Disertasi

The Effect of Sanitation-Hygiene-And-Water (SHAW) Program on Stunting Prevention through Diarrhea Reduction amongst 6-12 month-old-children: Structural Equation Modeling. = Pengaruh Program Sanitasi-Hygiene Dan Air terhadap Pencegahan Stunting Melalui Pengurangan Diare Pada Anak Umur 6-12 bulan: Analisa Model Persamaan Struktural.

BACKGROUND. Stunting is significantly a critical problem. Many studies discovered that there were many programs conducted to prevent stunting. The results of the studies showed that there were many variables affecting stunting. However, it is not clear about the relationship among these variables. The current study was aimed to find out a theoretical model explaining the effects of Sanitation-Hygiene-And-Water (SHAW) Program on stunting prevention through diarrhea reduction amongst 6-12 month-old-children. METHODS. A perspective cohort design was implemented to achieve the aims of the current study. The sample of the study were 340 healthy 6-7-months-old children divided into two groups: 170 children of SHAW program area and 170 children of non-SHAW program area. They were observed for six months. The data of the children’ length, access to sanitation, hygiene, water quality, diarrhea, dietary intake, social economic status, and health services were collected during six months. The data were then analyzed using Structural Equation Modelling (SEM) analysis to find the model fit which affected stunting focusing on the effects of the SHAW program. RESULTS. A good model fit was established, showing the relationships among the variables affecting stunting. Increment of dietary intake unit would contribute 0.207 point to change of LAZ (stunting) while each unit increment of diarrhea would decrease 0.190 point of dietary intake. An significant association was found for SHAW program with water. Water had a significant association with diarrhea. Furthermore, diarrhea had a significant inverse association with dietary intake, and finally dietary intake had a significant association with stunting. Meanwhile, dietary intake had higher contribution 5.2% while diarrhea only contributed 0.6% to stunting. CONCLUSION. This is the first study developing a Model Fit to explain the effect of SHAW program on stunting prevention through diarrhea reduction amongst 6–12 months old children after six months of observation in East Lombok District, West Nusa Tenggara Province. This model summarizes that SHAW Program is effective in improving water quality which directly affects the morbidity of diarrhea, subsequently improves the infant dietary intake, and finally contributes to stunting.
Keywords: SHAW program, stunting, diarrhea, structural equation modelling.


LATAR BELAKANG. Stunting merupakan masalah kritis. Beberapa penelitian telah dilakukan untuk mengatasi masalah stunting. Hasil berbagai penelitian tersebut menunjukkan adanya banyak variabel yang mempengaruhi stunting. Namun, dari hasil penelitian-penelitian tersebut belum ditemukan model persamaan struktural yang dapat menjelaskan bagaimana stunting dipengaruhi oleh variabel-veriabel yang mempengaruhinya. Penelitian ini mencoba menemukan model teoritis yang dapat menjelaskan pengaruh program SanitationHygiene-And-Water (SHAW) terhadap pencegahan stunting melalui pengurangan diare anak, terutama hubungan diare dengan kondisi sanitasi dan air minum. METODE. Rancangan penelitian ini adalah kohort prospektif, dengan subyek adalah anak usia 6-7 bulan sebanyak 340 anak katagori sehat terbagi dalam dua kelompok (170 anak terpapar program SHAW dan 170 anak tidak terpapar program SHAW), kemudian diikuti selama enam bulan untuk dilihat perkembangannya. Pengumpulan data meliputi pengukuran antropometri, asupan makanan, kondisi sanitasi, perilaku hygiene, kualitas air minum, dan kejadian penyakit diare. Analisa data utama menggunakan pendekatan SEM (Structural Equation Modeling). HASIL. Ditemukan “Model Fit” analisis jalur yang menjelaskan hubungan persamaan struktural pengaruh program SHAW terhadap stunting. Dari model, terlihat setiap variabel bersifat searah terhadap yang lain. Program SHAW bersifat searah terhadap sanitasi, kebersihan, air dan juga diare searah terhadap stunting. Kenaikan unit asupan makanan akan memberikan kontribusi 0,207 terhadap stunting, sementara setiap unit kenaikan diare akan menurunkan 0,189 poin asupan makanan. Lebih jauh juga ditemukan bahwa jalur dari air, berhubungan negatif dengan diare. Diare berhubungan negatif dengan asupan makanan, selanjutnya asupan makanan berpengaruh positif dengan stunting. Lebih jauh diketahui asupan makanan memiliki kontribusi yang lebih besar (5,2%) daripada diare yang hanya (0,6%) terhadap stunting. KESIMPULAN. Ini adalah studi pertama yang menemukan Model Fit yang menjelaskan pengaruh Program SHAW terhadap stunting. Dari model diketahui bahwa Program SHAW memiliki hubungan yang signifikan dengan air. Air memiliki hubungan signifikan dengan diare. Selanjutnya, diare memiliki hubungan terbalik dan signifikan dengan asupan makanan, dan akhirnya asupan makanan memiliki hubungan yang signifikan dengan stunting.
Kata kunci: program SHAW, stunting, diare, structural equation modelling.