Clean water, sanitation and diarrhoea in Indonesia: Effects of household and community factors

Diarrhoea is an important health issue in low- and middle-income countries, including Indonesia. We applied a multilevel regression analysis on the Indonesian Demographic and Health Survey to examine the effects of drinking water and sanitation facilities at the household and community level on diarrhoea prevalence among children under five (n = 33,339). The role of the circumstances was explored by studying interactions between the water and sanitation variables and other risk factors. Diarrhoea prevalence was reported by 4820 (14.4%) children, who on average were younger, poorer and were living in a poorer environment. At the household level, piped water was significantly associated with diarrhoea prevalence (OR = 0.797, 95% CI: 0.692-0.918), improved sanitation had no direct effect (OR = 0.992, 95% CI: 0.899-1.096) and water treatment was not related to diarrhoea incidence (OR = 1.106, 95% CI: 0.994-1.232). At the community level, improved water coverage had no direct effect (OR = 1.002, 95% CI: 0.950-1.057) but improved sanitation coverage was associated with lower diarrhoea prevalence (OR = 0.917, 95% CI: 0.843-0.998). Our interaction analysis showed that the protective effects of better sanitation at the community level were increased by better drinking water at the community level. This illustrates the importance of improving both drinking water and sanitation simultaneously.