Beyond Access to Sanitation Services: How Maternal Education Moderates Childhood Diarrhea Risk in Indonesia's Multilevel Context.

BACKGROUND

Despite long-standing efforts to improve water, sanitation, and hygiene (WASH) infrastructure in Indonesia, childhood diarrhea remains a pressing public health concern. This study focuses on the gaps between infrastructure and health equity by examining the intertwined effects of child, household, and environmental factors on the risk of diarrhea. Study

Design

A cross-sectional study.

METHODS

In this study, data from the 2017 Indonesia Demographic and Health Survey (IDHS) were analysed using a multilevel logistic regression model. The survey included 16632 children, with children nested within households and households within a cluster (environment). All child, household, and environmental-level variables were included as fixed effects. Cross-level interactions were examined with sanitation, maternal education, and household wealth in terms of the prevalence of diarrhea.

RESULTS

Children aged 12-23 months (AOR=4.24; 95% CI: 3.23, 5.43), those with low birth weight [AOR=1.33 (95% CI: 1.04-1.70)], and those born to mothers with low education (AOR=1.74; 95% CI: 1.25, 2.44) had significantly higher odds of experiencing diarrhea. A significant interaction revealed that the impact of poor sanitation on children with less-educated mothers (AOR=1.68; 95% CI: 1.19, 2.37) and among educated mothers in children from low-income households (AOR=1.6; 95% CI: 1.12, 2.29) remained elevated. Children in non-Java-Bali regions also had persistently higher rates of diarrhea.

CONCLUSION

Access to sanitation is insufficient to guarantee health equity. Maternal education plays a crucial moderating role in translating infrastructure into better health outcomes. To accomplish Sustainable Development Goals 6 and 10, integrated equity-focused sanitation programs, including poverty reduction and maternal empowerment, are of great importance.