Background

Diarrhea is a common symptom caused by gastrointestinal infections by a wide

variety of pathogens, including bacteria, viruses and protozoa. More diarrhea common in
developing countries due to lack of safe drinking water, sanitation and hygiene, as well as
poorer nutritional status. According to the latest figures available, an estimated 2.5 billion
people lack proper sanitation facilities feasible, and nearly a billion people do not have access
to safe drinking water. This unhealthy environment allows the pathogens that cause diarrhea
to spread easier (Cairo et al., 2020).

Diarrhea is a major killer of children accounting for about 8 percent of all deaths
among children under the age of 5 year around the world. Most deaths from diarrhea occur
among children children under the age of 5 living in South Asia and sub-Saharan Africa
(UNICEF, 2018).

Diarrhea is an endemic disease with potential for Extraordinary Events (KLB). often
accompanied by death in Indonesia. Diarrhea is still one health problems in Indonesia as the
largest contributor to the death rate in the group of children aged 29 days – 11 months.
Diarrhea is the most common disease number 2 which causes death in children in Indonesia,
namely as many as 746 deaths counted in 2019. Diarrhea morbidity rate in Indonesia based
on the diagnosis of health workers by 6.8%. Age group with The highest prevalence of
diarrhea (based on the diagnosis of health workers) is at age group 1-4 years by 11.5% and in
infants by 9% (Ministry RI Health, 2019).
A. Definition of diarrhea

Diarrhea is a disease characterized by excess bowel movements three times a day with
a change in the shape and consistency of the stool until it is soft liquefying which may be
accompanied by vomiting or bloody stools (WHO, 2017). Diarrhea is a condition in which a
person defecates with the consistency is soft or liquid, it can even be just water and the
frequency is more often (usually three times or more) in one day (MOH, 2011).

B. Etiology of diarrhea

Diarrhea is caused by a number of bacterial, viral and parasitic organisms, which are
mostly spread by water contaminated with faeces. Infections are more common when
sanitation is poor and water hygiene is safe for drinking, cooking and inadequate cleaning.
Rotavirus and Escherichia coli are two the most common etiological agent of moderate to
severe diarrhea in the country low income country. Other pathogens such as Cryptosporidium
species and Shigella may also cause diarrheal infections. Site-specific etiologic pattern as
well need to be considered. The next cause of diarrhea is malnutrition. Child Children who
die from diarrhea often suffer from malnutrition which makes them sick they are more prone
to diarrhea.

Diarrhea is a major cause of malnutrition in children under five years and causes
diarrheal disease their malnutrition gets worse (WHO, 2017) .

Water contaminated with human waste, for example, from sewage, septic tanks and
latrines, are of particular concern. Animal dung too contain microorganisms that can cause
diarrhea. Diarrhea can also transmitted from person to person, this situation is exacerbated by
poor personal hygiene bad. Food is a major cause of diarrhea when cooked or stored in
unhygienic conditions. Unsafe storage and handling of water as well is an important risk
factor. Fish and seafood from polluted water can also contribute to diarrheal disease (WHO,
2017).

According to Susilaningrum, Nursalam and Utami (2013) there are several behaviors
One thing that can increase the risk of diarrhea is not giving exclusive breastfeeding full for
the first 6 months of life, use a bottle, save cooked food at room temperature, drinking water
contaminated with fecal bacteria, no wash hands after defecation, after removing feces, and
before eat food.
C. Mechanism of diarrhea

Diarrhea can occur due to basic mechanisms such as osmotic disturbances, impaired
secretion and impaired intestinal motility. Osmotic disturbances occur due to there are foods
or substances that cannot be absorbed by the body and cause osmotic pressure in the intestine
increases so that water and electrolytes experience shift into the intestinal cavity. Impaired
secretion occurs as a result stimulation of toxins in the intestine which will cause an increase
secretion of water and electrolytes into the intestinal cavity and cause diarrhea.

Hyperistaltic in the intestine also results in reduced ability of the intestine to absorb
food and eventually cause diarrhea (Ambarwati & Nasution, 2015).

D. Clinical manifestations

According to the Indonesian Ministry of Health (2015), signs and symptoms of

diarrhea in children is as follows:

a. Acute diarrhea

1) Diarrhea with severe dehydration: lethargy or unconsciousness, sunken eyes, unable to

drink or lazy to drink, skin turgor returns very slowly.

2) Mild/moderate dehydration diarrhea: restlessness, fussiness, irritability, sunken eyes, skin

turgor returns slowly.

3) Diarrhea without dehydration: the baby is conscious, the eyes are not sunken, there is no
thirst excess and normal skin turgor.

b. Persistent or chronic diarrhea with/without dehydration

c. Dysentery diarrhea: there is blood in the stool

E. Classification and symptoms of diarrhea

Diarrhea can be grouped into 3, namely acute diarrhea, namely diarrhea that occurs
suddenly and lasts a maximum of 3-5 days, if diarrhea is prolonged diarrhea lasts more than 7
days, chronic diarrhea if diarrhea lasts more than 14 day (Ambarwati and Nasution, 2015)
 Classification and symptoms according to the guidebook LINTAS Diarrhea (2011),
namely as follows:

SYMPTOM CLASSIFICATION
There are two or more following signs:
a. Lethargic or unconscious
b. Sunken eyes. Severe Dehydrated Diarrhea

c. Can't drink or lazy drink.

d. Skin turgor returns greatly slow
There are two or more following signs:
a. Restless, fussy
b. Sunken eyes
c. Always want to drink, there is a taste Dehydrated Diarrhea Medium/Mild

thirsty
d. Skin turgor returns slowly
There are two or more following signs:
a. The general condition is good and
conscious Diarrhea Without Dehydration

b. Eyes are not sunken

c. There is no excess thirst
d. Normal turgor

F. Complications of diarrhea

The most severe complication caused by diarrhea is dehydration. When experience

water diarrhea and electrolyte loss through liquid stools, vomiting, sweating, urine and
breathing. Dehydration occurs when fluid loss is not replaced immediately (WHO, 2017).

According to Ambarwati and Nasution (2015) as a result of acute diarrhea and

chronic, the following can occur:

a. Loss of water and electrolytes (dehydration occurs)

This condition can cause acid-base balance disturbances (metabolic acidosis) due to:

1) Loss of sodium bicarbonate with feces

2) Presence of starvation ketosis and imperfect fat metabolism, so that ketone bodies
accumulate in the body.

3) Lactic acid accumulation occurs due to tissue anoxia

4) Metabolism products that are acidic increase because they can't excreted by the kidneys
(oliguria and anuria occur).

5) Transfer of sodium ions and extracellular fluid into the intracellular fluid.

b. hypoglycemia

Hypoglycemia occurs in 2-3% of children with diarrhea and more It often occurs in
children who have previously suffered from CTF.

c. Nutritional Disorders

When children suffer from diarrhea, nutritional disorders often occur resulting in
weight gain children tend to decrease, this is because parents are worried about diarrhea or
the vomiting will get worse.

d. Circulation Disorders

Diarrhea with or without vomiting can cause circulatory disturbances blood in the
form of hypovolemic shock, due to reduced tissue perfusion and hypoxia, acidosis worsens.

Bibliography

IDAI 2015. Tinja Bayi Normal atau Tidak. Diakses tanggal 24 November 2022 Dari
http://idai.go.id.

Dinas Kesehatan Provinsi Bali. 2019. Profil Kesehatan Provinsi Bali Tahun 2018.
https://www.diskes.baliprov.go.id/profil-kesehatan-provinsi-bali diakses tanggal 24
November 2022.