Sanitation, open defecation, and Diarrhea in Tangerang, Banten, Indonesia, in early 2017: A cross-sectional epidemiological study

Sanitasi Total Berbasis Masyarakat (STBM), an Indonesian program adopted from Community-Led Total Sanitation, only 17.3% of urban villages in Tangerang, Banten, Indonesia, are open defecation-free. Tangerang has the third highest incidence rate of diarrhea in Banten. This cross-sectional epidemiological study aims to establish a correlation among sanitation, open defecation, and diarrhea to determine the impact of the STBM program, particularly in Tangerang. We obtained open defecation and sanitation data of 104 urban villages from the STBM website of the Ministry of Health. In addition, diarrhea data from January 2017 to June 2017 were obtained from surveillance epidemiology data of the Ministry of Health. We statistically analyzed data using correlation analysis. The results revealed a significant negative correlation (P = 0.0005) between open defecation and sanitation access (r = -0.975). However, no significant correlation was established between diarrhea and sanitation access (r = -0.102) and between diarrhea and open defecation (r = 0.124), suggesting a significant correlation between open defecation and sanitation. Thus, all five pillars (i.e., no open defecation, hand washing, water safety, graywater treatment, and waste management) of the STBM should be executed simultaneously to assess the impact of health-related problems, particularly diarrhea.