Path Analysis of The Relationship between Diarrhea, Climate and Environmental Variables in Province of West Nusa Tenggara-Indonesia

Diarrhea is a major cause of morbidity and mortality, particularly in West Nusa Tenggara Province, Indonesia, due to certain factors. Therefore, this study aims to examine the influence of climate, economic status, demographic, water, sanitation, and hygiene factors on diarrhea. The study procedures were carried out using an ecological design that focused on the characteristics of the sample population. The unit of analysis was districts/cities, where data on diarrhea cases from 2017–2020 were used, along with other variables in the same period. The dependent variable was the number of diarrhea cases per month, while the independent variables included average temperature, economic status, population density, access to water, sanitation, and hygiene. A total of 480 records were analyzed descriptively using path analysis to determine the relationships between the variables. The results showed that average temperature had a significant direct relationship with diarrhea (b = 0.127, 95% CI = 0.027 – 0.227, p = 0.013;) and indirectly through unsafe drinking water-limited sanitation (b = 0.088, 95% CI = 0.001 – 0.175, p = 0.047). Economic status and population density were also reported to have a significant indirect effect, while unsafe drinking water-limited sanitation and limited hygiene had a direct influence (b = 0.166, 95% CI = 0.07 – 0.263, p = 0.001 and b = 0.124, 95% CI = 0.019 – 0.229, p = 0.021). In addition, the model also showed that water sanitation had a positive and significant correlation with hygiene. In summary, diarrhea was directly influenced by the average local temperature, access to water, sanitation, and hygiene. Indirectly, the average temperature played a significant role along with population density and economic status.