Althea Medical Journal. 2015;2(3)

375

Mother’s Knowledge, Attitude and Practice toward Safe Water Usage in
Baleendah, Bandung District, West Java from September–October 2012

Eliza Techa Fattima,1 Kuswandewi Mutyara,2 Yudith Setiati Ermaya,3 Elsa Pudji Setiawati2
1Faculty of Medicine Universitas Padjadjaran, 2Department of Public Health Faculty of

Medicine Universitas Padjadjaran, 3Department of Child Health Faculty of Medicine Universitas
Padjadjaran/Dr. Hasan Sadikin General Hospital Bandung

Abstract

Background: Poor environmental conditions contribute to the high incidence of diarrhea, most of those
caused by unsecure water and poor health knowledge. This study was conducted to evaluate the mother’s
knowledge, attitude, and practice toward safe water usage in Baleendah, Bandung.
Methods: A cross sectional descriptive study was conducted in Baleendah during September−October 2012,
participated by 210 mothers with 12−59 months children, and using rapid survey method. This study used
a questionnaire to measure the three domains, which consists of 8 questions of knowledge, 10 questions
of attitudes, 16 questions of practice, and 7 questions of diarrhea. The collected data were analyzed and
presented in table.
Results: As much as 168 (80%) of mothers were in moderate knowledge status, 126 (60%) of mothers were
in moderate attitude status. Practically, 127 (54.7%) of mothers used water from borehole/tube well. Most
of the mothers (54.6%) use drinking water from refillable water store.
Conclusions: Most mothers who participated have varied moderate knowledge and attitude status, and
practice toward safe water usage. [AMJ.2015;2(3):375–81]

Keywords: Attitude, knowledge, practices, safe water usage

Correspondence: Eliza Techa Fattima, Faculty of Medicine, Universitas Padjadjaran, Jalan Raya Bandung-Sumedang
Km.21, Jatinangor, Sumedang, Indonesia, Phone: +62 853 247 193 65 Email: elizatecha@yahoo.co.id

Introduction

Diarrhea is still one of the health problems in
developing countries, such as in Indonesia.
An outbreak of diarrhea occurred in 11
provinces in 2010, including West Java.1 Some
districts have tendency of high incidence of
diarrhea, such as Sukabumi, Garut, Bandung,
and Kuningan. In Baleendah, Bandung, more
than eight thousand cases of diarrhea occur
in 2011.2 According to a preliminary survey
in 2011 there were 224,323 people living in
Baleendah. Based on the data obtained from
Jelekong Public Health Centre in Baleendah
in 2011, the incidence of diarrhea in children
aged 12−59 months, were about 100 cases
of diarrhea every month.3 Diarrhea was
commonly found in salmonellosis, shigellosis,
amoebiasis, protozoal and viral intestinal
diseases.

Poor environmental conditions contribute
to the high incidence of diarrhea. About 88%
of diarrhea cases in the world are caused

by unsecured water use, lack of sanitation
and lack of health knowledge.4,5 Globally,
improving water sanitation, hygiene and
medical knowledge prevent at least 9.1%
of disability, or 6.3% of mortality.6 The
problem related to drinking water, hygiene
and sanitation still being the main issues.
The results of the WHO study in 2007, the
incidence of diarrhea decreased 39% with the
behavior management of drinking water in the
household, 32% by improving people's access
to sanitary excreta, and 45% with the behavior
of washing hands with soap, while integrating
all factors, the incidence of diarrhea decreased
by 94% .7

In society, health problems are determined
by two factors: behavioral factors and non-
behavioral factors (social, political, economic,
etc.). Behavioral factors are developed into
knowledge, attitude and practice. Health
behavior also refers to knowledge, attitude
and practice.

Many Indonesians use water from the

Althea Medical Journal. 2015;2(3)

376 AMJ September, 2015

river for their daily needs. Citarum River is
the longest river in West Java and about 25
million people from nine suburbs and three
cities rely on this river while about 15 million
people live on the bank of this river. Citarum
River is still inflood regularly every rainy
season. Baleendah is geographically located
in Bandung. This region is often flooded when
the rainy season arrives, since two major rivers
namely Citarum and Cisangkuy River cross in
Baleendah.

So far, there are no studies on the
relationship of mother’s knowledge, attitudes

and practices toward safe water usage with the
incidence of diarrhea in children in Baleendah,
Bandung. Therefore, this study concerned
about mother’s knowledge, attitudes and
practices toward safe water usage and the
incidence of diarrhea in children in Baleendah,
Bandung.

Methods

A cross sectional descriptive study was carried
out during the period of September−October
2012 on 210 mothers with 12−59 months

Table 1 Characteristics of Mothers and Children in Baleendah District

Characteristics Frequency Percentage (%)

Mother’s Characteristic
Family income per month
< Rp. 1.223.800,00 127 60.5
>= Rp. 1.223.800,00 83 39.5
Education Level
Elementary School (unfinished) 1 0.5
Graduated from Elementary School 47 22.4
Graduated from Junior High School 92 43.8
Graduated from Senior High School 63 30.0
Graduated from College 7 3.3
Father’s occupation
Labors 82 39.0
Farmer 1 0.5
Merchants street market 3 1.4
Entrepreneurs 65 31.0
Civil Servants 5 2.4
Private Employees 33 15.7
TNI/POLRI 2 1.0
Others 19 9.0
Child’s Characteristics
Sex
Male 113 53.8
Female 97 46.2
Age
12−23 months 97 46.2
24−35 months 50 23.8
36−47 months 37 17.6
48−59 months 26 12.4

Althea Medical Journal. 2015;2(3)

377

children in Baleendah, Bandung. The study
was approved by the Health Research Ethics
Committee of Faculty of Medicine Univeristas
Padjadjaran, Bandung.

The rapid survey method prescribed
minimum of 30 clusters with 7 subjects
taken from each cluster.8 The clusters in
this study were Neighborhood Associations
(RT) in the District of Baleendah. From each
Neighborhood Association (RT), was selected
randomly 7 houses that have children (simple
random sampling). This study was conducted
by first selecting a conspicuous place in the
cluster, such as stalls or mosque as early
benchmarks and then apply a nearby house
system. Researchers assumed one house is
occupied by one family which only has one
child, ideally after the data retrieval will be
obtained from 210 children. If there is one
house occupied by more than one family and
one family has more than one child, only 1 child
with the youngest age in the family becomes

the subject of research. Interviews were
conducted in a cluster to get the 7 respondents
who fit the criteria.

This study used a questionnaire to
measure the three domains, which consists
of 8 questions of knowledge, 10 questions
of attitudes, 16 questions of practice, and 7
questions of diarrhea.

Results

The most of the subjects had a low family
income and graduated from junior high school
(Table 1) and mostly had moderate level of
knowledge toward safe water usage (Table 2).

Table 3 showed that some respondents
already knew that they should not use Citarum
water for drinking, bathing, washing clothes,
and washing dishes because it is polluted,
and the water should not be disposed of large
and small household waste in the river due to

Table 2 Mother’s Knowledge toward Safe Water Usage

Level of knowledge Frequency (N) Percentage (%)

Good 19 9
Moderate 168 80
Poor 23 11

Table 3 Mother’s Attitudes toward Safe Water Usage
No Characteristic Frequency Total

Strongly
Agree

Agree Disagree Strongly
Disagree

1 Citarum river water potable. 0 3 122 85 210
2 Citarum river water can be used

to wash clothes
0 16 141 53 210

3 Defecating and urinating can be
done on river

1 62 114 33 210

4 Household waste can be disposed
on river

0 12 130 68 210

5 Water consumed should be clear 60 149 1 0 210
6 Before consumption, water

should be boiled
94 115 1 0 210

7 Drinking water stored in closed
storage

56 154 0 0 210

8 Up to 6 months, baby should only
be given breast milk

82 122 6 0 210

9 Milk bottles should be washed
with soap and clean running
water before used

62 124 24 0 210

10 Milk bottles should be boiled
with boiling water before used

85 123 2 0 210

Eliza Techa Fattima, Kuswandewi Mutyara, Yudith Setiati Ermaya, Elsa Pudji Setiawati: Mother’s Knowledge, Attitude and
Practice toward Safe Water Usage in Baleendah, Bandung District, West Java from September–October 2012

Althea Medical Journal. 2015;2(3)

378 AMJ September, 2015

Table 4 Mother’s Practices toward Safe Water Usage
Characteristics Frequency Percentages(%)

Type of Water Source
Tap water/PAM 15 6.5
Tap water retail / buying 11 4.8
Borehole/tube well 127 54.7
Dug well 75 32.3
Spring 3 1.3
Rainwater 1 0.4
Ownership of water resources
Personal 140 66.7
Public 70 33.3
Water resource availability
Always available 151 71.9
Difficult in dry season 59 28.1
Type of drinking water sources
Bottled water 19 7.3
water from refreshment stand 141 54.6
Tap water/PAM 11 4.2
Tap water retail / buying 1 0.4
Borehole/tube well 47 18.2
Dug well 35 13.7
Spring 4 1.6
Location of drinking water sources
Indoor 141 67.1
Outdoor 69 32.9
Physical quality of drinking water
Cloudy 4 1.9
Colored 10 4.7
Smell 3 1.4
Good 195 92.0

Drinking water treatment methods
Boiled 156 48.9
UV 136 42.6
Filtered 25 7.8

Without treatment 2 0.6
Water Shelter
Dispenser 113 42.5
Pot/kettle/thermos/jerry 128 48.1
Pitcher 5 1.9
Bucket/covered pot 13 4.9
Others 7 2.6

Althea Medical Journal. 2015;2(3)

379

water pollution can aggravate. Most mothers
(47.6%) knew that the source of water for
daily needs can come from rain water, surface
water, and groundwater. Two mothers (1%)
did not know that rain water, surface water,
and ground water is the source of water that
can be used for everyday needs.

Most of the mothers (94.8%) knew that the
water was turbid, colorless, tasteless, foaming,
and because of the smell it could not be used
as drinking water sources. Most mothers knew
that there are other ways besides drinking
water by boiling water, by irradiation with
ultraviolet light, giving chlorine, and filtering.

Based on the data obtained, 187 mothers
(89%) knew that regularly mopping the floor
in the house is one way to prevent diarrhea in
young children, while 23 mothers (11%) did
not know that mopping the floor can prevent
diarrhea.

Mother’s knowledge about breastfeeding
for the first 6 months of life in infants is
actually good. Based on the data obtained,
the 203 mothers (96.7%) knew that until the
age of 6 months a baby should only be given
breast milk. Prior to use the milk bottle should
be washed with soap and cleaned by running
water and boiled. Most of mothers (83.3%)
knew how to use a milk bottle properly.

Based on the data obtained, 45 mothers
(21.5%) had a good attitude in this category,
most of the mothers with moderate levels
of attitude in this category amounted to 126
people (60%), whereas women who belong to
the poor category were more than 39 people
(18.5%).

None of the mothers used water from
Citarum River. There were some mothers
(4.8%) who still threw garbage into Citarum
River. Mostly, disposal drains in the house
flowed into Citarum River (69%). Based on
the data obtained from the field about the
practice of mothers regarding water use of
210 respondents (Table 4).

Discussions

In general, the mothers have realized about
using clean water. This study found that
subjects had a moderate knowledge (80%). A
research about using river water in Ulu Pekon
Krui and Pekon Laay West Lampung9, shows
the distribution of knowledge about the use
of water good categories (30.6%), moderate
category (16.3%), and poor category (53.1%).
The difference in the level of knowledge in
these two areas can be influenced by education
level, hereditary habits and length of stay in

the riverbank.
In general, the level of maternal attitudes

towards safe water usage was moderate. It is
proven from the results of research showing
that the average rate of the respondents
attitude were in the moderate category
(60%). Most mothers agree the water used
for daily needs, especially for drinking should
be clean. Attitude is a reflection of various
psychiatric symptoms such as desires,
interests, knowledge, emotions, motivation,
and willing.10 Based on the research conducted
using river water in Ulu Pekon Krui and Pekon
Laay West Lampung9, it shows the distribution
of attitudes on the use of water good category
(28.5%), moderate category (37%), and poor
category (34.5%). Human attitude or a society
of health is determined by knowledge, beliefs,
and traditions of the individual.

Based on this study, there were 127 mothers
(54.7%) who used water from borehole/tube
well for daily needs. Water from borehole/tube
well is known as ground water. Ground water
comes from rain water which had absorption
and filtration into the soil. Ground water is
usually free of germs and contains substances
mineral.11 Based on data from Basic Health
Survey (Riset Kesehatan Dasar, RISKESDAS)
2010, currently Indonesia has some clean
water that can be classified into a number
of sources, including tap water (19.5%),
protected dug wells (27.9%), unprotected dug
wells (10.2%), boreholes/tube well (22.2%)
and the river/lake/irrigation (4.9%).12

Location of water sources should also be
considered whether being around the house or
outside the house. Based on the data obtained,
the majority of drinking water is inside the
house (67.1%). Based on data from RISKESDAS
2010, it shows that approximately 40% of
contaminated water sources are unprotected.
One form of pollution occurs due to seepage of
dirty water activity which results sanitation.12

Based on this study, there were still many
people who used public water sources for their
daily needs (33.3%). Based on the observations
of the current study, the limitation of many
rented houses was comprised by several
families who only provide a source of water.
Most mothers do not complain about the lack
of water because water is always available in
every season (71.9%). According to RISKESDAS
2010, most Indonesian people claimed about
easy access to clean water (81.7%).12

Based on the data obtained, no mother used
water from Citarum river. Water river/lake/
irrigation is the lowest level seen from the
quality of the water, because these sources are

Althea Medical Journal. 2015;2(3)

380 AMJ September, 2015

vulnerable contaminated likely condition of the
water is below health standards.12 There are 10
mothers (4.8%) who threw householdgarbage
into Citarum river. Mostly, the disposal drains
in the house flowed into Citarum River
(69%). The disposal of household waste and
water waste into Citarum River increased the
number of pollution in the river.

Restrictions on source of clean and safe
water are free from contamination or germs,
free from hazardous substances and toxic
chemicals, the water is tasteless and odorless,
and can be used to meet household needs, as
well as meet the minimum standards set by the
WHO or Department of Health RI.11 Based on
the data obtained, the majority of women used
drinking water from a water depot (54.6%).
While based on data from RISKESDAS 2010 in
West Java province, 27.3% of people who use
non-piped water is not protected, 11.19% use
piped water protected, and 61.59% using non-
piped water protected. Drinking water from
refreshment stand belongs to the category of
non-piped water is not protected.12 Based on
the data obtained, the majority of the physical
quality of drinking water is good (92%). The
water which is used for drinking should be
clear, colorless, odorless, and tasteless.13

Based on the data obtained, mostly mothers
boiled the water before drink it (48.9%), it
was a good way to kill some germs in the
water.11 Most of the mothers use a pot/kettle/
thermos/jerry cans as storages of drinking
water (48.1%). Good water reservoirs should
be closed in order not to be contaminated
easily.

Most mothers breastfeed exclusively to their
children (81.4%). According to RISKESDAS
2010, exclusive breastfeeding is higher in rural
areas than in the town.12 According to the WHO
study in Geneva in 1992, the risk of developing
diarrhea was greater in infants who are not
breast-fed infants compared with breast-fed
exclusively. It also increases the risk of death
caused by diarrhea.14

Some children are still using a bottle as
many as 91 infants (43.3%). According to a
research by the WHO in Geneva, the use of
this milk bottle facilitates the transmission
of germs, because it will not be perfectly
cleared.14 This study shows mothers washed
milk bottles with soap and running water
before using a bottle of milk (59%). Most
mothers boiled the milk bottles using boiling
water before using a bottle (64.3%). Washing
and boiling the bottle before use is one way to
prevent disease transmission.

This study provides the conclusions that

the level of knowledge toward safe water
usage in Baleendah is moderate (80%),the
level attitudes toward safe water usage in
Baleendah is moderate (60%). In practice, 127
mothers (54.7%) use for daily needs water
from borehole/tube well and most mothers
use drinking water from depot water (54.6%).
Incidence of diarrhea in children in Baleendah
in the past month was 92 cases (43.8%).

There should be another further study
about the relationship of mother’s knowledge,
attitudes, and practices toward safe water
usage and incidence of diarrhea in children
in Baleendah. Mothers need to be involved in
good and safe water usage, because mothers
have a very important role in the family.

References

1. Ministry of Health Republic of Indonesian.
Profil kesehatan Indonesia 2010. Jakarta:
Ministry of Health Republic of Indonesian;
2011.

2. Lucyati A. Hasil pencapaian pembangunan
kesehatan di Jawa Barat. Bandung: Dinas
Kesehatan Provinsi Jawa Barat; 2011.

3. Jelekong Public Health Centre. Laporan
Tahunan 2011. Bandung: Jelekong Public
Health Centre; 2011.

4. Esrey SA, Feachem RG, Hughes JM.
Interventions for the control of diarrhoeal
diseases among young children: improving
water supplies and excreta disposal
facilities. Bull World Health Organ. 1985;
63(4): 757−72

5. Esrey SA, Potash JB, Roberts L, Schiff
C. Health benefits from improvements
in water supply and sanitation: survey
and analysis of the literature on selected
disease. 66th ed. Arlington, VA, USA: Water
and Sanitation for Health Project (WASH).
1990; p.66−83

6. World Health Organization. Water,
Sanitation and Hygiene. World Health
Organization. 2012 [Cited 2012 April 6];
Available from: http://www.wpro.who.
int/health_topics/water_sanitation_and_
hygiene/general_info.htm.

7. Department of Health Republic of
Indonesia. Strategi nasional sanitasi total
berbasis masyarakat. Jakarta: Department
of Health Republic of Indonesia; 2008.

8. Pusat Data Kesehatan Departemen
Kesehatan RI. Metode survei cepat untuk
Dinas Kesehatan Kabupaten/Kotamadya.
Jakarta: Department of Health Republic of
Indonesia; 1996.

9. Saragi OV, Setiawan B, Ekayanti I. Analisis

Althea Medical Journal. 2015;2(3)

381

penyediaan dan penggunaan air sungai
pada rumah tangga di Pekon Ulu Krui dan
Pekon Laay Kabupaten Lampung Barat.
Jurnal Gizi dan Pangan. 2008;3(3): 167–71

10. Notoatmodjo S. Konsep perilaku
kesehatan: promosi kesehatan teori dan
aplikasi. Jakarta: Rineka Cipta; 2005.

11. Mubaraq WI, Chayatin N. Ilmu kesehatan
masyarakat: teori dan aplikasi. Jakarta:
Salemba Medika; 2009.

12. Council for Health Research and
Development. Riset Kesehatan Dasar
2010. Jakarta: Ministry of Health Republic
of Indonesian; 2010.

13. Soemitrat J. Kesehatan lingkungan.
Yogyakarta: Gajah Mada University Press;
2004.

14. World Health Organization. Reading
on diarrhoea. Geneva: World Health
Organization; 1992.

15. Pruss-Ustun A, Kay D, Fewtrell L, Bartram
J. Unsafe Water, Sanitation and Hygine. In:
Ezzati M, Lopez AD, Rodgers A, Murray CJL.
Comparative quantification of health risks
Vol 1. Geneva: World Health Organization;
2004. p. 1321−52

16. Simanjuntak CH, Punjabi NH,
Wangsasaputra F, Dazwir N, Pulungsih
SP, Rofiq A, et al. Diarrhoea episodes and
treatment-seeking behaviour in a slum
area of North Jakarta, Indonesia. J Health
Popul Nutr. 2004;22(2):119–29.