Factors Associated with the Incidence of Diarrhea in the Regional Technical Implementation Unit (UPTD) of the Community Health Center

In general, the problem of diarrhea disease is one of the environmental-based diseases which is still the biggest health problem in Indonesia due to poor basic sanitation conditions, the physical environment and the low behavior of the community to live clean and healthy, and there are still many factors that cause the emergence of diarrhea disease. This research method is descriptive analytic with cross sectional design with a research sample of 112 people. Data analysis used univariate analysis and bivariate analysis with Chi square statistical tests. The results of this study indicate the relationship between predisposing factors such as education with a value of p = 0.000 (p <0.05), work with a value of p = 0.013 (p <0.05), income with a value of p = 0.024 (p <0.05) and knowledge with a value p = 0.13 (p> 0.05) and attitude p = 0.47 (p> 0.05). The conclusion in this research is that there is a relationship such as education, work and income, there is no relationship between knowledge and attitude with the incidence of diarrhea. It is recommended that mothers under five should always adopt clean and healthy living habits and provide nutritious food to avoid infectious diseases, especially diarrhea


Introduction
Environmental cleanliness is something that greatly affects health in general.The number of environmental diseases that attack the community due to the lack of cleanliness of the surrounding environment or bad habits that pollute the environment.This can cause diseases carried by dirt in the free environment either directly or indirectly, namely through intermediaries (Hillel, 1998).
Diarrheal disease is a disease that has been known since the time of Hippocrates.Until now, diarrhea is still one of the main health problems of the Indonesian people.Diarrhea is a dangerous disease because it can cause death and can lead to outbreaks of extraordinary events (KLB).The main cause of death in diarrhea is dehydration, which is a result of loss of fluids and electrolyte salts in diarrhea stool.If they are not helped immediately, 50-60% of them can die (Bresee, 2003).
In Indonesia, the diarrhea morbidity rate for 2000 was 301 per 1,000 population, an increase compared to the results of the same survey in 1996 which was 280 per 1,000 population.Meanwhile, based on the regency / city reports in 2008, the diarrhea morbidity rate was 27.97 ISSN 2721-1215 (Print), ISSN 2721-1231 (Online) Copyright © 2021, Journal La Medihealtico, Under the license CC BY-SA 4.0 per 1000 population.Meanwhile, the diarrhea morbidity rate in 2009 was 27.25%.Much decreased compared to the previous 12 years.
Ministry of Health of the Republic of Indonesia, Diarrheal disease in Indonesia is still one of the main public health problems.This is due to the high morbidity and mortality rates, especially among children under five.It is estimated that more than 1.3 billion attacks and 3.2 million deaths per year among children under five are caused by diarrhea.Each child had an average of 3.3 episodes of diarrhea per year and more than 80% of the deaths occurred in children less than two years old.
The number of cases of diarrhea outbreaks in 2010 was 2,580 with 77 cases of death (CFR 2.98%).This result is different from 2009 where there were 3,037 cases of diarrhea outbreaks and 21 cases of death (CFR 0.69%).This difference, of course, needs to be seen from various factors, especially the completeness of the report.Apart from that, the awareness and knowledge of the community, the availability of clean water sources, the availability of family latrines and the reach of health services also need to be considered as factors that influence the outbreak of diarrhea data from Ministry of Health of the Republic of Indonesia As for diarrhea, the national prevalence rate in 2018 reached 12.3 percent.But the good news is, this figure has fallen to 4.5 percent in 2019.Even though deaths from diarrhea are still increasing (Lestari & Rosyidah, 2010).

Methods
This study used an analytic survey approach with a cross sectional design, and conducted observational studies to look at the factors associated with the incidence of diarrhea at the same time, to determine the relationship between the independent variable and the dependent variable.Nursalam (2014) The research was conducted at UPTD Puskesmas Biru from July to December 2014.The population was all children under five who visited the health center.Sampling was 112 mothers who had children under five by simple random sampling (Nursalam, 2016).

Univariate test
Based on the tests that have been carried out on the respondents of mothers who have toddlers by conducting an analysis that describes the frequency distribution of respondents between independent and dependent variables Based on table 1 above, it can be concluded that of the 112 respondents, the highest level of high school education is 53 people (47.3%), while the least is the level of undergraduate education, namely 4 people (3.6%).It can be seen from the 112 respondents that the most working as laborers was 44 people (39.5%), while the least working as civil servants was 2 people (1.8%).It can be seen from the 112 respondents, the largest income was below the UMK 2,529,000, namely 88 people (78.6%), while the lowest income was above the UMK 2,529,000, namely 24 people (21.4%).Based on the table above, between the level of education and the incidence of diarrhea, it can be found that the largest number of respondents with elementary education level is 17 (32.1%)with the incidence of diarrhea in under-five.Based on the results of the chi square test, it shows that the value of p = 0.000 (<0.05), this indicates that there is a relationship between low levels of education and the incidence of diarrhea.Based on the table above, between occupation and the incidence of diarrhea, it was found that respondents who worked as laborers (18.2%) had more bad behavior than respondents who worked as civil servants (0%).Based on the results of the chi square test with a value of p = 0.013 (<0.05), this indicates that there is a relationship between the respondent's occupation and the incidence of diarrhea.Based on the table above, between income and the incidence of diarrhea, it is known that respondents who have an income below the UMK are 86 people and experience diarrhea, namely 73 people (84.9%), while respondents who have an income above the UMK are 26 people and those who experience diarrhea as many as 16 people (61.5%), respondents.Based on the table above, it is found that respondents who have good attitudes are as many as 70 mothers of toddlers and experience diarrhea as many as 16 (77.1%)under five, while the attitude of aunt who is sufficient from 42 people who experience diarrhea is as many as 7 (83.3%)children under five.

Bivariate Test
Diarrhea is a change in the frequency and consistency of stool.WHO in 1984 defines diarrhea as liquid stools three or more times a day and night (24 hours).Diarrhea is loose or liquid bowel movements that can be in the form of water which is often more frequent than usual (usually three or more times a day) (Depkes RI, 2000).Based on the results of the research on the relationship between education level and the incidence of diarrhea, it can be found that the most respondents with elementary education level are 17 (32.1%)with the incidence of diarrhea among children under five.Based on the results of the chi square test, it shows that the value of p = 0.000 (<0.05), this indicates that there is a relationship between low levels of education and the incidence of diarrhea, this is due to low education so the ability to prevent diarrhea, especially in children under five, especially in managing a healthy environment and tend to neglect their children and let their children play without supervision.Iman (2016) stated Environmental cleanliness is something that greatly affects health in general (Sugiyono, 2010).
The number of environmental diseases that attack the community due to the lack of cleanliness of the environment around them (Notoatmodjo, 2012).Bad habits that pollute the environment, especially water sources, scatter garbage, resulting in many vectors that cause diarrhea (Notoatmodjo, 2012).This can cause diseases carried by dirt in the free environment either directly or indirectly, namely through intermediaries (Andriani et al., n.d) Whereas based on work with the incidence of diarrhea based on the results of the chi square test with p value = 0.013 (<0.05), this indicates that there is a relationship between the respondent's occupation and the incidence of diarrhea in their toddlers because toddlers' mothers who work tend to have less time at home so that cleanliness at home is neglected (Dinar,2009).Likewise, low income will affect the availability of nutritious food so that toddlers may lack the nutrients needed for their development (Mahing, & Ana 2011) The relationship of maternal knowledge based on research results shows that mothers have good knowledge because information sources are often obtained from the internet and other sources even though there are still those with low education (World Health Organization 2007) Based on the table above, it is found that respondents who have good attitudes are as many as 70 mothers of children under five and experience diarrhea as many as 16 (77.1%)children under five, while the attitudes of mothers who are sufficient from 42 people who experience diarrhea are as many as 7 (83.3%)under five.Diarrhea prevention is still lacking, this is because there are still toddlers who have diarrhea, this shows that mothers have not stimulated their toddlers, especially getting used to washing their hands, not playing in dirty places and providing nutritious food to increase their immunity so that they avoid infectious diseases (Smith et al., 2017).

Conclusion
Based on the results of the research, the relationship between the level of education, occupation, and parents' income has an effect on the incidence of diarrhea in under five.While knowledge and attitudes have no effect because P> 0.05 this happens because information about the prevention of diarrhea can be obtained from various sources, both from health workers, the community and at non-formal meetings.It is recommended to the public, especially mothers under toddlers, to always pay attention to clean living habits both at home and in the community and provide nutritional needs so that infectious diseases do not occur, especially experiencing diarrhea in their toddlers

Table 1 .
Recapitulation of diarrhea visits by region at UPTD Puskesmas Biru,

Period July to December 2019 Sub-district of Biru Month July August September October November December
The data obtained at the UPTD Puskesmas Biru is seen from the point of view of the place where it consists of 8 villages, namely the Kelurahan Biru, Masumpu, Manurunge, Bukaka, Watampone, Ta ', Walannae, and Pappolo.Of the 8 kelurahan, it shows that the kelurahan with the highest percentage of diarrhea disease incidence is Blue with a percentage of 48.7%.Then the lowest is Walannae Village with a percentage of 0.7% ISSN 2721-1215 (Print), ISSN 2721-1231 (Online) Copyright © 2021, Journal La Medihealtico, Under the license CC BY-SA 4.0 Number of visits by toddlers by age group

Table 2 .
Recap of diarrhea visits according to age group at UPTD Puskesmas Biru, Period July to December 2019 Percentage of diarrhea cases according to age group at UPTD Puskesmas Biru for the period July to December 2019.The data obtained at UPTD Puskesmas Biru if viewed from the highest number of cases of diarrhea disease is in the age group <5 years with a large percentage namely 44.3%.And the lowest is the age group <1 year with a percentage of 12.0%.

Table 3 .
Recapitulation of diarrhea visits by sex at UPTD Puskesmas Biru for the period July to December 2019

Table 3
.Percentage of diarrhea cases according to sex in UPTD Puskesmas Biru for the period July to December 2019 Data obtained at UPTD Puskesmas Biru if viewed from gender, female sex is greater, namely 69.9% and male 51.6%.

Table 4 .
Characteristics of respondents according to education level, occupation, income, knowledge and attitudes with the incidence of diarrhea ISSN 2721-1215 (Print), ISSN 2721-1231 (Online) Copyright © 2021, Journal La Medihealtico, Under the license CC BY-SA 4.0

Table 2 .
The relationship between maternal education and the incidence of diarrhea at Puskesmas Biru

Table 3 .
Relationship between maternal occupation and the incidence of diarrhea among children under five

Table 4 .
The relationship between income and the incidence of diarrhea

Table 5 .
The relationship between maternal knowledge and the incidence of diarrhea