Environmental and Sociodemographic Factors Associated with Reported Diarrhea in East Kalimantan, Indonesia: A Secondary Analysis of 2023 Indonesian Health Survey

Abstract

Introduction: Diarrhea is a major global public health concern that contributes substantially to morbidity and mortality. Environmental factors, including inadequate sanitation infrastructure and poor hygiene practices, have been associated with diarrhea. This study aimed to analyze the associations between environmental and sociodemographic factors and diarrhea occurrence in East Kalimantan Province.Methods: This cross-sectional study used secondary data from 15,854 respondents in the East Kalimantan subset of 2023 SKI. The variables included gender, age, education, drinking water sources, water quality and treatment, storage containers, raw water sources, wastewater disposal, waste management, sanitation access, and hygiene practices. Data were analyzed using chi-square and multivariable binary logistic regressions. Survey weights, strata, and primary sampling units were incorporated to account for the complex sampling designs.Results: The weighted prevalence of diarrhea was 2.1%. Bivariate analysis showed associations between diarrhea occurrence and age group, education, drinking water source, physical quality of drinking water, raw water source, waste management, and sanitation hygiene (p<0.05). The higher-risk age group (<5 and >70 years) was associated with higher odds of diarrhea than the lower-risk age group (aged 5–70 years) (AOR=2.933; 95% CI: 2.105–4.098; P <0.001). Unmet physical quality standards drinking water was also associated with higher odds of diarrhea (AOR=2.078; 95% CI: 1.254–3.443; p=0.005).Conclusion: Higher-risk age groups and drinking water that unmet physical quality standards drinking water were associated with diarrhea. Efforts to improve water quality and provide greater protection for vulnerable age groups may contribute to broader diarrheal prevention strategies in East Kalimantan Province.