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Peran Cuci Tangan Pakai Sabun Dan Akses Air Bersih Terhadap Diare Berulang Dan Status Gizi Balita: Tinjauan Sistematis
Abstract
Diare berulang dan gizi kurang (stunting) tetap menjadi tantangan kesehatan masyarakat utama pada anak di negara berpenghasilan rendah dan menengah. Infeksi enterik akibat sanitasi dan higiene yang buruk menyebabkan Environmental Enteric Dysfunction (EED), yang mengganggu penyerapan nutrisi dan menghambat pertumbuhan. Sementara intervensi nutrisi menunjukkan perbaikan kecil dalam pertumbuhan, peran Water, Sanitation, and Hygiene (WASH) dianggap krusial. Adapun tujuan penelitian ini adalah menganalisis peran praktik Cuci Tangan Pakai Sabun (CTPS) yang intensif dan ketersediaan sarana air bersih dalam mencegah diare berulang pada balita serta dampaknya terhadap status gizi anak. Pencarian literatur dilakukan melalui laman elektronik PubMed, UBESCO, dan Spriner dengan batas waktu terbit selama sepuluh tahun. Tinjauan sistematis dan sintesis bukti dilakukan dari uji coba terkontrol acak (RCT) skala besar (WASH Benefits, SHINE) dan meta-analisis di LMICs. Data difokuskan pada CTPS, diare, dan hasil pertumbuhan (Length-for-Age Z-score/LAZ). Hasil yang didapatkan yaitu CTPS terbukti dapat menurunkan diare berulang. Sebuah penelitian di Pakistan menunjukkan pengurangan insiden diare sebesar 53% secara keseluruhan dan 39% pada bayi di bawah 1 tahun, menegaskan manfaat perlindungan bagi kelompok berisiko tinggi. Namun, intervensi CTPS dan air bersih elementer saja tidak menunjukkan efek pada perbaikan stunting dalam RCT. Efek positif pada pertumbuhan (LAZ, WAZ) hanya terdeteksi ketika intervensi WASH digabungkan secara sinergis dengan nutrisi (MD = 0.13 untuk LAZ; MD = 0.09 untuk WAZ). Kegagalan intervensi dasar menunjukkan bahwa lingkungan tetap sangat terkontaminasi. Kesimpulannya yakni CTPS dan air bersih adalah pilar utama dalam mengurangi diare. Namun, untuk mengatasi stunting, diperlukan pendekatan "Transformative WASH" yang terintegrasi dengan nutrisi untuk secara radikal mengurangi kontaminasi fekal dan memastikan perbaikan status gizi balita. Program harus berinovasi untuk mencapai dan mempertahankan kepatuhan CTPS yang tinggi.
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DOI: https://doi.org/10.33024/jmm.v10i1.24697
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