open access

https://doi.org/10.14943/doctoral.k15827

https://hdl.handle.net/2115/91947

インドネシア・バンドンの都市スラムにおける水、衛生、栄養が子どもの健康に及ぼす影響

英語

2024-03-25

Hokkaido University

111p

Diarrhea and malnutrition remain significant global health concerns, posing a substantial risk to children. This health burden is particularly pronounced in low and middle-income countries, including Indonesia. Basic health survey reported that around 12.3% and 28.7% of Indonesian children are at risk of diarrhea and stunting, respectively. This situation may arise due to inadequate water, sanitation, and hygiene (WASH) facilities, unhygienic behavior, and lack of knowledge. During the COVID-19 pandemic, there was an expectation that this condition would improve as households followed health protocols. However, the connection between WASH levels and their impact on child health was not fully revealed, especially in urban slums. The objectives of this research were to: 1) investigate the effect of handwashing techniques on reducing E. coli on children's hands, 2) assess handwashing behavior and facilities during the COVID-19 pandemic and their correlation with diarrhea incidence among children, and 3) explore factors and perspectives about malnutrition related to WASH among children and mothers. The research was conducted in Bandung, West Java, Indonesia, comprised three studies: Study 1 observed 137 primary school students, focusing on handwashing practices and E. coli. Study 2 included 238 mother-student pairs, observing WASH facilities, handwashing behavior and diarrhea. Study 3 used a mixed-methods approach with 273 students and mothers for quantitative analysis and 47 mothers for qualitative study. Methods included questionnaires, anthropometric measurements, food recall, interviews, and focus group discussions. Data processing for all studies used JMP SAS version 17 and MAXQDA software. A school-based study revealed that children's handwashing techniques were effective but insufficient in fully removing E. coli contamination. Key factors for reducing E. coli included cleaning between fingers, using soap, and drying hands with a single-use tissue. However, children tended to overlook specific steps, highlighting the need for improvement. These findings align with a study on handwashing behavior, which observed a significant increase in handwashing frequency but not followed by improvement in technique during the COVID-19 pandemic. Additionally, families were also struggling with access to water and soap, contributing to a higher incidence of diarrhea. Malnutrition was also an emerging issue, with around 13.1% and 19.7% of children experiencing stunting and wasting, respectively. Malnutrition was associated with dietary intake and the WASH Index. Additionally, food insecurity was prevalent, posing a significant barrier to food access. This study highlights that handwashing and WASH practices of children were insufficient in minimizing contamination. The results emphasize the role of WASH behavior and facilities in addressing child health issues, especially among younger children as the crucial age group. Therefore, we need to design specific educational media and messages tailored to this age group to enhance their motivation and awareness. Additionally, we need to emphasize parental involvement in child education to create a home environment that encourages healthy practices.

2024-03-25

甲第15827号

博士(保健科学)

(主査) 教授 小笠原 克彦, 教授 山内 太郎, 准教授 BOMME GOWDA SIDDABASAVE GOWDA

保健科学院（保健科学専攻）

博士論文

Version of Record