Community Knowledge on Child Gastrointestinal Disease, Growth, and Development : A Cross Sectional Study in Mandangin Islan, Sampang, Indonesia

The prevalence of diarrhea in Madura is higher than in East Java. Mandangin island, an isolated island in Sampang, Madura has limited access to healthcare and knowledge. It will lead to disruptions in the children’s growth and development. This study aimed to evaluate the impact of health education on community knowledge about gastrointestinal disorders and children’s development. This cross-sectional study involved 48 subjects from Mandangin Island, Sampang by total sampling. The subjects received some presentations related to gastrointestinal disease, growth, and development in children using a handbook and audio-visual media. The subjects were required to complete pretest and posttest questionnaires. The pretest and post-test results were processed and analyzed using the statistical software “SPSS” and the Wilcoxon test. Most of the subjects were housewives with a mean age of 28.73 ± 6.22 years old. There was a significant difference between pre-and post-test in gastrointestinal disease, growth, and development in children (46.04 ± 21.71 vs 62.29 ± 13.25, p<0.001). This study found that health education through face-to-face, handbooks, and audiovisual media can enhance community knowledge.

INTRODUCTION

Indonesia is a country with the fourth-largest child population in the world. Children are highly susceptible to the health risks of environmental exposures during their crucial developmental phase. Contaminated water, air, food, and soil pose serious threats, leading to digestive issues and hindering proper growth and development. Many children still lack access to adequate nutrition¹¹. A common digestive issue that often occurs is diarrhea. Diarrhea continues to be a prevalent infectious disease in Indonesia, with a prevalence rate in toddlers reaching 12.3% and being the main cause of death in neonates at 7% and in infants aged 28 days at 6%²². It remains a primary cause of both child mortality and morbidity, predominantly attributed to suboptimal water, sanitation, and hygiene practices. Inadequate sanitation and hygiene correlate with elevated rates of stunting and malnutrition in children³³. With a prevailing rate exceeding 40% in children, stunting persistently represents a profound health challenge within the community population^4,545. This indicates that the child has endured a prolonged period of insufficient dietary intake and/or has been frequently exposed to illness^6–8678.

In the Sampang region, one of the regencies in East Java, the diarrhea prevalence (46.3%) was higher than in the whole East Java (44.8%)⁹⁹. Mandangin Island, an isolated area in Sampang, has limited access to healthcare and education. This is compounded by the low community participation in nutrition improvement efforts with a significant portion of the population having only completed primary education^10,111011. The majority of the community holds the belief that monitoring a child's development is unnecessary after completing full immunization. Insufficient exclusive breastfeeding and the utilization of rainwater for daily needs, particularly during the rainy season, increase the risk of cleanliness-related infectious diseases in children, particularly gastrointestinal diseases¹²¹².

Gastrointestinal diseases are predominantly preventable and treatable conditions¹³¹³. Community empowerment plays a crucial role in both prevention and initial treatment. Therefore, this study aimed to evaluate community knowledge of gastrointestinal disorders, growth, and development in children.

MATERIALS AND METHODS

This study employed a cross-sectional design. 48 daily active people of Mandangin Island were included in this study utilising the total sampling method. After completing the pretest questionnaire independently, the participants then received a direct health education intervention on gastrointestinal disease, growth, and development in children. A pediatrician and a doctor conducted this face-to-face activity using a presentation medium that the community could easily understand. Following the presentation, a discussion session between participants and speakers ensued. During this discussion, the speakers and other attending pediatricians encouraged participants to pose questions or share experiences related to the presented material. Each participant also received a handbook about gastrointestinal disease, growth, and development in children. We then administered a posttest using the same protocol as the pretest.

This study used pre and post-test questionnaires with 10 questions and demographic data. Statistical tests were used to compare results with normality testing for a limited number of participants (<50) using the Shapiro-Wilk test and Paired T-test for Windows, p > 0.05 was considered normal distribution.; otherwise the Wilcoxon test would be applied. Sociodemographic data were presented using univariate analysis.

In addition to the community health education for the Mandangin Island, medical check-ups were carried out for children under the age of five who voluntarily visited the examination site. These check-ups involved gathering medical history, conducting physical examinations, taking anthropometric measurements, and providing pediatric consultations. History taking covered current patient or family complaints, and demographic data such as age, gender, gestational age, birth weight, and birth length.

Anthropometric measurement included weight, length/height, head and upper arm circumference using standardized tools such as One-Med digital weighing scales and microtones for older children, One-Med baby scales and infantometers for infants, and General Care upper arm and head circumference tapes. Anthropometric data was graphed using WHO z-score 2006 charts for weight-for-age, length/height-for-age, and weight-for-length/height; Nellhaus 1968 chart for head circumference; and Indonesian Ministry of Health classification for upper arm circumference^14,151415. Univariate analysis was used to present the characteristics data of children under 5 years on Mandangin Island for each variable. All statistical tests were performed using IBM Statistical Product and Service Solutions (SPSS) Software version 16.0 for Windows.

RESULTS

The study involved forty-eight female subjects who were dominated by housewives with a mean age of 28.73 ± 6.22 years old. The subject characteristics are described in Table 1. After the intervention using a handbook and audio-visual media, there was an increase in the mean posttest score (62.29±13.25) compared to the mean pretest score (46.04±21.71), with a significance value of 0.001 (p<0.05) (Figure 1).

Figure 1.Example caption for this image

Table 1.Subject Characteristics

Variables	N (n=48) or mean ± SD	Percentage (%)
Age	28.73 ± 6.22
Occupation
Housewife	43	89.59
Fisherman	1	2.08
Cadres	3	6.25
Teacher	1	2.08
Sex
Female	48	100
Male	0	0
Educational
Level Not School	13	27.09
Elementary School	25	52.08
Junior High School	10	20.83

In this study, children under five years old were equally divided between boys and girls, with a mean age of 28±13.14 months. Most of them were born at full-term gestational age. The mean birth weight was 2949±517.67 grams, classified as normal birth weight. The mean height was 49±1.93 cm.

About 47.8% of the children under five years old