The dual burden of poor sanitation and climate variability on public health: A case study of diarrhea incidence in Surakarta

Surakarta, Indonesia, faced an acute public health challenge, with diarrhea cases surging by 58.6% (rising from 7,209 in 2023 to 11,434 in 2024). This study aimed to examine the temporal relationship between this rapid increase and the dual environmental burden: chronic sanitation failure (solid waste volume) and acute climatic instability (rainfall and temperature). We employed an ecological, retrospective correlational approach, integrating 3 years (2022–2024) of annual data from the City Health Office (Dinkes), the Central Statistics Agency (BPS), and the Meteorology, Climatology, and Geophysics Agency (BMKG). The results revealed a direct association. The disease outbreak occurred concurrently with a 5.66% surge in annual solid waste volume and a marked increase in heavy precipitation, from 1,743.40 mm to 2,456.60 mm. The persistent solid waste acted as a chronic pathogen reservoir, and the extreme rainfall exceeded hydrological thresholds, inundating infrastructure and flushing contaminants into public water systems. Furthermore, increasing mean ambient temperatures (up to 27.60 °C) promoted microbial multiplication. The high case rates, particularly in Jebres and Banjarsari, illustrate a systemic breakdown at the community level. The study highlights the urgent need for integrated, climate-adaptive strategies to consolidate waste disposal and protect water-hygiene infrastructure.