ID Design Press, Skopje, Republic of Macedonia

Open Access Macedonian Journal of Medical Sciences. 2019 Oct 30; 7(20):3497-3500.
https://doi.org/10.3889/oamjms.2019.686
eISSN: 1857-9655
Tropical and Infectious Diseases Control and Management

The Relationship of Gender, School Sanitation and Personal

Hygiene with Helminthiasis at Juhar Karo Regency in North
Sumatera Province, Indonesia

1* 1 2
Ginting Agustaria , Aguslina Siregar Fazidah , Nurmaini Nurmaini

1 2
Departement of Epidemiology, Faculty of Public Health, Universitas Sumatera Utara, Medan, Indonesia; Department of
Environment Health, Faculty of Public Health, Universitas Sumatera Utara, Jl. Universitas No. 21, Kampus USU, Medan,
20155, Indonesia

Abstract
Citation: Agustaria G, Fazidah AS, Nurmaini N. The BACKGROUND: Helminthiasis is a parasitic disease in human that causes a disturbance in food absorption and
Relationship of Gender, School Sanitation and Personal
Hygiene with Helminthiasis at Juhar Karo Regency in
lead to malnutrition. The disease slowly impacts on the intelligence. The incidence of helminthiasis in Indonesia
North Sumatera Province, Indonesia. Open Access remains high, ranging from 2.5% to 62%. A preliminary study found that the proportion of helminthiasis in children
Maced J Med Sci. 2019 Oct 30; 7(20):3497-3500. is 31.25%.
https://doi.org/10.3889/oamjms.2019.686
Keywords: Helminthiasis; Gender; School sanitation; AIM: The aim of the study to analyse the relationship between age, school sanitation and personal hygiene with
Personal hygiene
helminthiasis elementary school children in Juhar Karo Regency in 2019.
*Correspondence: Ginting Agustaria. Department of
Epidemiology, Faculty of Public Health, Universitas
Sumatera Utara, Medan, Indonesia. E-mail:
METHODS: This was an observational study with a cross-sectional design. Subjects were children in grades IV, V
[email protected] and VI with and without helminthiasis. A total of 194 children selected by proportional random sampling were
Received: 14-Aug-2019; Revised: 15-Sep-2019; enrolled. Data were collected by interview, observation, and stool examination with the Kato-Katz method.
Accepted: 16-Sep-2019; Online first: 14-Oct-2019
Copyright: © 2019 Ginting Agustaria, Aguslina Siregar RESULTS: The proportion of helminthiasis in boys was 51.0%, the proportion of poor sanitation in school was
Fazidah, Nurmaini Nurmaini. This is an open-access 36.6%, and the proportion of poor personal hygiene was 67.5%. Personal hygiene was significantly associated
article distributed under the terms of the Creative
Commons Attribution-NonCommercial 4.0 International
with the incidence of helminthiasis (RP = 6.052; 95% CI = 3.029-12.902; P-value = 0.001). Improved personal
License (CC BY-NC 4.0) hygiene may prevent the occurrence of helminthiasis.
Funding: This research did not receive any financial
support CONCLUSION: The proportion of helminthiasis in elementary school students in this region was 50.0%. Personal
Competing Interests: The authors have declared that no hygiene has been shown to be related to helminthiasis. In this study, subjects with poor personal hygiene had a
competing interests exist chance of 6.052 times greater to experience helminth infection compared to subjects who had good personal
hygiene.

Introduction need treatment due to this parasitic disease [2]. The

increased numbers of helminth infections in primary
school children may be caused by behavioural factors
Helminthiasis is one of the infectious diseases including not washing hands before eating, or after
that remain a public health problem, particularly in defecating, not using sandals when leaving the house
Indonesia. This disease affects food absorption, and not cutting the nails regularly. This situation can
nutritional status and reduces health condition, also be exacerbated by poor living environments such
especially in elementary school children [1]. as no latrines and high humidity environment [3].

World Health Organization (WHO, 2017) The Indonesian Ministry of Health (2017)
estimated more than 1.5 billion people or 24% of the proved that the prevalence of helminthiasis in
world population to be infected with soil-transmitted Indonesia ranged from 2.5% to 62% [4]. The
helminth (STH), and more than 880 million of children prevalence reported above is supported by the results
of a survey conducted in several regencies in 2011,
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where the prevalence of helminthiasis in Lebak and Enrolled subjects in this study were all
Pandeglang to be 62% and 43.3%, respectively; students of grades IV to VI at the Public Elementary
Sleman regency at 21.8%; Karangasem regency at School in Juhar Village in 2019. Inclusion criteria
51.3%; West Lombok regency at 29.5%; Mataram City included respondents who had settled in Juhar village
at 24.5%; and West Sumba at 29.6%[1]. in a minimum of 3 months and respondents who
agreed to be the subject of the study and followed all
A study by Martila et al., (2015) reported
study protocols. Exclusion criteria included
elementary school students in Pantai Jayapura,
respondents who consumed anthelminthic in the last 3
Papua had 50% prevalence of helminthiasis [5]. The
months and respondents who had siblings in the
numbers were dominated by infections by Ascaris
grades IV, V or VI.
lumbricoides (48.5%), followed by Trichuris trichiura
(28.6%) and hookworm (14.3%). While other study
reported prevalence as high as 59.3% in Wera district,
Data Collection
Bima regency [6].
Data was collected directly through interviews
The initial survey conducted by the North
using questionnaires. School personal hygiene and
Sumatra Health Office in 2014 found that in some
sanitation data were taken using a questionnaire in
North Sumatra regencies, the prevalence of
the form of tested and standardised questions. The
helminthiasis was 29%; 25% was caused by A.
stool was collected in a labelled pot that had been
lumbricoides, and 1% each was due to T. trichiura and
distributed previously to school children. The label
hookworms. This prevalence decreased to 22.5% in
included the student's name, date of birth, gender,
2016 [7].
and class. A stool sample, a size of a thumb, was
In Karo regency, the prevalence was 41.1% in taken using an ice cream stick, then put in a stool pot
2014 with A. lumbricoides as the predominant and closed tightly. Stool examination was done in the
species. In 2017, this prevalence increased to 57.6% laboratory using the Kato Katz method.
with A. lumbricoides at 41.4% and T. trichiura at
The following data were identified: gender,
16.2% [7]. A repeat survey in 2018 in two elementary
school sanitation, personal hygiene of each
schools in Juhar District of Karo regency
respondent. Data analysis was done by stages, with
demonstrated a remaining high prevalence at 31.25%
univariate analysis, bivariate analysis with Chi-Square
This may be due to several risk factors like human
test at a significance level of 0.05.
habits and environmental factors. Saeni and Arief
(2016) have shown the relationship between
helminthiasis and personal habits. The prevalence of
helminthiasis was significantly higher in children who
did not wash their hands before eating (64.0%) and Results
after defecation (62.2%) [8].
Furthermore, environmental sanitation factors
like sanitation, sewage, and waste facilities, and Table 1 showed the baseline characteristics
housing conditions like dirt floor, access to clean of the subjects. The majority of subjects were male
water, availability of trash bin and wastewater disposal (99, 51.0%). Poor school sanitation was found in
facilities are associated with the helminthiasis 36.6% of subjects, and poor personal hygiene was
incidence [9], [10]. found in 131 people (67.5%). While the prevalence of
helminth infections was 50%.
The aim of this study was to analyse the
association between gender, school sanitation and Table 1: Baseline characteristics (n = 194)
personal hygiene with the incidence helminthiasis on Characteristics n %
elementary school students in Juhar Village, Juhar Gender
Male 99 51.0
District, Karo Regency of North Sumatra Province. Female 95 49.0
School sanitation
Poor 71 36.6
Good 123 63.4
Personal hygiene
Poor 131 67.5
Good 63 32.5

Methods Bivariate analysis showed a significant

relationship between personal hygiene and
helminthiasis (PR = 6.052), which means that the
Study Design helminth infection was 6 times more likely to occur in
children with poor personal hygiene than those with
This study was an analytic observational
good personal hygiene. However, there was no
study with a cross-sectional design.
significant relationship between school sanitation (P =
Subjects 0.315), gender (P = 0.655) and helminthiasis.

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 Agustaria et al. The Relationship of Gender, School Sanitation and Personal Hygiene with Helminthiasis at Juhar Karo Regency in North Sumatera Province,
Indonesia
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Table 2: Gender relationship, school sanitation and personal failed to show a significant association between poor
hygiene with helminthiasis accidence in 2019
sanitation with helminthiasis.
Helminthiasis p
Total
Variable (+) (-) value RP (CI=95%) On the other hand, we found a significant
n % n % n %
Gender relationship between personal hygiene and the
Male 46 46.5 53 53.5 99 100
0.315
0.749 incidence of helminthiasis. A similar association has
Female 51 52.7 44 46.3 95 100 (0.426 - 1.317)
School sanitation been shown in other studies with children with poor
Poor 37 38.1 34 35.1 71 100 0.655 1.143
Good 60 61.9 63 64.9 123 100 (0.637-2.050) personal hygiene had an increased risk to experience
Personal hygiene helminthiasis [14], [15], [16], [17].
Poor 83 63.4 48 36.6 131 100 6.052
0.001
Good 14 22.2 49 77.8 63 100 (3.029 -12.092)
Personal hygiene is very important in efforts
to control the risk factors for helminthiasis. This can
be done through efforts to improve personal hygiene
or environmental cleanliness. Poor personal hygiene
of a person may cause helminthiasis which is often
Discussions influenced by the poor behavior of children such as
not washing their hands after defecation, not using the
soap when washing hands, not washing their feet and
Stool examination on 194 elementary school hands with soap after playing on the ground, not using
students in Juhar Village, Juhar District, Karo footwear when playing and going out of the house, fail
Regency showed 50% positivity for STH infection. to maintain the cleanliness of nails, and consuming
This prevalence is considered high, which is similar to uncooked water [4].
other findings in other parts of Indonesia [4].
Based on the results of the study, it can be
There are 25 villages in Juhar District, Tanah concluded that helminth infection in this study can be
Karo Regency with a population of 15,937 people and influenced by various factors, one of which is personal
mainly works as farmers. Our previous study has hygiene. Poor personal hygiene will be at risk of
shown that this area is disadvantaged areas as seen contracting an infection, especially by STH. This has
from the numbers of houses that still had not met the been shown in several other studies where
good environmental sanitation standards. During our respondents with poor personal hygiene experienced
observations, many houses still had the sewage run more infections than children who had good personal
into their yard. School environmental sanitation hygiene. Poor personal hygiene will aggravate the
facilities such as toilets were provided but not well incidence of helminthiasis in elementary school
maintained so they could not be used properly. students because at the age of the elementary school
Besides, there was also no sink for washing hands. they are not able to independently manage their
As a result of inappropriate facilities, elementary personal hygiene. And good personal hygiene is an
school students can defecate anywhere near the important requirement in preventing and breaking the
school. This then leads to an increasingly uncontrolled chain of the spread of infectious diseases such as
spread of worms. This was also supported by the poor helminthiasis.
hygiene behaviour of elementary school children like
lack of attention to nail hygiene, and not wearing The regulation by the Ministry of Health of
footwear when playing on the schoolyard. Indonesia (2017) on helminthiasis prevention
including reducing the prevalence of helminth
In this study, we found no significant infections by killing the worms through mass treatment
relationship between gender and helminthiasis. This is to reduce the intensity of infections (number of worms
in line with other studies by Ginting (2005) and Kartini per person), in order to improve health level. But the
(2014). These studies described that gender did not treatment of worms must be accompanied by the
influence the incidence of helminth infection. In Karo efforts to live clean and healthy, improved
region, the majority of occupation for both male and environmental sanitation, and nutritious food intake.
female is farming, therefore the same activities For this reason, there is a need for cross-program
including washing, fetching water, farming and taking cooperation and cross-sector collaboration between
care of the house were done by both male and female the government and the private sector. So continuous
[11], [12]. communication and understanding between these
Similar to gender, school sanitation was also sectors will be achieved, and helminthiasis can be
not associated with helminthiasis, as reported by prevented in the short and long term [4].
Sumanto (2010) that school sanitation is not a risk In conclusion, the proportion of helminthiasis
factor for hookworm infection among school students in elementary school students in this region was
[13]. In this study, school sanitation condition was 50.0%. Personal hygiene has been shown to be
assessed based on the condition of the bathroom, related to helminthiasis. In this study, subjects with
availability of public handwashing place in the poor personal hygiene had a chance of 6.052 times
canteen, bathroom tubs, and distance of garbage greater to experience helminth infection compared to
collection with a canteen < 20 meters. Despite poor subjects who had good personal hygiene.
condition found in all 4 studied schools, our study
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