Penyakit diare merupakan salah satu penyakit menular yang masih menjadi masalah kesehatan masyarakat di Indonesia. lni disebabkan angka kesakitan dan kematiannya masih menduduki rangking atas. Insiden diare di Kabupaten Bekasi Tahun 2000 adalah 19,4 per seribu penduduk dan menyerang 63 % usia Balita. Pada Tingkat Kecamatan insiden diare tertinggi terjadi di Kecamatan Kedung Waringin yaitu 56,7 per seribu penduduk (semua golongan umur), pada usia Balita mencapai 294,1 per seribu Balita. Insiden ini melebihi insiden diare nasional yaitu 26,1 per seribu penduduk. Cakupan sanitasi masih rendah yaitu 55,1 % untuk air bersih; 38,4 % jamban sehat; dan 39,4 % rumah sehat. Kejadian diare pada Balita dipengaruhi banyak faktor terutama perilaku dan lingkungan fisik (sanitasi dasar). Mengingat informasi tentang hal ini belum banyak diketahui maka penelitian perlu dilakukan. Tujuan penelitian ini untuk mengetahui apakah kejadian diare di wilayah tersebut berhubungan dengan kondisi sanitasi dasar dan perilaku ibu. Disain penelitian menggunakan kasus kontrol dengan populasi Balita yang tinggal di wilayah puskesmas Kedung Waringin Kecamatan Kedung Waringin Kabupaten Bekasi. Sampel penelitian adalah 80 Balita yang menderita diare yang datang berobat ke puskesmas sebagai kasus, dan 80 Balita tetangga yang tidak diare pada saat disurvei sebagai kontrol yang dipilih secara random (Simple Random Sample). Pengumpulan data dilakukan dengan cara mengunjungi rumah keluarga Balita untuk melakukan wawancara dan pengamatan dengan menggunakan kuisioner. Hasil analisis menunjukkan bahwa terdapat empat variabel yang berhubungan secara signifikan dengan kejadian .diare Balita yaitu sarana air bersih, jamban, SPAL dan perilaku ibu dalam upaya pencegahan diare. Sedangkan variabel yang tidak berhubungan dengan kejadian diare Balita adalah kualitas air bersih, sampah, dan rumah. Dari ke empat Variabel yang berhubungan tersebut yang paling dominan berisiko terhadap kejadian diare Balita adalah perilaku ibu dalam upaya pencegahan diare. Sehubungan dengan itu upaya-upaya yang perlu dilakukan adalah penyuluhan kesehatan lingkungan kepada masayarakat agar terfokus pada wanita dan Balita dalam rangka perilaku hidup bersih dan sehat, pemantauan sarana sanitasi (sarana air bersih, jamban, dan SPAL) secara kontinyu dan berkesinambungan, perbaikan sarana sanitasi (sarana air bersih, jamban, dan SPAL) perlu dilaakukan pada sarana yang dianggap sudah tidak memenuhi syarat tetapi masih dipakai masyarakat dengan menggunakan dana pemerintah maupun swadaya masyarakat serta penelitian lanjutan pada faktor risiko lainnya baik yang berhubungan langsung maupun tidak langsung dengan kejadian diare Balita.

---

Basic Sanitation, Maternal Behavior, and Diarrhea Incidence of Children Under-five at the Health Center Catchment Area in Kedung Waringin, Sub-District of Kedung Waringin, District of Bekasi, 2003Diarrhea disease is one of communicable diseases, which is currently still becoming a public health problem in Indonesia.

In 2000, the incidence rate of diarrhea disease in District of Bekasi was reported 19.4 per 1,000 population which attacked 63% children under-five. The highest incidence rate of diarrhea disease for all age groups was 563 per 1,000 population in Sub-District of Kedung Waringin. The incidence rate among children under-five reached 294.1 per 1,000 population. This figure had exceeded the national incidence rate of diarrhea disease, 26.1 per 1,000 population. The sanitation coverage of the population in Kedung Waringin was considered low. Of the total population, 55.1% had access to clean water supply, 38.4% adequate sanitary latrines, and 39.4% healthy housing.

The incidence of diarrhea among children under-five is influenced by several factors including maternal behavior characteristics and basic environmental sanitation. This study was to provide information on their relationships, which can be used for developing better strategy for diarrhea disease -control in the sub-district. The objectives of the study were to identify basic sanitation conditions, maternal behavior characteristics, and its relationship with diarrhea! diseases incidence in Kedung Waringin.

A case control study design was employed in the study. The study population was children under-five who are living in the catchments area of Kedung Waringin Health Center, Sub-District of Kedung Waringin, District of Bekasi. A total sample of 80 cases of children under-five was selected from those having diarrhea whom came to the Health Center for medical treatment. In addition, a total of 80 neighboring children under-five without diarrhea disease were selected through simple random sampling method as the control group. Data were collected by interviews the selected mothers through a combination of opened and closed questionnaires. Moreover, home visits and observation were completed to identify environmental sanitation conditions and maternal behavior characteristics.

There were four variables significantly associated with the incidence of diarrhea, including clean water, latrine, wastewater disposal facilities, and maternal behavior. On the other hand, the variables which were not associated with the incidence of diarrhea among children under five included clean water quality, solid waste, and housing. Of the four associated variables, maternal behavior was the highest risk of diarrheal incidence among children under-five.

In line with the preventive efforts of diarrhea, it is recommended that the community health education and promotion activities should be focused on women or mothers as the main target groups. The intervention priorities should include a hygienic and healthy behavior, regular monitoring of sanitation facilities such as clean water, latrine, wastewater disposal facilities. In addition, the sanitation facilities improvement especially for those, which do not meet sanitary standard, should become the responsibility of the local government as well as community and also follow up research for the other risk factor of diarrhea.