Journal of Vocational Nursing Vol. 3, No.

2 (2022): 105-109

Volume 3, Number 2, October 2022

Journal of Vocational Nursing

www.e-journal.unair.ac.id/JoViN/

THE RELATIONSHIP OF HAND WASHING BEHAVIOR

TOWARDS DIARRHEA CASES IN SCHOOL-AGE CHILDREN
Ade Nuraeni1, Rosiah1, Megga Putri Kemala Supendi1, Adhan Efendi1
1
Politeknik Negeri Subang, Indonesia Research Report

ABSTRACT ARTICLE INFO

Introduction: Hand washing is one of the current clean and healthy living behaviours Received September 3, 2022
that is a world concern. The problem of bad-hand washing behaviour not only occurs Accepted October 20, 2022
in developing countries but also in developed countries where most people still forget Online October 31, 2022
the importance of washing hands. The prevalence of diarrhoea among children aged
5-14 years reaches 182.338 (6.2%). The objective of this study was to determine the *Correspondence:
relationship between hand-washing behaviour and cases of diarrhoea in school-age Ade Nuraeni
children at Angkasa 2 Elementary School. Methods: This research method is
quantitative, with a descriptive correlation research design, and uses a cross-
*Email:
sectional approach. The sample in this study was 63 respondents taken by purposive
sampling. Data collection used questionnaires and observation sheets, analyzing data adenuraeni1@gmail.com
using a Chi-square test. Results: 73.01% of respondents had good hand-washing
behaviour, while 26.98% had less hand-washing behaviour. Then, the respondents
with good diarrhoea cases were 69.84%, and those with fewer diarrhoea cases were
30.15%. The statistical test showed a relationship between the variables of hand-
washing behaviour with cases of diarrhoea (p =<0.001). Conclusions: There is a
relationship between hand-washing behaviour and cases of diarrhoea in school-age
children at Angkasa 2 elementary school. Hand washing is the most important basic
technique in preventing and controlling the transmission of diarrheal diseases. It is
necessary to have good facilities and knowledge about hand-washing, and the delivery Keywords:
of messages must be done recur so that understanding can align with these Diarrhoea, hand washing
behavioural practices.

INTRODUCTION According to the World Health Organization

Hand washing is one of the clean and healthy (WHO), diarrhea is the occurrence of bowel
living behaviors (PHBS) is currently a world movements with a more fluid consistency than
concern. The problem of bad-hand washing usual, with a frequency of three or more times in 24-
behavior does not only occur in developing hours caused by infection with microorganisms
countries but also in developed countries where including bacteria, viruses, parasites, protozoa, and
most people still forget about the importance of fecal-oral transmission. There are 1.7 billion cases
washing hands. As a result, the incidence of diarrhea of diarrhea child mortality reach 525,000 annually
is still high in countries such as Indonesia. (Hamzah et al., 2020).
Therefore, on October 15, 2008, the United Nations The prevalence of diarrhea in Indonesia
(UN) set a global handwashing day with a soap that according to the characteristics based on the 2018
focuses on school children as agents of change Riskesdas was recorded as 18,225 (9%) children
(Kementerian Kesehatan Republik Indonesia, with diarrhea in the <1 year age group, 73,188
2011). (11.5%) children with diarrhea in the 1–4-year age
School-age children have a habit of not group, 182,338 (6.2%) children with diarrhea in the
paying attention to the need for hand washing in age group 5-14 years, and as many as 165,644
daily life. This behavior is certainly influential and (6.7%) children with diarrhea in the age group 15-
can contribute to the diarrheal disease. Hand 24 years (Riset Kesehatan Dasar, 2019).
washing is the most important basic technique in Cases of diarrhea in West Java according to
preventing and controlling the transmission of the characteristics based on the 2018 Riskesdas,
diarrheal diseases (Kementerian Kesehatan there were 1,287 (10.40%) children with diarrhea in
Republik Indonesia, 2016). the <1 year age group, 5312 (13.43%) children with
 Ade Nuraeni, et al. | Journal of Vocational Nursing Vol. 3, No. 2 (2022): 105-109

diarrhea in the 1–4 year age group, 12,806 (6.98%) that 7 out of 10 children could not wash their hands
children with diarrhea in the age group of 5-14 years, according to the 6-step handwashing standard from
and as many as 12,409 (7.24%) children with the Indonesian Ministry of Health.
diarrhea in the age group of 15-24 years. The purpose of this study was to determine
Furthermore, in cases of diarrhea in the Subang the relationship between hand washing behavior and
district based on the 2018 Riskesdas, the incidence cases of diarrhea in school-age children at SDN
of diarrhea was recorded at 2,378 (5.61%) people, Angkasa 2 Subang.
while in toddlers there were 184 (9.58%) (Riset
Kesehatan Dasar, 2019). MATERIALS AND METHODS
The high incidence of diarrhea in children is This research is a type of quantitative
caused by many factors. Factors that increase the research, with a descriptive correlation research
risk of diarrhea are: poor sanitation, poor hygiene design, which uses a cross-sectional approach. This
facilities, poor personal hygiene (not washing hands research was conducted at Angkasa 2 Elementary
before, after eating, and after defecating) School, Suryadarma Air Base, West Kalijati Village,
Steps taken by the government to reduce the Kalijati District, Subang Regency, West Java
incidence of diarrhea, especially in school-age Province. The research was conducted on 7 - 8 April
children, are to organize a School Health Business 2022. The population in this study was 221 students
(UKS). One of the UKS programs designed to in grades 1-6 at SDN Angkasa 2 Kalijati District of
improve students' health is by providing Health Subang Regency. Sampling using the Purposive
Education on Clean and Healthy Life Behavior Sampling technique. The sample used in this study
(PHBS). While the PHBS indicators are one of them, is the population that is included in the inclusion and
namely washing hands with running water and using exclusion criteria.
soap. The inclusion and exclusion criteria in this
Based on research conducted by Awyono study are Inclusion Criteria is School-age children
(2016) about the relationship between handwashing (6-12 years old), student at SDN Angkasa 2, can read
behavior in diarrhea sufferers in Kintamani Village, and write fluently, cooperatives become participants
Bangli Regency, Bali, the results showed: research in this study. Exclusion criteria is moderately ill,
showed good handwashing behavior had the least refuse to participate in research. The sample size in
incidence of diarrhea (14.89%), followed by poor this study amounted to 63 people based on the
handwashing behavior. (53.8%), and the most Arikunto (2015) formula, namely the sample was
experienced diarrhea is poor hand washing behavior taken 30% of the total population.
(64.3%). This univariate analysis was to determine the
The results of a comparative study at SDN behavior of washing hands and diarrhea cases of
Angkasa 2 show that SDN Angkasa 2 has facilitated respondents. The analyzed data has an ordinal scale,
its students with tap water and hand washing soap in so the statistical test used is chi-square. The results
front of each class so that students can wash their of the analysis will be obtained in p-value. If the p-
hands properly using soap and running water, UKS value <0.05, it means that there is a relationship
at SDN Angkasa 2 are also still active in providing between hand washing behavior and cases of
health education about Clean and Healthy Life diarrhea. Meanwhile, to decide whether there is a
Behavior (PHBS), one of which is washing hands, relationship between the independent variable and
but at SDN Angkasa 2 itself, there are still many the dependent variable, a p-value is used which is
students who experience the diarrheal disease as compared with the level of significance (alpha) used,
evidenced by the homeroom teachers often getting which is 5% or 0.05. If the p-value < 0.05 means that
sick leave letters from students' parents who say there is a relationship between the independent
their children have affected diarrhea so that they variable and the dependent variable.
cannot follow the lessons at school. The results of
the researchers' observations on March 9-11 showed

RESULTS
Table 1. Distribution of Respondents Characteristics Angkasa 2 Elementary School, Suryadarma Air Base, West
Kalijati Village, Kalijati District, Subang Regency, West Java Province (April, 2022).

Characteristics Frequency Percentage

Age 9 5 7,93
10 20 31,75
11 22 34,92
12 16 25,40
Total 63 100
Class Class 4 22 34,92
Class 5 25 39,68
Class 6 16 25,39

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Characteristics Frequency Percentage

Total 63 100
Gender Man 47 74,60
Woman 16 25,40
Total 63 100

Data distribution of respondents almost (39.68%). And the data on the distribution of gender
half the age of respondents is 11 years (34.92%). respondents showed that most of the respondents
Then the distribution data of respondents by class were male (74.60%).
shows that almost half of the respondents are class 5
Table 2. Distribution of Frequency Handwashing Behavior and Diarrhea Cases Respondent at SDN Angkasa 2
Elementary School, Suryadarma Air Base, West Kalijati Village, Kalijati District, Subang Regency, West
Java Province (April, 2022).

Category Interval f (%)

Hand Washing Behavior
Good 11-20 46 73,01
Bad 0-10 17 26,98
Total 63 100
Diarrhea Cases
Low 0-2 44 69,84
High 3-5 19 30,15
Total 63 100

It shows that most respondents have good respondents who had low cases of diarrhea were
hand washing behavior as much as 73.01%, and 69.84%, and those who had high cases of diarrhea
respondents who have less hand washing behavior were 30.15%.
as much as 26.98%. Table 3 shows that most of the

Table 4. Handwashing Behavior Against Diarrhea Cases at SDN Angkasa 2 Elementary School, Suryadarma Air
Base, West Kalijati Village, Kalijati District, Subang Regency, West Java Province (April, 2022).

Hand washing Diarrhea Cases Total

behavior Low High
f (%) f (%) f %
Good 42 66.66 0 0 42 66,66
Bad 4 6,34 17 26,98 21 33,33
Total 46 73,01 17 26,98 63 100
P value < 0,001

Statistical test results obtained p value <0.001 there is a relationship between the variables of hand
with a correlation value of 92.5%. This shows that washing behavior with cases of diarrhea (p <0.05).

DISCUSSION guaranteed, diarrhea is the most common disease

Most of the respondents had diarrhea cases in experienced. This problem occurs because the food
the low category, namely 69.84%, but there were consumed is not necessarily clean and of good
still respondents with high diarrhea cases. This is in quality. Both from the raw materials, processing
line with the research conducted by Indriyan et al., processes, to storage.
(2018) with the title of diarrhea prevalence in This is reinforced by the research conducted
elementary school children in the working area of by Utama et al., (2019) with the title of the
the Mulyorejo Health Center, Surabaya, showing relationship between family latrine conditions and
that the prevalence of diarrhea is 51.5%, clean water facilities with the incidence of diarrhea
Based on Witsqa Firmansyah et al., (2021) in children, the results show that there is a
the factors that influence cases of diarrhea in relationship between latrine conditions and the
children are water sources, latrines and snack habits. incidence of diarrhea (p = 0.001) and there is a
The water source at SDN Angkasa 2 is good because relationship between the condition of the facilities
the water used is odorless, tasteless and colorless. clean water with diarrhea (p=0.009). In a study
The latrines also look clean with good water sources. conducted by Almanfaluthi & Hidayat Budi (2015)
Snacking habits, when snacking carelessly, entitled the relationship between street food
especially in places where cleanliness is not consumption and diarrheal disease in elementary

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school children, the results showed that there was a knowledge about hand washing, and in terms of
relationship between street food and diarrhea (p = facilities it is very adequate where in front of each
0.002). class there is a water tap with a good source of water
Good water sources and latrines at SDN and soap.
Angkasa 2 will not reduce cases of diarrhea if the This is reinforced by research conducted by
habit of snacking, washing hands, and the (Pauzan & Fatih, 2107) with the title of research on
respondent's clean and healthy living behavior is still the relationship of knowledge with hand washing
bad. This is what causes there are still respondents behavior of students at SDN Cicadas 2 Bandung
who experience diarrhea. City, which shows the results of a relationship
Hand washing behavior is related to diarrhea between knowledge and hand washing behavior (p =
cases (p=<0.001) with a correlation value of 92.5%. 0.015). In a study conducted by Nufus & Tahlil
This is in accordance with the opinion of World (2017) with the title the availability of facilities and
Health Organization (2019) that washing hands with hand washing behavior in elementary school age
soap has been shown to reduce the incidence of children, it was shown that there was a significant
diarrheal diseases by approximately 40%. Washing relationship between the availability of facilities and
hands here is more emphasized at the time before hand washing behavior of school age children (p =
eating and after defecating. Hand washing is one of 0.002).
the most cost-effective interventions to reduce the The survey conducted by Kementerian
incidence of diarrhea in children. Kesehatan Republik Indonesia, (2016) If someone
This is reinforced by the results of research already understands the importance of washing
conducted by Rompas et al., (2013), with the title of hands with soap, they do not automatically practice
research on the influence of handwashing with soap it. The fact shows that the introduction of hand
and the incidence of diarrhea in school-age children washing with soap in Indonesia has started since the
at SD GMIM 2 Tareran District (p=0.003), Sunardi; 1980, but the survey of hand washing behavior in
& Ruhyanuddin, (2017) with the title handwashing Indonesia on the 5 important times of washing hands
behavior has an impact on the incidence of diarrhea with soap shows very low results, 12% after going
in school-age children in Malang Regency to the toilet, 9% after defecating, 14% before eating,
(p=<0.001), and Radhika (2020) with the title the 7% before handling food, and only 6% before
relationship between handwashing behavior with preparing food.
soap and the incidence of diarrhea in elementary This is in line with Merlina (2021), entitled
school-aged children (p=0.013), of the three The the relationship between knowledge and behavior of
research journal shows that the results of statistical washing hands with soap in elementary school
tests have a relationship between hand washing students in the working area of the Gedong Tataan
behavior and the incidence of diarrhea. Health Center, with the result that 62.2% of students
According to the hand washing is one of the have good knowledge but only 53.3% have good
sanitation actions by cleaning hands and fingers knowledge. have good hand washing behavior, the
using water and soap by humans to clean and break results also show a relationship between knowledge
the chain of germs, washing hands using soap is also and behavior in washing hands with soap (p =
known as an effort to prevent disease. Based on 0.022).
research by Cordita et al., (2019) in the title of Therefore, in addition to providing good
comparing the effectiveness of washing hands using facilities and knowledge about hand washing, the
soap with hand sanitizer, washing hands using soap delivery of messages must also be done repeatedly
is much more effective in killing germs with a so that understanding can be in line with these
decrease in the number of germs reaching 73%. behavioral practices. This is what causes there are
Based on the research journal above, it can be still respondents who have poor hand washing
concluded that hand washing can reduce cases of behavior.
diarrhea, by washing hands can kill the germs that
cause diarrhea itself because the germs that cause CONCLUSIONS
diarrhea are transmitted fecal-oral, namely through There is a relationship between handwashing
food or drink contaminated with germs or direct behavior and cases of diarrhea in school-age
contact with sufferers or indirectly, through flies. children at SDN Angkasa 2. (p=<0.001), with a
Hand washing behavior most of the correlation value of 92.5%. Develop community
respondents were in the good category as much as nursing practice, especially in schools in the School
73.01%, but there were also respondents whose hand Health Unit program.
washing behavior was still lacking. This is in line
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