Exploring environmental risk factors for diarrhea: Evidence from the Indonesian Health Survey, 2023

Diarrhea remains one of the leading causes of morbidity and mortality in Indonesia, especially in vulnerable age groups. Although access to clean water and sanitation has improved, the quality of environmental management and hygiene practices still varies across households and could potentially affect the incidence of diarrhea. Aim: This study aimed to analyze the association between various household environmental risk factors and the occurrence of diarrhea at the national level using data from the 2023 Indonesian Health Survey (SKI-Survei Kesehatan Indonesia). This was an analytical observational study with a cross-sectional design, utilizing secondary data from the 2023 SKI. A total of 877,531 respondents from all provinces in Indonesia were included in the analysis. Independent variables comprised physical quality of drinking water, water sources, methods of water treatment and storage, sanitation systems, liquid and solid waste management, and hygiene practices. Bivariate and multivariate analyses were conducted using logistic regression. The prevalence of diarrhea was 1.9% among respondents. Multivariable logistic regression analysis indicated that poor physical quality of drinking water was the strongest predictor of diarrhea (Adjusted Odds Ratio [AOR] = 1.478; p = 0.000). Other significant factors included unsafe raw water sources (AOR = 1.199; p=0.001), inadequate sanitation (AOR = 0.762; p = 0.001), improper liquid waste disposal (AOR = 0.956; p = 0.001), poor solid waste management (AOR = 0.932; p = 0.027), inadequate hygiene practices (AOR = 0.872; p= 0.001), and use of open water storage containers (AOR=1.056; p = 0.004).. Household environmental factors play a critical role in the incidence of diarrhea in Indonesia. Effective diarrhea prevention strategies should include improvements in water quality, sanitation access, waste management, and community-based hygiene education. These findings can inform evidence-based policies to strengthen national programs for diarrhea control and prevention.