SYSTEMATIC LITERATURE REVIEW: THE RELATIONSHIP BETWEEN CLEAN AND HEALTHY LIVING BEHAVIOR (PHBS) AS A PREVENTION OF DIARRHEAL DISEASE
Keywords:
clean and healthy living behavior, diarrheal disease, prevention, health, systematic literature reviewAbstract
Diarrhea remains a global public health problem, especially in developing countries, one of which is Indonesia, with a high incidence rate in vulnerable groups such as toddlers. The implementation of Clean and Healthy Living Behavior (PHBS) is an essential preventive strategy in reducing the incidence of diarrhea, but previous research results have shown varying findings. This study systematically examines the relationship between the implementation of Clean and Healthy Living Behavior (PHBS) and the prevention of diarrheal disease based on current scientific evidence. This study uses a systematic literature review design with the PICOS approach. Literature searches were conducted through Google Scholar, PubMed, ScienceDirect, ResearchGate, and ProQuest for articles published between 2021 and 2025 in Indonesian and English. Study selection was carried out through title and abstract screening stages, followed by full-text review according to criteria. A total of 20 articles were analyzed descriptively and systematically. Most of the literature reveals a significant relationship between the implementation of PHBS and a reduced risk of diarrhea incidence. Individuals or groups with good PHBS implementation have a lower risk of diarrhea compared to those who do not implement PHBS optimally. The PHBS components that play a dominant role include hand hygiene practices with soap, use of clean water sources, use of proper sanitation facilities, and hygienic food and waste management. Factors influencing the effectiveness of PHBS include knowledge, attitudes, socioeconomic conditions, availability of sanitation facilities, as well as environmental support and health policies. The implementation of PHBS is an effective, evidence-based preventive strategy for preventing diarrheal disease. Strengthening education and improving access to adequate sanitation are needed to support sustainable public health interventions.
References
Mbakaya BC, Lee PH, Lee RLT. Hand Hygiene Intervention Strategies to Reduce Diarrhoea and Respiratory Infections among Schoolchildren in Developing Countries : A Systematic Review. Published online 2017:1-14. doi:10.3390/ijerph14040371
Ri E nwadiaro, Je E, Arikpo D, Mm M, Ja C. Hand-washing promotion for preventing diarrhoea ( Review ). Published online 2021. doi:10.1002/14651858.CD004265.pub4.www.cochranelibrary.com
Ditjen P2. Orientasi Program Penanggulangan PISP. Kementerian Kesehatan Republik Indonesia.
Kemenkes. Pencanangan Nasional Perluasan Imunisasi Rotavirus (RV). Kementerian Kesehatan Republik Indonesia.
Bill F, Foundation MG. Estimates of the global , regional , and national morbidity , mortality , and aetiologies of diarrhoea in 195 countries : a systematic analysis for the Global Burden of Disease Study 2016. Published online 2018:1211-1228. doi:10.1016/S1473-3099(18)30362-1
Sabira NZ. Jurnal Nasional Kesehatan Lingkungan Global Distribusi Kejadian Diare pada Balita dan Kualitas Sumber Air Minum di Indonesia : Studi Ekologi Distribusi Kejadian Diare pada Balita dan Kualitas Sumber Air Minum di Indonesia : Studi Ekologi. 2025;6(1):10-18. doi:10.7454/jnklg.v6i1.1044
Wolf J, Hubbard S, Brauer M, et al. Effectiveness of interventions to improve drinking water , sanitation , and handwashing with soap on risk of diarrhoeal disease in children in low-income and middle-income settings : a systematic review and meta-analysis. 2022;400. doi:10.1016/S0140-6736(22)00937-0
Null C, Stewart CP, Pickering AJ, et al. Effects of water quality, sanitation, handwashing, and nutritional interventions on diarrhoea and child growth in rural Kenya: a cluster-randomised controlled trial. Lancet Glob Heal. 2018;6(3):e316-e329. doi:10.1016/S2214-109X(18)30005-6
Darvesh N, Das JK, Vaivada T, Gaffey MF, Rasanathan K, Bhutta ZA. Water , sanitation and hygiene interventions for acute childhood diarrhea : a systematic review to provide estimates for the Lives Saved Tool. 2017;17(Suppl 4). doi:10.1186/s12889-017-4746-1
Cairncross S, Hunt ÃC, Boisson S, Bostoen K, Curtis V, Fung ICH. Water , sanitation and hygiene for the prevention of diarrhoea. Published online 2010. doi:10.1093/ije/dyq035
Auma B, Id MM, Ojuka E, et al. Prevalence of diarrhea and water sanitation and hygiene ( WASH ) associated factors among children under five years in Lira City Northern Uganda : Community based study. 2024;425:1-14. doi:10.1371/journal.pone.0305054
Mwishingo A, Endres K, Bisimwa L, et al. Effect of a Water , Sanitation , and Hygiene Program on Handwashing with a Cleansing Agent among Diarrhea Patients and Attendants in Healthcare Facilities in the Democratic Republic of the Congo : A Randomized Pilot of the PICHA7 Program. Published online 2024.
Bennion N, Mulokozi G, Allen E, et al. Association between WASH-Related Behaviors and Knowledge with Childhood Diarrhea in Tanzania. Published online 2021.
Puteri AD, Syahfitri CA, Mufti L, Isnaeni A, Yusristin D. Faktor-Faktor Penyebab Kejadian Diare Pada Balita Di Wilayah Kerja Puskesmas Air Tiris Pendahuluan Menurut World Health Organization ( WHO ) , diare dapat didefinisikan sebagai buang air. 2025;4(1):17-27.
Rosiska M. Hubungan Perilaku Hidup Bersih dan Sehat (PHBS) Ibu dengan Kejadian Diare pada Anak Balita di Puskesmas Sungai Liuk. 2021;01:82-87.
Mardhiah A, Inayati R. Analisis Hubungan antara Perilaku Hidup Bersih dan Sehat pada Ibu Rumah Tangga terhadap Kejadian Diare pada Balita Galenical is licensed under a Creative Commons Attribution-ShareAlike yang dapat menular atau masuk ke dalam tubuh individu melalui konsumsi makanan atau. 2025;4(3):56-66.
Kusuma NN, Maharani NE. Pro Health Jurnal Ilmiah Kesehatan Hubungan Perilaku Hidup Bersih dan Sehat ( PHBS ) Ibu Rumah Tangga Dengan Angka Kejadian Diare di Kelurahan Bulakrejo Kecamatan Sukoharjo Kabupaten Sukoharjo. 2022;4(2):242-248.
Saputri D, Susanto AD, Sartika I. Jurnal Dunia Ilmu Kesehatan Hubungan Perilaku Hidup Bersih Dan Sehat Terhadap Kejadian Diare Pada Anak Sekolah Di Sdn Total Persada Tahun 2023 Jurnal Dunia Ilmu Kesehatan. 2024;2:1-4.
Febriawan NR, Khasanah U, Yusuf A. The Relationship between Clean and Healthy Living Behavior and Risk of Diarrhea in Toddler. 2024;09:228-238.
Firenza MD, Syafridah A. Hubungan Pengetahuan Ibu dan Perilaku Hidup Bersih dan Sehat ( PHBS ) dengan Kejadian Diare pada Balita di Desa Pusong Lhokseumawe. 2022;1(3).
Mapingure M, Makota RB, Chingombe I, et al. Water , sanitation , and hygiene – specific risk factors of recent diarrheal episodes in children aged under 5 years : analysis of secondary data from the multiple indicator cluster survey ( MICS 2019 ). IJID Reg. 2024;12(July):100417. doi:10.1016/j.ijregi.2024.100417
Soe TK, Laohasiriwong W, Sornlorm K, Mahato RK. Hygiene practice and diarrhea prevalence among underfive children in Myanmar : a cross-sectional study. Published online 2024.
Roy S, Kiruthika G, Muthappan S, Rizwan SA, Kathiresan J. Association between water , sanitation and hygiene practices and diarrhea among under 3-year-old children : Evidence from a nationally representative sample in India ( 2019 – 2021 ). 2023;13(9):711-722. doi:10.2166/washdev.2023.108
Suparmi S, Sasman MF, Ratnawati R, Rustanti N. Hygiene and food safety practices among mothers as predictors of diarrhea risk in toddlers in Purwawinangun Village , West Java , Indonesia. 2025;(March):1-6. doi:10.3389/fpubh.2025.1530828
Ntakarutimana A. Relationship Between Household Water Sanitation and Hygiene Behaviors and Diarrhea in Rwanda , 2010 – 2020. 2024;18(1):312-331.
Nuraeni A, Putri M, Supendi K, Efendi A. The Relationship Of Hand Washing Behavior Towards Diarrhea Cases In School-Age Children. 2022;3(2):104-108.
Kas SR. Hubungan perilaku hidup bersih dan sehat dengan kejadian diare pada anak sekolah. 2025;6:15585-15590.
Rosdiana. Hubungan Perilaku Hidup Bersih dan Sehat (PHBS) dengan Kejadian Penyakit. Kesehatan, J Ilmu. 2025;4(1):193-205.
Fatmawati DA, Murti B. Meta-Analysis the Effects of Hand Washing Behavior Using Soap and Latrine Availability on the Diarrhea Incidence in Children Under Five. 2024;09:119-131.
Anhar KH, Martani NS, Teresa A, Widodo T. Hubungan Perilaku Penggunaan Air Terlindung Dan Jamban Layak Terhadap Angka Diare 2022 Correlation Between The Behavior Of Using Protected Water And Proper Latrines To The Incidence Of Diarrhea In 2022. 2024;2(3):90-96. doi:10.37304/barigas.v2i3.11861
Anggelina P, Maramis S, Drew C. Hubungan perilaku hidup bersih dan sehat dengan kejadian diare pada mahasiswa. Holistik J Kesehat. 2025;19(8):2431-2436.
Gustini G, Sumiyati S, Asmi AS, Nordianiwati N, Hendrick H. Jurnal Pengabdian Masyarakat Edukasi Indonesia ( JPMEI ). J Pengabdi Masy Edukasi Indones. 2024;1:63-69. doi:10.61099/jpmei.v1i2.42
Puspita MI, Tinggi S, Kesehatan I, Yakkum B. Hubungan Perilaku Hidup Bersih Dan Sehat (Phbs) Terhadap Perilaku Pencegahan Diare. Published online 2024:157-164.
Yasin Z, Nawawi A, Devy SR, Rahayu S. The Effect of Family Clean and Healthy Living Behavior Education ( PHBS ) on the Prevention of Diarrhea in Toddlers. J Promkes Indones J Heal Promot Heal Educ. 2025;13(1):94-102. doi:10.20473/jpk.V13.I1SI.2025.94-102
Wesiyem, Amelia D, Pane P, Unzila F, Rahima AF. TOFEDU : The Future of Education Journal The Clean and Healthy Living Behavior as an Effort to Prevent Diarrhea in the Community of Cemara Kembar Coastal Area. TOFEDU Futur Educ J. 2025;4(9):398-404.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Nurul Maghfirah Junaid, Armanto Makmun, Abbas Zavey Nurdin, Husni Esa Darussalam, Ardiyanto (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors publishing here keep copyright but grant the journal first publication rights, under a Creative Commons Attribution-NonCommercial 4.0 License. They can distribute their work non-exclusively elsewhere with an acknowledgment of its first publication in this journal. Posting the work online before and during submission for earlier and greater citation is encouraged, reflecting Open Access benefits.
