Clean and healthy living behavior of Baubau city: A geographic information system approach

Background : The main determinant of the degree of public health apart from environmental conditions is the behavior of the community. Riskesda 2007 data shows that only 38.7% of households that have practiced clean and healthy living behavior have practiced clean and healthy living behavior. In Baubau City, people still wash their hands and defecate improperly. So, they are still at risk of contracting infectious diseases. Objective : This study aims to determine the risk areas for clean and healthy living behavior in Baubau City. Methods : This type of research is an observational study with a Geographic Information System (GIS) approach. The number of respondents was 1.720 in 43 villages. Each village was represented by 40 respondents with the sampling method in each village namely simple random sampling. Results : Based on the calculation results obtained a maximum total risk index of 38 and a minimum total risk index of 9. to obtain an interval value is 7. Villages with clean and healthy living behavior Very high risk in 3 villages. High risk in 13 villages. Medium risk in 21 villages and less risky in 6 villages. Conclusion : Most of the villages in Baubau City are included in clean and healthy living behavior at medium risk.


Introduction
Environmental conditions.Community behavior.Health services.And genetics essentially affect the level of public health that is not yet optimal.The main determinant of the degree of public health in addition to environmental conditions is the behavior of the community.Riskesda 2007 data shows that households that have practiced clean and healthy living behavior have only reached 38.7% of households that have implemented clean and healthy living behavior (1).
The behavior of washing hands and defecating properly is part of the indicators for implementing clean and healthy living behavior.Based on the results of Riskesdas 2018.In Indonesia.49.8% of people wash their hands properly.There are still 50.2%who wash their hands incorrectly.While the habit of defecating properly is 88.2%.There are still 11 .8% of people who defecate in an improper way (2).
The people of Southeast Sulawesi Province who wash their hands properly are still.Namely 42.30% and Baubau City 70.58%.While the habit of defecating correctly in Southeast Sulawesi Province is 87.34% and in Baubau City is 98.40% (3).The data shows that people mainly in Baubau City still wash their hands and defecate improperly.So they are still at risk of contracting infectious diseases.One of the infectious diseases that can be caused by poor clean and healthy living behavior is diarrhea.Based on the results of Riskesdas 2018.The prevalence of diarrheal disease in Baubau City based on diagnoses by health workers (doctors.Nurses.Or midwives) was 6.94%.While based on diagnoses by health workers or symptoms experienced by household members reached 7.38% (3).
The application of clean and healthy living behavior is something that is important and must be done by humans and it would be better if it was made a daily habit.The impression is that clean and healthy living behavior is a simple thing.But there are still many who do not pay attention to how important clean and healthy living behavior is, there are still many people who do not realize that clean and healthy living behavior is very important for themselves.Clean and healthy living behavior is very important when the world is hit by the COVID-19 pandemic.This situation should make us aware of how important clean and healthy living behavior is to prevent the spread of infectious diseases.In addition to themselves.Clean and healthy living behavior also plays a role in maintaining environmental cleanliness.For example not throwing garbage/waste carelessly.The successful implementation of clean and healthy living behavior must also be supported by the provision of sanitation services.Especially the problem of the availability of clean water.The implementation of clean and healthy living behavior will bring many benefits to our health of ourselves.Our families.And the environment around us.

Material and methods
This type of research is an observational study with a Geographic Information System (GIS) approach.This research was conducted in March 2021 in Baubau City.Data collection was carried out by household surveys using questionnaires and observation sheets in all 43 villages in Baubau City.Each village was represented by 40 households so 1.720 households became the target of the survey.The sampling method for each village used was simple random sampling.
Recap of research data using the SPSS version 20.2 application.Then an analysis is carried out to determine the level of risk using the interval method.The level of risk is divided into 4 levels.Namely low risk.Medium risk.High risk.And very high risk.The value used to determine the level of risk is the clean and healthy living behavior value which is not good for each variable.Then a percentage calculation is carried out.The percentage value is then taken as the highest and lowest values among all villages/villages and then divided into 4 levels of risk so that the interval value is obtained.The value of this interval will determine the value of 4 levels of risk so that the level of clean and healthy living behavior risk is known for each village that is the target of the survey.The results of this risk level calculation are then processed with the application of the Geographic Information System using Quantum GIS Version 3.26.0.Resulting in a clean and healthy living behavior risk level map with color gradations according to each risk level.
Determination of the level of risk based on variables related to clean and healthy living behavior in the Environmental Health Risk Assessment (EHRA) Study.Namely.The habit of washing hands with soap at five important times.The condition of the latrine walls free from feces.Latrines free from cockroaches and flies.Functioning of closed flushing.Presence of soap in the latrine.Contamination of water storage and handling containers and open defecation (4).The risk areas are then entered into a GIS application which produces a map of the risk areas using color gradations based on the risk level of each village.

Habit of Washing Hands with Soap at Five Important Times
Based on the table.Most of the respondents (72.2%) did not wash their hands at five important times.Only a small proportion (27.8%) practice hand washing at five important times.Namely before eating.After defecating.After washing children.Before managing food.And before performing ablution.There are several sub-districts where all respondents do not wash their hands at five important times.Namely Sukanayo.Waruruma.And Waborobo Villages.Based on the table above.Most respondents (91.0%) had latrines that were free from human feces.And only a small proportion of respondents (9.0%) still found feces around or on the walls of the latrine.The sub-district with the largest number of respondents who still found the presence of feces on the toilet wall is Liwuto Village.Which is 47.5% of the 40 respondents.

Latrine Free from Cockroaches and Flies
Based on the table.Most of the respondents (87.5%) had latrines that were free from insects such as cockroaches and flies.But only a small proportion of respondents (12.5%) still found the presence of cockroaches and flies around the toilet.The village with the most respondents who still found the presence of cockroaches and flies is Waliabu Village.Which is 77.5% of respondents.Based on the table above.Most of the respondents (93.5%) had toilet flushers that were still functioning.But only a small percentage of respondents (6.5%) still found non-functioning toilets.The village with the most respondents who still found the flushing was not functioning was Batulo Village.Which was 52.5% or 21 out of 40 respondents.

The presence of soap in the latrine
Based on the table.Most of the respondents (91.5%) found soap in the toilets that were still available.But only a small proportion of respondents (8.5%) found soap in the toilets that were still there.The village with the most respondents who did not find soap in the latrine was Bugi Village.Which was 30% or 12 of 40 respondents.Based on the table above.Most of the respondents (94.59%) in water storage and handling containers did not find any contamination.But only a small proportion of respondents (5.41%) still found pollution.The village with the most respondents who did not find any contamination of water storage and handling containers was Batulo Village.Which was 25% or 10 out of 40 respondents.

Indiscriminate Defecation Behavior
Based on the table.Most of the respondents (92.33%) did not defecate anywhere.only a small proportion of respondents (9.77%) still behaved to defecate in any place.The village with the most respondents behaving in open defecation is Waliabuku Village.which is 50% or 20 of the 40 respondents.

Areas of Risk for Clean and Healthy Living Behavior
The risk area assessment is calculated by taking the variable that has a bad score, namely the answer No on the habit of washing hands with soap at five important times (A), the answer No on the variable condition of the latrine wall free of feces (B), the answer No on the independent latrine variable from cockroaches and flies (C), the answer is No to the closed flushing function variable (D), the answer is No to the variable presence of soap in the latrine (E), the answer is Yes to the variable of contamination in the storage container (F) and the answer is Yes to the handling variable water and open defecation behavior (G).
Furthermore, each variable has used as the value of the proportion of each variable that is included at risk, then each variable is given a weight.The variables of the habit of washing hands with soap at five important times, the presence of contamination in water storage and handling contain, er and the behavior of open defecation are each given a weight of 25%, and the variables of the condition of the latrine walls are free from feces, the latrine is free from cockroaches and flies, the flushing function is closed., and the presence of soap in the latrine was given a weight of 6% (4).
The risk area index value uses the formula: = ( 25%) + ( 6%) + ( 6%) + (6%) + ( 6%) + ( 25%)+( 25%) So that the interval value is 7. From the interval value, the range of risk level values is obtained as follows: The level of risk of a Clean and Healthy Lifestyle for each village in Baubau City is as follows: Based on the calculation results above, the clean and healthy living behavior Risk Areas in Baubau City in 2021 are described on the map as follows:

Discussion
Clean and Healthy Living Behavior is a set of behaviors that are practiced based on awareness as a result of learning, which makes a person, family, group, or community they can help themselves (independently), especially in the field of Health, and can also play an active role in creating public health (1).

Habit of Washing Hands with Soap at Five Important Times
The habit of washing hands at five important times consists of washing hands with soap before eating, after defecating, before breastfeeding, before preparing food, after washing children, and after contact with animals.Most of the respondents did not wash their hands with soap at five important times.Hand-washing time is mostly done before eating and after defecating.
Hand washing is an important way to prevent cross-contamination with pathogens during food preparation.Many people think that washing hands with water only and washing hands with soap are considered the same thing (5).
During the Covid-19 pandemic, hand washing has become one of the things that must be done.hand washing habits should be better and more often done.World Health and other major world authorities recommend frequent hand washing and proper hand hygiene procedures as one of the cheapest, easiest, and most important ways to prevent the spread of the virus, For most circumstances hand washing, including those related to eating, personal hygiene, leaving home, socializing, health, and household chores, where nowadays the habit of always washing hands is much higher during the COVID-19 pandemic period (6).

The state of the toilet wall is free from feces
There are still latrine walls owned by the community in Baubau City which is classified as unclean, there are still stains of feces on the walls of the latrines.The utilization of latrines is not accompanied by good behavior.When finished defecating, cleaning should be carried out not only cleaning the flushing but also cleaning around the flushing.Many factors are related to the habit of using latrines.
Factors that were significantly related to the use of latrines were the number of household members from one to three people, the presence of primary or secondary school students in the house, the time since the household latrine was built for two years or more, and the frequency of daily latrine cleaning (7).The habit of cleaning the toilet and the frequency of cleaning the latrine can be the cause of whether or not the latrine is free from feces.
Feces scattered in latrines that are not cleaned will certainly pose a risk / negative impact on users.Users of the latrine will be contaminated with feces.As a result contamination of feces can cause infectious diseases, one of which is diarrhea (8).

Latrine Free from Cockroaches and Flies
Insects that are found around the latrines owned by the community are flies and cockroaches.There are still people who allow cockroaches and flies to be around latrines, without exterminating and preventing flies and cockroaches from being around latrines.The cleanliness of the latrine is related to the presence of insects.Dirty latrines will invite insects to land and even live and breed around the latrine.this poses a serious risk to public health.
The habit of cleaning latrines can indirectly prevent insects that can transmit diseases such as cockroaches and flies.
Cockroaches and flies have lived near humans throughout history.However, these insects can also serve as vectors for many zoonotic enteric parasites (ZEPs).The risk of transmitting insect vectors in our shared environment makes it very important to adopt a One Health approach to reducing the transmission of ZEP (9).Cockroaches and flies that land on dirty latrines and then land on food are very at risk of carrying harmful parasites into food which is ultimately consumed by humans and can cause disease.

Flushing Function
The latrines owned by the community in Baubau City are still found to have flushed that are no longer functioning.This happens mostly in people who have a low economy, people claim to have no money to repair their latrines, especially the flushing that is no longer functioning, as a result, people switch to throwing feces in the surrounding environment (defeating in any place).
Flushing on the latrine greatly determines the use and cleanliness of the latrine, flushing that does not work, the user becomes reluctant, or even does not use the latrine.The problem that can arise from the malfunction of the flush is when the latrine is used by people who do not have good manners.even though the flushing is not working, the latrine is still used, so it can cause feces to contaminate the latrine, which in turn can cause disease in users.

The presence of soap in the latrine
Washing hands with soap can clean other dirt and can also kill germs.Germs and dirt when washing hands using only water can still be left behind if you don't wash your hands with soap and water.Therefore, the presence of soap in the toilet is very important to kill germs after defecation.

Contamination of Water Storage and Handling Containers
Only a small portion of the water storage and handling containers owned by the community in Baubau City have been detected as contaminated because most of the storage containers have lids and the intensity of cleaning the containers is more frequent.a container that is polluted because the water storage container does not have a cover and is rarely cleaned because the water is never empty so the container continues to be filled without regular cleaning.Water storage containers that do not meet health requirements will be easily contaminated.from both human and animal waste.Water consumed from these containers can hurt users.

Indiscriminate Defecation Behavior
Only a small part of the people of Baubau City still defecate openly.This habit certainly hurts society.The bad habits of a small number of people can have an impact on other people, the faces that are dumped in any place will contaminate the groundwater consumed by many people, and insects can also be infested which then land on the food consumed by the community.
Open defecation behavior can be influenced by several factors such as economic status, attitude, distance from house to river, and latrine ownership.Of these several factors, the most influential factor is attitude, which is closely related to latrine behavior and ownership (10).Unsafe sanitation, and more specifically open defecation, is one of the main causes, leading to fecal contamination of water bodies and transmission of fecal bacteria (11).
The level of risk of clean and healthy living behavior in each village becomes information that can be used by local governments, especially those related to public health to determine priority areas that need to be intervened related to changes in clean and healthy living behavior, both physical intervention and interventions related to clean and healthy living habits. .Very high-risk areas can be the priority target of intervention.

Conclusion
Most of the sub-districts in Baubau City are included in the behavior of a clean and healthy life of medium risk.The number of sub-districts based on the level of risk of clean and healthy living behavior is Villages with clean and healthy living behaviors in the very high-risk category as many as 3 villages, 13 villages at high risk, 21 villages at moderate risk, and 6 villages at low risk.

Figure 1
Figure 1 Map of Areas at Risk for Clean and Healthy Lifestyles in Baubau City in 2021

Table 1
Distribution of Respondents based on the Habit of Washing Hands with Soap at Five Important Times in Baubau City in 2021

.2. The state of the toilet wall is free from feces Table 2
Distribution of Respondents based on the State of the Toilet Walls Free of Feces in Baubau City in 2021

Code Village The State of the Toilet Walls Free of Feces
Sources: Primary Data.2021

Table 3
Distribution of Respondents based on Condition of Latrine Free from Cockroaches and Flies in Baubau City in 2021

Table 4
Distribution of Respondents based on Flushing Functions in Baubau City in 2021 Source: Primary Data.2021

Table 5
Distribution of Respondents based on the Presence of Soap in Latrine in Baubau City in 2021

Contamination of Water Storage and Handling ContainersTable 6
Distribution of Respondents based on the Presence of Pollution in Water Storage and Handling Containers in Baubau City in 2021

Table 7
Distribution of Respondents based on Open Defecation Behavior in Baubau City in 2021

Table 8
Risk Level Criteria

Table 7
Risk Level of Clean and Healthy Life Behavior in Baubau City in 2021