Health Education to Prevent Diarrhea in Preschoolers

*Arbianingsih Tiro*

#### **Abstract**

Preschoolers are the second largest group suffering from diarrhea. Numerous studies have identified poor community hygiene and health practices contributing as causes of diarrhea, making it necessary to teach children healthy behavior for prevention. Healthy behavior can reduce the risk of diarrhea by 36–48%. Unfortunately, health education is commonly given to parents, but it is limited for children. Preschool is a period of transition from parental control to self-control. This period is also the best time to build concepts and ideas with constant reason. Applying an important concept for healthy behavior in this period will help to develop a child's mindset in the future to prevent diarrhea. Health education to prevent diarrhea is pivotal to identify health behavior of preschoolers. When preschoolers' health behavior has been identified, then it can be used to design an effective education model in preventing diarrhea.

**Keywords:** diarrhea prevention, educational game, healthy behavior, health education, preschoolers

#### **1. Introduction**

One of the goals of the Sustainable Development Goals in 2030 is the third goal of reducing child mortality. It is estimated that around 5.9 million children under age five died in 2015 due to preventable diseases [1]. Southeast Asia is the third place for the highest child mortality in the world after sub-Saharan Africa and South Asia. Among ASEAN countries, Indonesia ranks fourth for the highest under-five mortality rate [2]. The most common cause of death of children under five in the world is pneumonia by 18% and diarrhea by 15% [3].

The main factor causing diarrhea is the effect of poor living behavior in the community. The longitudinal study conducted by Santos et al. in preschool children with diarrhea in Brazil found that the duration's determinant of diarrhea was the low ability of the community (low family purchasing power) caused by environmental conditions and children's characteristics and clean behavior [4]. Furthermore, in reducing the incidence of diarrhea, an effective method is selective eating and maintaining personal hygiene [5]. The study conducted by Kariuki et al. in Turkana district, Kenya, found that hygiene and sanitation interventions could reduce the prevalence of diarrhea in children under five from 91.3 to 78.3% [6].

There are several behaviors that can contribute to the incidence of diarrhea, including handwashing with soap, unhealthy snack behavior, and the habit of cutting nails and biting fingers [7, 8]. Those behaviors can contribute to intestinal infections which is one of the causes of diarrhea. Both hands are also the main

pathway for the entry of germs into the body because the hands are part of the body most associated with the mouth and nose. The habit of washing hands with soap can reduce the incidence of diarrhea by up to 50% or the same as saving about 1 million children in the world each year [9].

dishes (meat, fish, chicken, tofu, and *tempe*), vegetables, and fruit every day. Making eating activities is a fun time. Do not force children to eat because the most important thing for children is not the quantity of food but the quality of

perform are disposing garbage in its place, putting shoes in place, putting dirty eating utensils in place, using footwear when being outside of the house, covering the mouth when coughing and sneezing, keeping away from cigarette smoke, kitchen smoke, smoke burning garbage, and motor vehicle fumes,

• Maintaining environmental cleanliness: Some activities that children can

cleaning toys regularly, and defecating and urinating in the toilet.

after each trip and each time going up to bed.

well-being and maintaining physical fitness [17].

important intrinsic factors for changing behavior [12].

**2.1 Handwashing practice**

benefits than antibacterial soap [19].

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people who are not aware that they are being infected [1].

• Using clean water and clean latrines for daily needs: It is important to teach children to defecate in the toilet. Encourage children to use clean water for bathing twice a day, shampooing every other day, brushing their teeth at least twice a day, cleaning their ears every time they shower, and washing their feet

• Do not smoke and do physical activities: Teach children about the dangers of smoking for health. Regular physical activity is important for improving

Healthy behavior varies due to several factors, including (1) access to healthcare facilities, (2) attitudes toward health workers, (3) perceptions of disease threats, (4) knowledge of diseases, (5) characteristics of social networks, and (6) demographic factors. The second to fifth factors are part of cognitive factors (beliefs, attitudes, and knowledge). Cognitive factors are determinants of the most

In short, the important healthy behaviors that need to be taught to preschoolers are handwashing practices, clean eating practices, and eating balanced nutrition.

Handwashing with soap is one of the clean and healthy behaviors. Nowadays, the behavior of washing hands with soap has become a worldwide concern because the problem of lack of practice of handwashing behavior does not only occur in developing countries but also in developed countries. Thereby, the United Nations (UN) general meeting stipulated the Global Handwashing Day on October 15, 2008. This is a manifestation of the need to improve the practice of personal hygiene and sanitation throughout the world. The Global Handwashing Day which is celebrated by many countries in the world is an effort to improve handwashing with soap culture globally, so that the spread of diseases caused by the environment and human behavior such as diarrheal diseases can be reduced [18]. The behavior of handwashing with soap can reduce gastrointestinal disease by 31% and respiratory tract disease by 21%. Washing hands using non-antibacterial soap shows greater

Washing hands with soap is an effort to prevent disease. This is done because hands often become agents that carry germs and cause pathogens to move from one person to another, either by direct contact or indirect contact (using other surfaces such as towels and glasses). Hands that come in direct contact with human and animal feces or other body fluids (such as snot) and contaminated food/drinks when not washed with soap can move bacteria, viruses, and parasites to other

what they eat.

*Health Education to Prevent Diarrhea in Preschoolers DOI: http://dx.doi.org/10.5772/intechopen.86414*

To create healthy behavior, it should be instilled early. Preschool age is an early age for reasoning and constant ideas that are grounded. Planting the concept of healthy behavior at this age will form a healthy lifestyle later on. This preschool period is a transition period from the dominance of parental control to control by the children themselves. In this phase, the children have been able to internalize the standards and values that develop around them, and play is part of the life of preschoolers [10]. The study conducted by Peñalvo et al. stated that health promotion for children aged 3–5 years by integrating behavioral interventions into school curricula in Spain was effective in improving children's healthy behavior [11].

Educating healthy behavior to children in their early life requires appropriate educational strategy. Therefore, things that are needed for that are (1) knowing the behavior of people to prevent health which can be taught to children in school, (2) knowing the health education model that can be applied to children, (3) knowing the effectiveness of the education model that can improve the use of behaviors in diarrhea prevention, and (4) knowing the components of the educational model that must be considered in providing health education.
