Analysis of Diarrhea Cases in Indonesian Coastal Areas:

Literature Review
1)
Yul Andrinatha, 2)Haryati, Ramadhan Tosepu1), Devi Savitri Effendy1), Sri
Susanty1)

Faculty of Public Health, Halu Oleo University, Kendari City, Indonesia

a)
Corresponding author:example@gmail.com
b)
yulandrinata@gmail.com
c)
haryatitabara@gmail.com

Abstract.Coastal communities are people who live in areas close to the sea where the majority work as fishermen.
Coastal communities are communities that are vulnerable to disease due to environmental conditions, especially at young
ages such as toddlers. Diarrhea is a problem that often occurs, especially in children under five, many factors influence
the occurrence of diarrhea in children under five, especially in coastal areas. The aim of this research is to carry out a
literature study analyzing the incidence of diarrhea in coastal areas. The method used in this research is literature study,
which involves looking for several articles related to this research. 5 categories of articles that meet the criteria for
problems that occur.

Keywords: coastal areas, diarrhea, toddlers

INTRODUCTION
Diarrhea is an endemic disease that can cause Extraordinary Events (KLB) and is still a contributor to the
death rate in Indonesia, especially among children under five (Ministry of Health, 2020). The number of diarrhea
sufferers according to Indonesia's health status in 2018 was 1,637,708 children under five served in health facilities.
40.90% Estimated diarrhea in health facilities. According to WHO data, diarrhea is the number one cause of death in
children under the age of five globally.[1]
Diarrhea is the second killer of toddlers in Indonesia after ISPA (Acute Respiratory Infection). Meanwhile,
the United Nations Children's Fund (UNICEF) estimates that every person dies from diarrhea within 30 seconds. In
Indonesia, every year 10,000 children under five die from diarrhea. Diarrhea is a disease with high morbidity and
mortality, so this disease is still considered a health problem that cannot be overcome in developing countries, for
example Indonesia. In developing countries, children under 3 years of age suffer from diarrhea an average of 3 times
a year. Diarrhea can cause children to miss out on the nutrients they need as they grow and develop. Diarrhea is still
the biggest cause of death among children under five in Indonesia after ISPA (Acute Respiratory Infection) which
kills 100,000 children under five every year. One of the causes of diarrhea is household problems and health
facilities.[2]
Environmental-based diseases are still a problem today. This is because environmental-based diseases are
always included in the top 10 diseases in almost all Community Health Centers in Indonesia. The incidence of
environmental-based diseases such as dengue fever, diarrhea and ARI is still a public health problem. The
development of epidemiology specifically describes the role of the environment in the occurrence of disease and
epidemics, that the environment influences the occurrence of disease. The environment is one of the factors that
plays a major role in the history of disease in communities, including coastal communities, which includes sanitation
in public places and sanitation in residential areas.[3]
Indonesia is also known as a Mega Biodiversity country in terms of biodiversity, and has coastal areas that
have great potential for various transitional development options between land and sea that form diverse and highly
productive ecosystems and provide extraordinary economic value to humans.[4]. Coastal areas have enormous
potential in improving the nation's economy. Economic activity in coastal areas is very dominant and is
accompanied by population growth. There are still many residential areas in coastal areas that are not well
organized, have poor environmental health and are unfit for habitation.[5]
Population growth and rapid development activities in coastal areas such as settlements, fisheries, ports,
tourist attractions and so on, the ecological pressure on coastal and marine resource ecosystems is increasing, so that
this increasing pressure of course results in various kinds of pollution such as; Sea water pollution due to the
dumping of rubbish in the sea and waste water in the sea as well as various kinds of human activities which can
damage the environment so that these impacts can cause problems with existing health problems such as
environmental-based health.[4]
Basically, coastal areas are developing into areas with quite rapid growth, considering that coastal areas can
provide space with high accessibility relatively cheaply compared to the land space above them, therefore the coast
has become a destination for population movement. In relation to ease of access and connections between islands
and between regions, some of the big cities in Indonesia are located in coastal areas so that if the environment is not
well maintained, it can result in an increase in the spread of environmentally based diseases in coastal areas.[6]
Based on Southeast Sulawesi Health profile data, the percentage of diarrhea cases treated at all ages in 2019
amounted to 45.47% of cases, this number decreased in 2020, namely by 18.97%, then increased again in 2021 by
24.81%, and in 2022 it will be 29.67%.[7]
Based on data from the Soropia Health Center in 2020, there were 286 toddlers suffering from diarrhea, in
2021 there were 269 toddlers suffering from diarrhea and in 2022, there were 160 toddlers suffering from diarrhea,
in 2023 for the January to June period there were 96 toddlers suffering from diarrhea.
In several studies of diarrhea cases in coastal areas, there are many factors from each coastal area. So it is
necessary to collect what are the main factors that occur with the problem of diarrhea in toddlers in coastal areas of
Indonesia. Through this literature review method, it is used to find out the extent of research that has been carried
out because according to literature study rules it is a research method that summarizes the main research findings to
provide a more comprehensive and balanced set of facts to find out what causes diarrhea in toddlers in the region.
coast.

METHOD
The method used in this research is a literature review by going through the process of searching for research
results from articles that are relevant to the research topic, namely the incidence of diarrhea in coastal areas.
Researchers refer to journals or research results related to the topic being discussed by filtering journals for the last 3
years via the Google Scholar online search site. The selection of literature to be reviewed was determined using
inclusion and exclusion criteria. Selection of inclusion and exclusion criteria, including:

Inclusion Criteria:
a) The literature taken has a range of 2020-2024
b) Articles can be accessed in their entirety.
c) Articles according to the topic of literature study.
d) Discuss the incidence of diarrhea
e) Discusses coastal areas

Exclusion Criteria:
a) The literature has a year range below 2020
b) Articles are not fully accessible to researchers
c) Not relevant to the research topic
d) Unclear and not in accordance with discussions about coastal areas

The results of searching and filtering articles obtained 5 titles that were relevant to the discussion of the articles
that would be reviewed in this research. The summary of research variables is as follows:
 RESULTS AND DISCUSSION

Research
No. Researcher, Title, Year Method Variables / Work Focus Research result
subject
1. Fitri Rachmillah Fadmi, et al, Factors Cross Toddler Diarrhea Occurrence In other research that determines the main factors in the occurrence
Associated with the Incidence of Diarrhea Sectionals of diarrhea problems in toddlers in coastal areas, namely research by
in Toddlers in Coastal Areas, Lapulu Study (Fitri Rachmillah Fadmi et al., 2020), the research concludes that
Village, Abeli District, Kendari City, 2020 there is a relationship with the level of knowledge, provision of clean
water and ownership of family toilets with the incidence of diarrheal
disease in the community. coastal area, Lapulu Village, Abeli
District, Kendari City.[8]

2. Fatimatuzzahro, et al, Water Pollution
Index (WPI) and Incidence of Diarrhea
Among Children Under Five Years Old in
Coastal Area of Semarang City, Indonesia,
2020
Cross Toddler Diarrhea Occurrence The article belongs to (Fatimatuzzahro et al., 2020) in his research on
Sectionals "Water Pollution Index (WPI) and the incidence of diarrhea in
Study children under five on the coast of Semarang City, Indonesia" which
explains the influence of salinity in water which causes
The occurrence of diarrheal disease is directly caused by growth. The
occurrence of rehydration or low water flow caused by salt has the
potential to increase microbial growth. This causes changes in the
muscles and mucosa of the gastrointestinal tract, thus becoming one
of the factors causing diarrhea.[9]

3. Irma, et al, Prevalence and Determinants Cross Toddler Diarrhea Occurrence Similarly, research (Irma et al., 2021) shows that the main
Incidence of Diarrhea in Toddlers in the Sectionals determinants of diarrhea cases in coastal areas are seen from the
Region Study environmental aspect, namely the healthy latrine program and the
Coast of North Buton Regency, 2021 Community-Based Total Sanitation (STBM) program. This activity
has had an influence on reducing the number of diarrhea cases in the
area.[10]
4. Samsia Winda, et al, Toddlers Diarrheal
Cases in the UPTD Coastal Areas of the
Wadiabero Public Health Center, 2022
5. Nurna Ningsih, Sanitation and Diarrheal
Diseases in the Coastal Areas of the Abeli
District in Kendari City, 2023
Cross Toddler Diarrhea Occurrence Cases of diarrhea in toddlers also occurred in the coastal area of the
Sectionals Wadiabero Community Health Center (Winda et al., 2022) which
Study explains that the occurrence of diarrhea cases in toddlers aged 0-1
with 24 cases where the results of the annual data survey show that
there is a history of exclusive breastfeeding is the main factor in
preventing diarrhea. About 1.8 times the risk if the baby does not
receive exclusive breast milk compared to babies who are given
exclusive breast milk[11]
Cross Toddler Diarrhea Occurrence Similar to the article by (Ningsih et al., 2023), the sanitation factor
Sectionals regarding diarrheal disease in coastal areas is due to the availability
Study of waste water sewer (WWS) conditions which still do not meet the
requirements and can pose a risk of diarrhea in coastal areas in Abeli
District. The toilets in this district have met the requirements. The
waste water sewer (WWS) requirements are said to meet the
requirements based on the Indonesian Ministry of Health in 2014 that
if the sewer does not pollute clean water sources, then the channel is
made of watertight material, closed, odorless, smooth and also
without puddles of water. Meanwhile, the reality is that the condition
of the WWS does not meet the requirements, such as not being
closed, being clogged and having standing water. Some local
communities throw their wastewater into the sea, where it is diverted
into open sewers, and is rarely cleaned. These things cause diarrhea
problems due to lack of awareness of the cleanliness of the
surrounding environment.[12]
 Table 1 shows the identity of research regarding factors that influence the occurrence of diarrhea in toddlers
in coastal areas starting from 2019 to 2023. It can be seen from the 5 articles that use a cross-sectional research
design. These articles were filtered again to review what factors are the most important in the problem of diarrhea in
toddlers in coastal areas. Likewise, the article by (Ningsih et al., 2023) about sanitation factors in diarrheal diseases
in coastal areas is due to the availability of waste water sewer (WWS) conditions which still do not meet the
requirements and can pose a risk of diarrhea in coastal areas in Abeli District. The toilets in this district have met the
requirements. The waste water sewer (WWS) requirements are said to meet the requirements based on the
Indonesian Ministry of Health in 2014 that if the sewer does not pollute clean water sources, then the channel is
made of watertight material, closed, odorless, smooth and also without puddles of water. Meanwhile, the reality is
that the condition of the WWS does not meet the requirements, such as not being closed, being clogged and having
standing water. Some local communities throw their wastewater into the sea, where it is diverted into open sewers,
and is rarely cleaned. So these things cause diarrhea problems due to lack of awareness of the cleanliness of the
surrounding environment. The pattern of sanitation problems in coastal communities as a whole includes providing
clean water, providing proper waste disposal sites, liquid waste disposal, and household waste disposal sites. These
factors include a lack of knowledge and understanding about environmental sanitation of the population, a lack of
public awareness, limited morbidity and mortality and also a lack of socialization and views about the environment
on health.[13]
The article belongs to (Fatimatuzzahro et al., 2020) in his research on "Water Pollution Index (WPI) and
the incidence of diarrhea in children under five on the coast of Semarang City, Indonesia" which explains the
influence of salinity in water which causes diarrheal disease which is directly caused by growth. . The occurrence of
rehydration or low water flow caused by salt has the potential to increase microbial growth. This causes changes in
the muscles and mucosa of the digestive tract, which becomes one of the factors causing diarrhea. Cases of diarrhea
in toddlers also occurred in the coastal area of the Wadiabero Community Health Center which explained that there
were 24 cases of diarrhea in toddlers aged 0 months to 1 year, where the results of the annual data survey showed
that there was a history of exclusive breastfeeding which was the main factor in preventing diarrhea. About 1.8
times the risk if the baby does not receive exclusive breast milk compared to babies who are given exclusive breast
milk.[11]In other research that determines the main factors in the occurrence of diarrhea problems in toddlers in
coastal areas, namely research by (Fitri Rachmillah Fadmi et al., 2020), the research concludes that there is a
relationship with the level of knowledge, provision of clean water and ownership of family toilets with the incidence
of diarrheal disease in the community. coastal area, Lapulu Village, Abeli District, Kendari City. Similarly, research
(Irma et al., 2021) shows that the main determinants of diarrhea cases in coastal areas are seen from the
environmental aspect, namely the healthy latrine program and the Community-Based Total Sanitation (STBM)
program. This activity has an effect on reducing the number of diarrhea cases in the area.

CONCLUSION
Environmental factors are very relevant and many cases of diarrhea in toddlers in coastal areas. Good sanitation
and good community behavior have resulted in a reduction in the number of cases of diarrhea, especially in toddlers.
Coastal communities, especially coastal areas with minimal access to clean water, also cause diarrhea. Parental
behavioral factors also cause the same thing. Lack of awareness still chooses traditional beliefs, so there is still a
lack of understanding about the cleanliness of residences in coastal areas. Another factor is also the lack of health
service infrastructure and socialization about health in coastal areas.

THANK-YOU NOTE
The author would like to express all praise and gratitude to God Almighty for all His power and grace so that this
article can be completed and the author also does not forget to express his gratitude to all parties who helped in
preparing this article, especially for the authors of the journals used as as reference material in preparing this journal.
It is hoped that this journal can be used as learning material to determine the right policy direction and also become
an additional reference source for subsequent written works related to cleanliness and sanitation practices in coastal
areas.
 BIBLIOGRAPHY

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