e
an
d
latrin
e own
e
rsh
i
p
th
at affect to
the incidence
of
diarrhea. Th
e
pe
rcenta
ge
of
educate
d
less t
h
an sec
o
nd
ary
school i
n
cases
and c
ont
rols
groups
is lo
wer th
an
t
h
e
p
e
rcen
tag
e
o
f
edu
cated
h
i
g
h
schoo
l / colleg
e
, bu
t th
e
p
e
rcen
tag
e
in
t
h
e cases
(3
0.6%) is
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Em
pl
oy
ment
,
K
now
l
e
d
g
e
a
n
d
L
a
t
r
i
n
e
Ow
n
e
rshi
p
as
Ri
sk
Fact
or
s
an
d P
r
edi
c
t
i
on
Mo
del
...
. (
I
rf
an)
16
1
hi
g
h
er t
h
a
n
i
n
cont
r
o
l
s
(
1
7.
7
%
). H
o
wev
e
r,
m
u
l
tiv
ariate an
alysis sh
owed
edu
cation
is n
o
t
a risk
facto
r
fo
r
diarrhea. Previ
ous
re
searc
h
st
ates that m
a
ter
n
al e
ducatio
n i
s
not ass
o
ciated
with t
h
e
behavior
of fam
ilies i
n
th
e u
s
e latrin
e
[10
]
so
th
at even
if
th
e m
o
th
er's ed
u
cation
is h
i
gh
bu
t th
ey
co
u
l
d
do
d
e
fecate n
o
t
in
th
e
to
ilet,
and
vice versa
although m
a
te
rnal educa
tion is low, they can always do de
fecate in latrines
which is one for
th
e p
r
ev
en
tio
n
o
f
th
e o
c
currence o
f
d
i
arrh
ea, th
e p
o
s
sib
ility
o
f
wh
ich
were related
b
ecau
s
e
latrin
e
o
w
n
e
rsh
i
p.
Thi
s
m
eans t
h
a
t
hi
g
h
er e
d
ucat
i
on
do
es n
o
t
g
u
ara
n
t
ee a
pers
on'
s be
ha
vi
o
r
i
s
heal
t
h
y
.
It
i
s
di
ffe
re
nt
wi
t
h
t
h
eo
ry
fro
m
No
to
atmo
djo
t
h
at th
e lev
e
l
o
f
edu
cation
will i
m
p
r
ov
e h
ealth kno
wled
g
e
an
d it
will bring
an
i
n
crease i
n
p
o
s
itiv
e
b
e
h
a
vio
r
chang
e
[11]. Accord
i
n
g
t
o
research
b
y
Ev
ayan
ti et al. co
ndu
cted
in
Tab
a
n
a
n
also
stated
there
was
no as
sociation bet
w
een m
a
tern
al ed
u
cation
with th
e in
ci
d
e
n
ce
of diarrhea
in
chi
l
dre
n
[12].
Em
ploym
ent in this
researc
h
is risk
facto
r
fo
r di
a
r
r
h
ea wi
t
h
OR
3.
16
7.
I
t
m
eans that mothe
r
s who
have
j
o
b
s
l
i
k
e
ho
use
w
i
v
es
, f
a
rm
ers, or
wo
rke
r
s at
ri
s
k
for t
h
e childre
n affected
by
di
arr
h
ea 3.
16
7
t
i
m
e
s
greater t
h
an m
o
the
r
s who work self-e
m
p
loyed, pri
v
ate
employees or
civi
l
serva
n
ts. T
h
is is proba
bly because
in
add
itio
n to
th
eir edu
cation lo
w also
at
work as
h
o
u
s
ewiv
es, farm
ers o
r
labo
rers
no
inform
atio
n
ab
ou
t
Diarrhea, while
m
o
ther worked
as
a
self-employed, private
e
m
ployees and
civil serva
n
ts there is access
to ge
t
inform
ation about
Diarrhea i
n
their
workpl
ace coul
d eventually increase
knowledge about
diarrhea a
n
d their
heal
t
h
y
be
ha
vi
ors
.
Th
is stud
y f
oun
d
th
e m
a
j
o
r
i
t
y
o
f
m
o
th
er
s
h
a
v
e
less know
ledg
e abo
u
t
d
i
ar
rh
ea eith
er in
th
e cases
gr
o
up a
nd t
h
e
cont
rol
s
gr
o
u
p
,
b
u
t
i
n
t
h
e ca
ses gr
o
up l
e
ss
kn
o
w
l
e
d
g
e ha
s
a hi
g
h
er
perc
ent
a
ge t
h
a
n
c
o
nt
r
o
l
s
g
r
ou
p. Resu
lts o
f
m
u
ltiv
ariate an
alysis tu
rn
s
o
u
t
th
ere is
an
in
flu
e
n
ce of mo
th
er's k
n
o
wled
g
e
on
th
e in
ci
d
e
n
c
e
of
di
arr
h
ea wi
t
h
OR
4.
3
9
2
,
m
eani
ng
th
at
ch
ild
ren
th
at th
eir m
o
th
ers hav
e
lack the knowle
dge at risk of
su
ff
er
i
n
g
f
r
o
m
d
i
ar
rh
ea 4
.
392
ti
m
e
s g
r
eater
th
an
th
e r
i
sk
of
ch
ildr
e
n th
at th
eir
mo
th
er
s h
a
v
e
a g
ood
k
now
ledg
e
of
d
i
ar
rh
ea. I
t
is
also the sam
e
as
in Sra
g
en a
nd
Kara
nganya
r
research t
h
at is base
d on chi-s
qua
re
test k
nowledg
e correlate wit
h
th
e
in
ciden
c
e of
d
i
ar
rh
ea [
1
3
]
,[
14
].
The i
m
port
a
nc
e o
f
t
h
e i
n
fl
u
e
nce
of
kn
o
w
l
e
dge
on
t
h
e
i
n
ci
de
nce
of
di
arr
h
ea i
s
i
n
c
ont
rast
wi
t
h
p
r
ev
iou
s
stud
ies th
at d
i
d
no
t sp
ecify th
e m
o
t
h
er's k
nowle
dge in
th
e u
s
e o
f
latrin
es [10
]
. So
th
e u
s
e of latrin
e
as one
way
of
pre
v
e
n
t
i
ng
di
ar
rhea i
s
n
o
t
cau
sed by
k
n
o
wl
e
dge
b
u
t
by
ot
h
e
r fact
o
r
s,
nam
e
l
y
t
h
e at
t
i
t
ude
of t
h
e
m
o
th
er, po
ssessio
n of latrin
es, clean
water fac
ilities, co
ach
in
g staff an
d sup
port p
e
rso
n
n
e
l [10
]
.
Edu
catio
n
is gu
id
ing
p
e
op
le to
ob
tain
in
fo
rmatio
n
th
at can
b
e
u
s
ed
to
i
m
p
r
o
v
e
th
e quality
o
f
life. In
gene
ral, t
h
e
hi
ghe
r
one's education t
h
e easi
e
r it will
recei
ve m
o
re and
bet
t
er inform
ation and
knowledge [15].
But in this study m
a
ternal education
has
no e
ffect
on the incide
nce
of
diarrhea,
because educa
tion is
measu
r
ed in
this stu
d
y
is a form
al ed
u
catio
n, wh
ile a
sou
r
ce o
f
kn
ow
ledge o
f
t
h
e m
o
th
er
is no
t on
ly fo
r
m
al
education but
coul
d inform
al exam
ple
of
co
uns
el
i
n
g
,
f
r
o
m
p
r
i
n
t
a
n
d
el
ect
ro
ni
c m
e
di
a, f
r
om
fri
en
ds,
o
r
fr
om
work(1
1) as d
e
scrib
e
d
earlier
in
th
is st
u
d
y
t
h
at
the job als
o
affect the inci
dence
of diarrhe
a
.
In
th
is stud
y, th
e m
a
j
o
rity alread
y u
s
ed
latrin
es,
b
u
t
i
n
t
h
e
perce
n
t
a
ge
of
ow
ne
rshi
p o
f
p
r
i
v
at
e l
a
t
r
i
n
e
i
n
t
h
e cont
rol
gr
o
up wa
s hi
g
h
er t
h
a
n
t
h
e ca
ses and a
f
t
e
r
m
u
l
tiv
ariate an
alysis tu
rn
s latrin
e own
e
rsh
i
p in
th
is
st
udy
ha
s t
h
e
OR
4.
4
0
4
,
w
h
i
c
h m
eans t
h
ey
do
not
have t
h
ei
r o
w
n l
a
t
r
i
n
es t
h
en t
h
e c
h
i
l
d at
ri
sk Di
a
r
r
h
ea i
s
4.
40
4 t
i
m
es gr
eat
er t
h
a
n
w
h
e
n
t
h
ey
ha
ve
t
h
ei
r o
w
n l
a
t
r
i
n
es. Th
is is
po
ssib
ly related
t
o
th
e
u
s
e of lat
r
in
es,
p
e
op
le h
a
v
e
their o
w
n
latrin
es it wil
l
b
e
g
r
eater u
s
e o
f
latrin
es to
d
e
fecate eith
er fo
r th
em
selv
es o
r
th
eir
ch
ild
ren
and
t
h
e wh
o
l
e fam
ily. Statis
ticall
y
ro
le latrin
e owne
rshi
p of the use of latrines has also been
dem
onstrated i
n
previ
o
us studies w
ith
OR 27.03,
or t
hose
who ha
ve la
trines will use the toilet for de
fecate
27
.0
3 t
i
m
es
m
o
re
oft
e
n t
h
a
n
t
hose
w
ho
d
o
not
ha
ve t
h
ei
r
ow
n l
a
t
r
i
n
e
s
[
1
0]
. Si
m
i
l
a
rl
y
,
research
i
n
S
u
k
oha
r
j
o
an
d
Bo
y
o
lali
sh
owed
th
ere
is a relatio
n
s
hip
b
e
tween
the incidence of diarrhea
with latrin
e o
w
n
e
rsh
i
p
[1
6]
,[
1
7
]
and t
h
e pe
rce
n
t
a
ge
of
di
ar
rhea
wa
s l
o
we
r i
n
c
h
i
l
d
re
n w
h
o l
i
v
e
at
hom
e wi
t
h
t
h
ei
r
ow
n l
a
t
r
i
n
es [4]
.
Th
us sy
st
em
atic revi
e
w
of
re
search
t
h
at
be
do
ne
by
Ad
isasmito
fou
n
d
t
h
at th
ere
a
r
e
five studies
that
claim
latrin
e own
e
rsh
i
p
statisticall
y
sign
ifican
t
risk
factors for the incide
nce of diarrhea [18].
Latrines a
r
e
fa
ctors
ena
b
ling
or ena
b
ling
he
alth be
ha
viors
do not
de
fecate in a
n
y
place
in
orde
r t
o
p
r
ev
en
t th
e in
cid
e
n
ce of d
i
arrh
ea. Th
e to
ilet is essen
tia
l
th
at th
ere sh
ou
ld b
e
a facilit
y f
o
r fam
ilies
n
o
t
to
do
ope
n
defecat
i
o
n [
10]
Al
t
h
o
u
gh t
h
e m
o
t
h
er'
s
kn
o
w
l
e
d
g
e i
s
go
o
d
,
but
i
f
i
t
i
s
not
sup
p
o
rt
e
d
by
t
h
e l
a
t
r
i
n
e
owne
rshi
p it
will be
diffic
u
lt for
fam
i
ly m
e
m
b
ers to
do not
ope
n
defecation
[10] and it ce
rtainly can
co
n
t
am
in
ate so
il an
d
water in
th
e v
i
cin
ity. Typ
e
o
f
latrin
e t
h
at go
od
and
fi
t fo
r
h
ealth
requ
irem
en
ts is th
e typ
e
of swa
n
nec
k
s
o
it does
not al
low a
n
im
als and
odors
out
t
h
rough the
holes
closet
b
ecause
the
neck is al
ways
filled
with wat
e
r [19
]
.
Research in Ban
g
li
foun
d that latrin
e
o
w
n
e
rsh
i
p
rela
ted t
o
seve
ral
factors suc
h
as ec
onom
i
c factors
,
attitu
d
e
s, kn
owledg
e, attitu
de an
d
ro
le
of h
ealth
p
e
rso
nnel, so
h
e
re to
ch
ang
e
th
e latrin
e own
e
rsh
i
p
m
u
st
co
nsid
er fact
o
r
s related
t
o
th
em
, an
d
th
at chan
g
e
will no
t
hap
p
e
n
qu
ick
l
y
so
th
at ex
ten
s
io
n or tri
g
g
e
rs t
o
th
e
com
m
uni
t
y
shoul
d be re
peat
ed wi
t
h
t
h
e i
n
vol
vem
e
nt
of rel
e
va
nt
sect
or
s [2
0]
. Eve
n
t
h
o
u
gh i
n
t
h
i
s
st
udy
l
a
t
r
i
n
e ow
ne
rs
hi
p i
s
a ri
sk f
act
or o
f
di
ar
r
h
ea, t
h
e co
ndi
t
i
on
of l
a
t
r
i
n
e i
s
not
a ri
sk fa
ct
or f
o
r
di
arr
h
ea. In
co
n
t
rast, th
e stu
d
y
in
Suko
h
a
rjo
fo
und
an
asso
ciatio
n
b
e
tween
th
e qu
ality
o
f
th
e latrin
es with
th
e in
cid
e
n
ce of
d
i
arrh
ea [1
6
]
an
d also b
y
syste
m
atic rev
i
ew
p
r
ev
iou
s
ly
foun
d th
at t
h
ere are fou
r
stud
ies
th
at th
e con
d
itio
n
of
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJP
H
S V
o
l
.
5, No
. 2,
J
u
ne 2
0
1
6
:
15
8 – 1
6
3
16
2
latrin
es as a
ri
sk
factor fo
r
d
i
arrh
ea and
on
ly on
e st
ud
y
statin
g
latrin
e
con
d
ition
n
o
t
as
a risk
fact
o
r
fo
r
diarrhea [18].
Th
ere are still
man
y
o
t
h
e
r facto
r
s th
at affect
to
th
e in
cid
e
n
c
e o
f
d
i
arrh
ea t
h
at
m
a
y b
e
m
o
re d
o
m
in
an
t
ro
le th
an
th
e co
nd
itio
n
o
f
to
ilet o
r
latrin
e o
w
n
e
rsh
i
p
,
su
ch as th
e av
ailab
ility
o
f
clean
water, h
y
g
i
en
e of food
an
d
b
e
v
e
r
a
g
e
s as w
e
ll as th
e
eq
u
i
p
m
en
t th
e
y
w
ear
, em
p
l
o
y
m
en
t, k
n
o
w
l
ed
g
e
o
f
d
i
ar
rh
ea, so
cio-
economic an
d
ot
he
r fact
o
r
s [
21]
. B
r
ea
st
fee
d
i
n
g i
s
al
so v
e
ry
i
n
fl
ue
nt
i
a
l
,
[2
2]
-[
2
4
]
as wel
l
as fact
or
s un
pr
ot
ect
ed
wat
e
r
sou
r
ces cl
ean
, and
ow
ne
rshi
p
of ani
m
al
s at
hom
e [25]
,
[
26]. The age of
childre
n an
d their m
o
ther are also
pre
d
i
c
t
e
d as i
m
port
a
nt
fact
o
r
s of
Di
arh
h
ea
i
n
ci
dence [
18]
,[
27]
. It
has al
so bee
n
sh
ow
n
i
n
t
h
i
s
st
udy
that
t
h
e
th
ree si
gn
ifican
t v
a
riab
les on
ly in
fl
u
e
n
c
e t
h
e
Diarrh
ea incid
e
n
c
e 68
.5
%, wh
ich m
ean
s th
at th
ere are still
31
.5
% i
n
fl
ue
n
ce o
f
ot
he
r
fac
t
ors
o
u
t
s
i
d
e
o
f
em
pl
oym
ent
,
kn
o
w
l
e
d
g
e a
n
d l
a
t
r
i
n
e
ow
ne
rshi
p t
h
at
af
fec
t
t
o
t
h
e
incidenc
e of di
arrhea.
4.
CO
NCL
USI
O
N
There a
r
e thre
e variables that significantl
y affect
to the incidence of
diar
rhea that are working,
k
now
ledg
e and latr
in
e o
w
n
e
r
s
h
i
p
.
Th
is r
e
sear
ch
ob
tain
ed
the
m
o
d
e
l eq
u
a
tio
n
Y
= -
2
.
048 +1
.153
w
o
rk
in
g
+
1.483 knowle
dge +
1.480 la
trine owne
rs
hip, with th
e
percenta
ge of accuracy in cla
ssifying
obse
r
vation
m
o
d
e
ls is 6
8
.5%. Th
e m
o
st do
m
i
n
a
n
t
v
a
riable is kn
owledge with
OR
4
.
353
.
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