Implementation for WASH Program in Households and

Its Relationship with Nutritional Status of Children in Susuk Village

Nenni Dwi Aprianti Lubis, Sri Amelia, Merina Panggabean and Hemma Yulfi

Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia

Keywords: Age-school children, households, nutritional status, WASH facilities.

Abstract: Water, Sanitation, and Hygiene (WASH) are basic human needs that are strictly related to health and

therefore, having a significant impact on the economy. Studies on the effects of WASH have a paramount

benefit to improve the nutritional status of children. This study aimed to describe the implementation of the

WASH program in households in Susuk Village. This research is analytic with a cross-sectional design,

using a total sampling technique. The population of this study is the whole of 135 student’s families in SDN

040494 Susuk, Sub-district of Tiganderket, District of Karo. Data was obtained by conducting direct

observation and interviews at the study site. According to Body mass Index per ages, there are 85.2% of

students have a normal nutritional status, and 14.8% of students with wasting. Based on the nutritional

status of students according to TB per age, there are 47 people (34.82%) classified as stunting and the rest

classified as normal (65.18%). The results also show that 97% of the households were at the level of basic

service according to the drinking water indicator, and 3% were of limited service. Based on the sanitation

indicator, 74.8% of households were at the level of limited service, and 25.2% were of no service. While in

the hygiene indicator, 84.4% of households were at the level of basic service and 15.6% were of limited

service. Based on these results, we suggest that further intervention from the government and contribution

from private sectors are required in the WASH program. Therefore, it will provide evidence on the concern

to improve public health, since the program has a direct impact on community health.

1 INTRODUCTION

The Government of Indonesia has launched a Health

Development National Movement based on Healthy

Paradigma. This paradigma is a perspective or

mindset that sees the importance of maintaining

health and preventing disease rather than restoring

health or treating illness. Therefore we need a

preventive, promotive effort that is balanced with

curative-rehabilitative efforts.

Water, Sanitation, and Hygiene (WASH) are basic

human needs that are strictly related to health and

have a significant impact on business and the

economy. The study report on the effect of sanitation

reports that poor sanitation is a contributor to the

increasing incidence of diarrhea in Indonesia. There

are 120 million disease occurrences each year; even

100,000 Indonesian children die from diarrhea every

year. According to WHO (2014), 94% of the

incidence of diarrhea can be prevented through

increased clean water supply (25%), improved

sanitation (32%), and improved hygiene practices,

specifically handwashing with soap (43%) (USAID,

2017).

Indonesian children as part of excellent and quality

human resources are needed in increasing national

development - one way to improve the nutrition and

health of children. Optimal nutritional status can be

achieved if dietary needs are required for physical

growth and brain development (Almatsier, 2001).

Nutritional problems are caused by three main

factors, namely low consumption of food, not to be

exact parenting, and the high number of infectious

diseases related to the environment. In 2009, FAO

mentioned that health, food availability, socio-

economic, and environmental problems could cause

a decrease in nutritional status. Furthermore, the

2017 USAID Report states that poor sanitation is

one of the reasons for solving nutrition problems in

Indonesia. Families play a role in overcoming

nutritional challenges through meeting food and

nutrition needs, improving parenting, and increasing

access to clean water-sanitation and adequate health

services.

Lubis, N., Amelia, S., Panggabean, M. and Yulﬁ, H.

Implementation for WASH Program in Households and Its Relationship with Nutritional Status of Children in Susuk Village.

DOI: 10.5220/0010204400002775

In Proceedings of the 1st International MIPAnet Conference on Science and Mathematics (IMC-SciMath 2019), pages 445-449

ISBN: 978-989-758-556-2

445

2 METHODS

This research was an observational analytic study

with a cross-sectional design that was carried out

with a combination of quantitative and qualitative

methods. The study population was all households,

namely the families of students of SDN 040494

Susuk, Tiganderket District, Karo District. A sample

of 135 families was taken in total sampling.

Quantitative data collected included respondent

characteristics, observations of drinking water,

sanitation, and family hand washing facilities as

distinguished as Table 1. Besides that, we assess the

nutritional status of school children according to

body weight per age - classified as stunting and

normal and body mass index per age – divided into

wasting and normal. Public perception regarding the

implementation of the WASH program is qualitative

data. This data was collected through focus group

discussions (FGD). This activity was attended by ten

families consisting of three families whose children

were classified as stunting and or wasting, and seven

other families had children with normal nutritional

status. The selection of families for this work is

carried out randomly.

Table 1: Classification of indicator household WASH

(Modificafion from Emerging JMP Service Ladders for

Monitoring WASH in Schools the SDGs).

Service Ladder Criteria

Drinkin

Wate

Basic service Drinking water from an improve

source is available at the household

Limited service There is an improved source (piped

water, protected well/spring,

rainwater, bottled

water), but water not available at

time of surve

Sanitation

Limited service There are improved facilities

(flush/pour flush, pit latrine with

slab, composting toilet) or not

usable

No service No toilet or latrines or unimproved

facilities

iene

Basic service Handwashing facilities, which have

water and soap available

Limited service Handwashing facilities with water,

but no soap

Univariate analysis was used to describe the

characteristics of respondents and the implementation

of WASH facilities. Furthermore, the bivariate

analysis uses the chi-square test to determine the

relationship between the implementation of WASH

facilities and the nutritional status of children.

3 RESULTS AND DISCUSSION

Primary data in the form of qualitative data include

data on family characteristics, student

characteristics, and WASH indicators.

3.1 Family Characteristics

The socioeconomic characteristics of the family

describe the demographic status of parents,

including age, level of education, employment, and

income. Professional level classification data are

assumed to represent the economic level of the

family, which indirectly influences family income.

Based on the results of the study note, the majority

of the age of the head of the family is above 40 years

and included in the productive age (36-45 years).

This condition is almost balanced with the

proportion of wives in the same age group.

The highest percentage is in the heads of families

and wives with high school education. The research

location is an agricultural area so that most of the

family heads and wives have non-permanent income,

namely as farmers/ranchers. The characteristics of

the respondent's family can be seen in Table 2. The

monthly family income is around Rp 2,100,000 - this

figure is lower than the Karo Regency UMK in 2019

which is Rp 2,829,558.

Table 2: Respondent characteristic according to ages, level

of education and occupational.

The socioeconomic

chararacteristics

Husbands* Wives

n % n %

Ages (years)

<= 25 - - 1 0.7

26-35 16 12.1 49 36.3

36-45 74 56.0 68 50.4

>= 46 42 31.9 17 12.6

Level of education

Primary school 32 24.2 17 12.6

Junior hi

h school 45 34.1 36 26.7

h school 51 38.6 78 57.8

Universit

4 3.1 4 3.0

Occupational

Permanent income 1 0.8 1 0.7

Non-

ermanent income 131 99.2 111 82.2

Housewives - - 23 17.1

* Three families do not have a husband as the head of

family because they have died and divorced.

IMC-SciMath 2019 - The International MIPAnet Conference on Science and Mathematics (IMC-SciMath)

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3.2 Student Characteristics

Referring to the age grouping issued by the Ministry

of Health in 2009, most students are aged 5-11 years

(82.22%) - classified as childhood. There were 69

male students (51.1%) and the remaining 66 female

students (48.9%).

Table 3: Nutritional status for students

The demographic

chararacteristics

Students

n %

Ages (years)

5-11 111 82.8

12-16 24 17.8

Gender

Male 69 51.1

Female 66 48.9

According to the anthropometric index, the

nutritional status of school children is differentiated

based on the body height per age index and the body

mass index for ages (BMI index). The proportion of

stunting school children, according to body height

per ages, occupies the highest proportion compared

to BMI per age. Data analysis shows 14.8% wasting

suffered, and 34.8% stunting. This figures is hingher

than tUhe prevalence of nutritional status of school

children in Indonesia and North Sumatra are

respectively 10.9% and 9.8% for wasting and 27.7%

and 33.7% for stunting (NIHRDI, 2018).

Table 4: Distribution of nutritional status of students

The demographic

chararacteristics

Students

n %

Body Mass Index per Ages

Wasting 20 14.8

Normal 115 85.2

Body Height per Ages

Stunting 47 34.8

Normal 88 65.2

3.3 Wash Implementations

Table 5 shows the distribution of WASH program

implementation, which includes indicators of

drinking water, sanitation, and hygiene. In the

drinking water indicator of 135 families studied, the

majority of households are in the category of basic

service, as many as 131 respondents (97.0%), while

the remaining 4 respondents (3.0%) are in the

limited-service category. In the sanitation indicator

of 135 respondents studied, the majority of

households are in the limited service category, with

101 respondents (74.8%), while the remaining 34

respondents (25.2%) are in the no service category.

In the hygiene indicator of 135 respondents studied,

the majority of households are in the basic service

category, namely 114 respondents (84.4%), while

the remaining 21 respondents (15.6%) are in the

limited-service category.

Table 5: Distribution respondents according to indicator

household WASH

Indicator households

WASH

Households

n %

Drinking Water

Limited service (LS) 4 3.0

Basic service (BS) 131 97.0

Sanitation

No service 34 25.2

Limited service 101 74.8

Hygiene

Limited service 21 15.6

Basic service 114 84.4

Environmental health affects individual health which

is an indirect cause of nutritional status. In this

study, ecological health includes access to clean

water for drinking, sanitation, and hygiene. Table 6

presents statistical data that looks at the relationship

between WASH indicators and nutritional status.

Table 6: Distribution of nutritional status of students

according to the WASH indicator

*significant, p value <0.05

Implementation for WASH Program in Households and Its Relationship with Nutritional Status of Children in Susuk Village

447

The analysis shows that students who are

wasting (BMI index) in families with limited access

to clean water are greater in number than another

normal nutritional status. In contrast, families with

adequate access to clean water have more normal

nutritional status than those classified as wasting.

Statistically shows a significant relationship (p-value

= 0.010). Likewise, based on the classification of

nutritional status of body height per age, a similar

situation also occurs, only statistically shows a

meaningless relationship.

The proportion of wasting students from families

who do not have bathrooms and lavatories and the

lack of handwashing facilities is higher than the

percentage of students with normal nutritional status.

Statistical analysis also showed a significant

relationship between nutritional status based on BMI

index with sanitation and hygiene (p-value = 0.001).

Different things happen to students with nutritional

status classification based on body height per age,

and only hygiene is related to nutritional status.

The prevalence of nutritional status based on

BMI index provides information about a nutritional

status that is acute. Stunting (body height per age)

gives an overview of chronic nutritional status. The

nutritional problem is a result of long-standing

conditions such as poverty, inadequate parenting,

and recurring illness. Low community access to

clean water and basic sanitation can increase the

incidence of diarrhea that affects nutritional status

(WHO & Unicef, 2006). By addressing the problems

that cause disease due to the availability of clean

water and poor hygiene and sanitation,

environmental issues can be overcome (Hapsari,

Supraptini, Hananto, 2010).

The results of qualitative studies based on focus

group discussions are described as follows. From the

question about "what and how is the WASH

Program?" The majority of informants answered the

following: "in our opinion, this program is a

community-based sanitation drinking water supply

program, where the program aims to meet clean

water and community drinking water and try to help

change the habits of people who are less clean to

have a clean and healthy lifestyle."

To the question "how was the implementation of

the WASH program at the research site?" Most of

the informants answered as follows:"not going well,

it can be seen from the fact that there are still many

people who do not want to change clean and healthy

behavior such as defecating improperly, not washing

their hands with soap. The most dominant reason is

the financial inability to build bathrooms, lavatories,

and handwashing facilities."

To the question about "is an aid for water sources

needed by the community?", The majority of

informants answered as follows: "in our opinion,

what is currently needed by the community is easy

access to clean water for drinking and daily needs

from water sources, such as the availability of pipes

and water installations that can flow water from the

mountains to people's homes."

In the sanitation indicator, the community is

asked to assess the scope of the toilet and bathroom

supply program. From the question about "how is

the description of sanitation coverage covering

bathrooms and latrines?" The majority of informants

answered as follows: "there are still many people

who do not have bathrooms and lavatories. The

community wants its toilet and lavatory in each

house, but the lack of funds is a barrier. Besides,

defecation in fields or rivers have become a habit."

The final question, from the question "What are

the main WASH indicators for improving health,

especially the nutritional status of children?" The

majority of informants answered as follows: "the

availability of sanitation facilities, namely

bathrooms and lavatories. Because defecation in any

place will transmit diseases that have an impact on

the nutritional status of children. Therefore, the

community wants assistance from the government

and the private sector to realize adequate and

adequate sanitation facilities."

Lack of community access to clean water and

poor sanitation and hygiene behavior contribute to

death (Musadad and Hananto, 2008). Diarrhea and

or other infectious diseases are the cause of death.

One of the efforts to reduce the mortality rate is

by creating healthy environmental sanitation that

ultimately affects the nutritional status of the family.

Various studies have shown that malnutrition is

associated with poor WASH behavior (Prüss-Üstün

et al, 2008; Langford et al, 2011; Spears, 2013; Rah

et al, 2015).

A meta-analysis study conducted by Gizaw and

Worku (2019) states that interventions on WASH

have an impact on improving children's nutritional

status. The research also indicates that policymakers,

health practitioners, nutritionists, and WASH experts

are responsible for improving the health status and

nutritional status of children and improving sanitary

conditions to prevent infectious diseases. WASH

interventions are the most holistic and approaches to

prevent wasting and stunting among children

especially among two children.

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4 CONCLUSIONS

The prevalence of school students who suffer from

wasting and stunting is higher than the national data

and the Province of North Sumatra. Based on the

WASH indicator, most families have access to clean

water, sanitation, and adequate hygiene. The results

of statistical analysis show that indicator of WASH

i.e. drinking water, sanitation facilities (bathrooms

and latrines) and cleanliness (handwashing) are

related to the nutritional status of students according

to the BMI index.

ACKNOWLEDGEMENTS

Thank you to Universitas Sumatera Utara for

providing research funding under the TALENTA -

Basic Scheme by Non-PNBP USU of the Year 2019

No. 4167/UN5.1.R/PPM/ 2019, April 1st 2019.

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