Multilevel Analysis on the Contextual Effects of Hygiene, Environmental Sanitation, and Diarrhea Prevention in Elementary School Students in Ngawi, East Java

Abstract

Background: Clean and healthy behavior in school is an important factor to prevent diarrhea and improve health status of school children. This study aimed to determine the effects of hygiene and school environmental sanitation on diarrhea prevention behavior. Subjects and Method: This was an analytic observational study with a cross sectional design. This study was conducted in Ngawi, East Java, in October 2018. A sample of 225 elementary school students was selected randomly from 25 elementary high schools in Ngawi. The dependent variable was diarrhea prevention. The independent variables were student's knowledge, attitude, hygiene, school sanitation, school health unit, canteen sanitation, and maternal education. The data were collected by questionnaire and analyzed by a multilevel logistic regression run on Stata 13. Results: Good hygiene facility (b=1.77; 95% CI=0.66 to 2.87; p=0.002), good school sanitation (b=1.37; 95% CI=0.27 to 2.48; p=0.015), clean canteen (b=1.84; 95% CI=0.23 to 3.44; p=0.025), school health unit (b=1.49; 95% CI=0.31 to 2.68; p=0.013), high student's knowledge (b=2.30; 95% CI=1.20 to 3.40; p<0.001), positive attitude (b=2.03; 95% CI=0.96 to 3.10; p<0.001), maternal education >= senior high school (b=1.60; 95% CI=0.37 to 2.83; p=0.011) were positively associated with diarrhea prevention. School had contextual effect on diarrhea prevention with ICC=54.03%. Conclusion: Good hygiene facility, good school sanitation, clean canteen, school health unit, high student's knowledge, positive attitude, maternal education >= senior high school are positively associated with diarrhea prevention in elementary school students. School has contextual effect on diarrhea prevention.