THE RELATIONSHIP BETWEEN CLIMATE VARIABILITY AND INFANT DIARRHEA IN A COASTAL AREA OF JAKARTA
DOI:
https://doi.org/10.22437/jiituj.v10i1.53419Keywords:
Climate, Diarrhea, Infant, Seasons, Time Series AnalysisAbstract
This study examines climatic patterns and the delayed relationship between climate factors and diarrheal cases in this age group. This ecological panel study uses secondary data on monthly diarrhea cases in Penjaringan Subdistrict, North Jakarta, Indonesia. Diarrhea cases obtained from the DKI Jakarta Provincial Health Office between 2013 and 2024 (144 months). Climate factors included temperature, rainfall, relative humidity, and El Niño–Southern Oscillation (ENSO) index. The analysis of climatic patterns was examined descriptively. Associations were analyzed using a negative binomial mixed-effects model with distributed lags to account for delayed effects and spatial heterogeneity. The results indicate that infant diarrhea cases varied significantly by season. An increase of 1°C in temperature at lag 1 increased the case rate by 35% (IRR = 1.35; p = 0.038). Rainfall at lags 0 and 1 showed a small but substantial positive relationship with diarrhea. Higher relative humidity was associated with a lower risk, while ENSO conditions were positively associated with diarrhea. The study found that local meteorological conditions and large-scale climate variability influence the incidence of infant diarrhea in coastal areas. The novelty of this study lies in integrating a distributed lag model with ENSO effects on vulnerable populations. These findings support the development of climate-sensitive monitoring and early warning systems, and strengthening water, sanitation, and hygiene interventions during periods of high climate risk may help reduce the burden of diarrheal disease among high-risk groups.
Downloads
References
Adams, N., Dhimal, M., Mathews, S., Iyer, V., Murtugudde, R., Liang, X.-Z. X. Z., Haider, M., Cruz-Cano, R., Thu, D. T. A., Hashim, J. H., Gao, C., Wang, Y.-C. Y. C., & Sapkota, A. (2022). El Niño Southern Oscillation, monsoon anomaly, and childhood diarrheal disease morbidity in Nepal. PNAS Nexus, 1(2), 1–7. https://doi.org/10.1093/pnasnexus/pgac032.
Adeboyejo, A. T., Adejumobi, D. O., Adewoyin, Y., & Oyasiji, A. O. (2020). Spatial and demographic patterns of climate related diseases among hospitalized children in parts of southwest nigeria. Human Geographies, 14(1), 59–71. https://doi.org/10.5719/hgeo.2020.141.4.
Aik, J., Ong, J., & Ng, L.-C. L. C. (2020). The effects of climate variability and seasonal influence on diarrhoeal disease in the tropical city-state of Singapore – A time-series analysis. International Journal of Hygiene and Environmental Health, 227(March), 113517. https://doi.org/10.1016/j.ijheh.2020.113517.
Alfiansyah, I., Dolphina, E., Astuti, A., & Murthada. (2023). Effects of climate change on environmental health in the Jakarta Metropolitan Area. West Science Nature and Technology, 1(02), 73–80. https://doi.org/10.58812/wsnt.v1i02.492.
Alqassim, A. Y. (2025). Differential impacts of extreme weather events on vector-borne disease transmission across urban and rural settings: A scoping review. Healthcare, 13(2425), 1–25. https://doi.org/https://doi.org/10.3390/ healthcare13192425.
Bhandari, D., Bi, P., Sherchand, J. B., Dhimal, M., & Hanson-Easey, S. (2020). Assessing the effect of climate factors on childhood diarrhoea burden in Kathmandu, Nepal. International Journal of Hygiene and Environmental Health, 223(1), 199–206. https://doi.org/10.1016/j.ijheh.2019.09.002.
Bolker, B. M., Brooks, M. E., Clark, C. J., Geange, S. W., Poulsen, J. R., Stevens, M. H. H., & White, J. S. S. (2009). Generalized linear mixed models: a practical guide for ecology and evolution. Trends in Ecology and Evolution, 24(3), 127–135. https://doi.org/10.1016/j.tree.2008.10.008.
Chua, P. L. C. C., Huber, V., Ng, C. F. S., Seposo, X. T., Madaniyazi, L., Hales, S., Woodward, A., & Hashizume, M. (2021). Global projections of temperature-attributable mortality due to enteric infections: a modelling study. The Lancet Planetary Health, 5(7), e436–e445. https://doi.org/10.1016/S2542-5196(21)00152-2.
Daoud, J. I. (2017). Multicollinearity and Regression Analysis. IOP Conference Series: Journal of Physics, 949(012009). https://doi.org/10.1088/1742-6596/949/1/012009.
Delahoy, M. J., Cárcamo, C., Huerta, A., Lavado, W., Escajadillo, Y., Ordoñez, L., Vasquez, V., Lopman, B., Clasen, T., Gonzales, G. F., Steenland, K., & Levy, K. (2021). Meteorological factors and childhood diarrhea in Peru, 2005–2015: a time series analysis of historic associations, with implications for climate change. Environmental Health: A Global Access Science Source, 20(1), 1–10. https://doi.org/10.1186/s12940-021-00703-4.
Deshpande, A., Miller-Petrie, M. K., Lindstedt, P. A., Baumann, M. M., Johnson, K. B., Blacker, B. F., Abbastabar, H., Abd-Allah, F., Abdelalim, A., Abdollahpour, I., Abegaz, K. H., Abejie, A. N., Abreu, L. G., Abrigo, M. R. M., Abualhasan, A., Accrombessi, M. M. K., Adamu, A. A., Adebayo, O. M., Adedeji, I. A., … Reiner, R. C. (2020). Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000–17. The Lancet Global Health, 8(9), e1162–e1185. https://doi.org/https://doi.org/10.1016/S2214-109X(20)30278-3.
Dharmayanti, I., Tjandrarini, D. H., & Hidayangsih, P. S. (2022). Climatic Factors and Childhood Diarrhea in South Kalimantan in 2017-2020. Southeast Asian Journal of Tropical Medicine and Public Health, 53(Supplement 2), 65–80.
Dhimal, M., Bhandari, D., Karki, K. B., Shrestha, S. L., Khanal, M., Shrestha, R. R. P., Dahal, S., Bista, B., Ebi, K. L., Cissé, G., Sapkota, A., & Groneberg, D. A. (2022). Effects of climatic factors on diarrheal diseases among children below 5 years of age at national and subnational levels in Nepal: An ecological study. International Journal of Environmental Research and Public Health, 19(10), 6138. https://doi.org/10.3390/ijerph19106138.
Fang, X., Liu, W., Ai, J., He, M., Wu, Y., Shi, Y., Shen, W., & Bao, C. (2020). Forecasting incidence of infectious diarrhea using random forest in Jiangsu Province, China. BMC Infectious Diseases, 20(1), 1–8. https://doi.org/10.1186/s12879-020-4930-2.
Geremew, G., Cumming, O., Haddis, A., Freeman, M. C., & Ambelu, A. (2024). Rainfall and Temperature Influences on Childhood Diarrhea and the Effect Modification Role of Water and Sanitation Conditions: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health, 21(7), 823. https://doi.org/10.3390/ijerph21070823.
Gobena, T., & Mengistu, D. A. (2025). Impact of Climate Variability on Foodborne Diarrheal Disease: Systematic Review and Meta-Analysis. Public Health Reviews, 46(February), 1–13. https://doi.org/10.3389/phrs.2025.1607859.
Grembi, J. A., Nguyen, A. T., Riviere, M., Heitmann, G. B., Patil, A., Athni, T. S., Djajadi, S., Ercumen, A., Lin, A., Crider, Y., Mertens, A., Karim, M. A., Islam, M. O., Miah, R., Famida, S. L., Hossen, M. S., Mutsuddi, P., Ali, S., Rahman, M. Z. M., … Benjamin-Chung, J. (2024). Influence of hydrometeorological risk factors on child diarrhea and enteropathogens in rural Bangladesh. PLOS Neglected Tropical Diseases, 18(5), e0012157. https://doi.org/10.1371/journal.pntd.0012157.
Hajat, S., Gampe, D., Sarsour, A., & Abuzerr, S. (2022). Climate change and diarrhoeal disease burdens in the gaza strip, palestine: Health impacts of 1.5◦c and 2◦c global warming scenarios. International Journal of Environmental Research and Public Health, 19(8). https://doi.org/10.3390/ijerph19084898.
Hanifa, R., & Wiratmo, J. (2024). ENSO and IOD influence on extreme rainfall in Indonesia : Historical and Future Analysis. Agromet, 38(2), 78–87. https://doi.org/10.29244/j.agromet.38.2.78-87.
Haque, F., Lampe, F. C., Hajat, S., Stavrianaki, K., Hasan, S. M. T., Faruque, A. S. G., Ahmed, T., Jubayer, S., & Kelman, I. (2024). Impacts of climate change on diarrhoeal disease hospitalisations: How does the global warming targets of 1.5-2°C affect Dhaka, Bangladesh? PLoS Neglected Tropical Diseases, 18(9), e0012139. https://doi.org/10.1371/journal.pntd.0012139.
Hardin, J. W., & Hilbe, J. M. (2014). Regression models for count data based on the negative binomial(p) distribution. Stata Journal, 14(2), 280–291. https://doi.org/10.1177/1536867x1401400203.
Heaney, A. K., Shaman, J., & Alexander, K. A. (2019). El Niño-Southern oscillation and under-5 diarrhea in Botswana. Nature Communications, 10(1). https://doi.org/10.1038/s41467-019-13584-6.
Horn, L. M., Hajat, A., Sheppard, L., Quinn, C., Colborn, J., Zermoglio, M. F., Gudo, E. S., Marrufo, T., & Ebi, K. L. (2018). Association between precipitation and diarrheal disease in Mozambique. International Journal of Environmental Research and Public Health, 15(4). https://doi.org/10.3390/ijerph15040709.
Hossain, N., Madaniyazi, L., Ng, C. F. S., Nasrin, D., Seposo, X. T., Chua, P. L. C., Pan, R., Faruque, A. S. G., & Hashizume, M. (2024). Short-term associations of diarrhoeal diseases in children with temperature and precipitation in seven low-and middle-income countries from Sub-Saharan Africa and South Asia in the Global Enteric Multicenter Study. PLoS Neglected Tropical Diseases, 2024-Octob, 1–17. https://doi.org/10.1371/journal.pntd.0011834.
Huynh, T. T. N., Hofstra, N., Nguyen, H. Q., Baker, S., Pathirana, A., Corzo Perez, G. A., & Zevenbergen, C. (2024). Estimating disease burden of rotavirus in floodwater through traffic in the urban areas: A case study of Can Tho city, Vietnam. Journal of Flood Risk Management, 17(1), 1–20. https://doi.org/10.1111/jfr3.12955.
Karuppusami, R., Antonisamy, B., Suresh, B., Siaw-frimpong, M., Korula, P. J., & Choudhury, R. (2026). Robustness of zero truncated negative binomial models over traditional models with application to analysing factor association to length of ICU stay in a middle- income country. BMC Research Notes, 19:63, 1–12. https://doi.org/10.1186/s13104-026-07644-6.
Kotloff, K. L. (2017). The burden and etiology of diarrheal illness in developing countries. Pediatric Clinics of North America, 64(4), 799–814. https://doi.org/10.1016/j.pcl.2017.03.006.
Kraay, A. N. M. M., Man, O., Levy, M. C., Levy, K., Ionides, E., & Eisenberg, J. N. S. S. (2020). Understanding the impact of rainfall on diarrhea: Testing the concentration-dilution hypothesis using a systematic review and meta-analysis. Environmental Health Perspectives, 128(12), 126001-1-126001–126016. https://doi.org/10.1289/EHP6181.
Lan, T., Hu, Y., Cheng, L., Chen, L., Guan, X., Yang, Y., Guo, Y., & Pan, J. (2022). Floods and diarrheal morbidity: Evidence on the relationship, effect modifiers, and attributable risk from Sichuan Province, China. Journal of Global Health, 12, 11007. https://doi.org/10.7189/JOGH.12.11007.
Lee, T. T., Dalvie, M. A., Röösli, M., Merten, S., Kwiatkowski, M., Mahomed, H., Sweijd, N., & Cissé, G. (2023). Understanding diarrhoeal diseases in response to climate variability and drought in Cape Town, South Africa: a mixed methods approach. Infectious Diseases of Poverty, 12(1), 1–14. https://doi.org/10.1186/s40249-023-01127-7.
Levy, K., Smith, S. M., & Carlton, E. J. (2018). Climate Change Impacts on Waterborne Diseases: Moving Toward Designing Interventions. Current Environmental Health Reports, 5(2), 272–282. https://doi.org/10.1053/j.gastro.2019.03.013.Mechanical.
Malik, I., Anjayati, S., Musdhalifa, P., Binti, D., & Tosepu, R. (2021). Impact of weather and climate on diarrhea incidence: A review. IOP Conference Series: Earth and Environmental Science, 755(1). https://doi.org/10.1088/1755-1315/755/1/012088.
Martín-Miguélez, J. M., Martín, I., Peromingo, B., & Delgado, J. (2025). Pathogen and spoilage microorganisms in meat and dairy analogues: Occurrence and control strategies. Foods, 14(1819). https://doi.org/10.3390/foods14101819.
Mengistie, B., Gobena, T., Admassu, D., Assefa, N., Mekbib Ayele, D., Mengistu, D. A., Worku, A., Kumie, A., Terfa, W., Bikila, Z., & Azage, M. (2022). Seasonal variability influence on the prevalence of diarrhoea among under-five-year-old children in Kersa District, Eastern Ethiopia: A Community-Based Longitudinal Study. Environmental Health Insights, 16. https://doi.org/10.1177/11786302221093480.
Pan, R., Chua, P. L. C., Madaniyazi, L., Fook, C., Ng, S., Tobias, A., Guo, Q., Ling, V., Phung, H., Hossain, N., Lynch, V., Jung, C., Salazar, M. A., Roye, D., Phung, D., Sousa, M. De, Stagliorio, Z., Hilario, P., Saldiva, N., … Hashizume, M. (2025). The association between total precipitation and diarrhea morbidity: A multicountry study across diverse climate zones Rui. Environmental Epidemiology, 9:e430, 1–10. https://doi.org/10.5061/dryad.dk1j0.
Paulos, A. P., Mboya, J., Lowe, J., Kim, D. D., Wharton, H. C., Thuita, F., Flax, V. L., Njenga, S. M., Harris, A. R., & Pickering, A. J. (2025). Zoonotic and Environmental Sources of Infant Enteric Pathogen Infections Identified with Longitudinal Sampling [Research-article]. Environmental Science and Technology, 59(26), 13181–13191. https://doi.org/10.1021/acs.est.5c02027.
Perreault, S., Dong, G. Y., Stringer, A., Shin, H., & Brown, P. E. (2024). Case-crossover designs and overdispersion with application to air pollution epidemiology. Biometrics, 80(4). https://doi.org/10.1093/biomtc/ujae117.
Phuangrach, N., & Sarakarn, P. (2023). Using multilevel negative binomial modeling to detect active smoking in colorectal cancer screening. Asian Pacific Journal of Cancer Prevention, 24(8), 2823–2827. https://doi.org/10.31557/APJCP.2023.24.8.2823.
Phung, D., Rutherford, S., Chu, C., Wang, X., Nguyen, M., Nguyen, N. H., Do, C. M., Nguyen, T. H., & Huang, C. (2015). Temperature as a risk factor for hospitalisations among young children in the Mekong Delta area, Vietnam. Occupational and Environmental Medicine, 72(7), 529–535. http://www.jstor.org/stable/43870095.
Rahaman, M. R., Dear, K., Satter, S. M., Tong, M., Milazzo, A., Marshall, H., Varghese, B. M., Rahman, M., & Bi, P. (2023). Short-Term effects of climate variability on childhood diarrhoea in bangladesh: multi-site time-series regression analysis. International Journal of Environmental Research and Public Health, 20(13). https://doi.org/10.3390/ijerph20136279.
Rizki, S., Simaremare, S., Mph, B. R., Nugraheni, W. P., Rizki, D., & Mepi, F. (2025). How sociodemographic, water, and sanitation factors influence diarrhea in children under five: Insights from indonesia’s underdeveloped regions. Hamadan University of Medical Sciences, 25(1), e00636–e00636. https://doi.org/10.34172/jrhs.2025.171.
Troeger, C. E., Khalil, I. A., Blacker, B. F., Biehl, M. H., Albertson, S. B., Zimsen, S. R. M., Rao, P. C., Abate, D., Ahmadi, A., Ahmed, M. L. C. brahim, Akal, C. G., Alahdab, F., Alam, N., Alene, K. A., Alipour, V., Aljunid, S. M., Al-Raddadi, R. M., Alvis-Guzman, N., Amini, S., … Reiner, R. C. (2020). Quantifying risks and interventions that have affected the burden of diarrhoea among children younger than 5 years: an analysis of the Global Burden of Disease Study 2017. The Lancet Infectious Diseases, 20(1), 37–59. https://doi.org/10.1016/S1473-3099(19)30401-3.
Wang, M. (2014). Generalized estimating equations in longitudinal data analysis: A review and recent developments. Advances in Statistics, 303728, 1–11. https://doi.org/10.1155/2014/303728.
Wang, P., Asare, E. O., Pitzer, V. E., Dubrow, R., & Chen, K. (2023). Floods and diarrhea risk in young children in low-and middle-income countries. JAMA Pediatrics, 177(11), 1206–1214. https://doi.org/10.1001/jamapediatrics.2023.3964.
Wang, P., Asare, E., Pitzer, V. E., Dubrow, R., & Chen, K. (2022). Associations between long-term drought and diarrhea among children under five in low- and middle-income countries. Nature Communications, 13(1), 3661. https://doi.org/10.1038/s41467-022-31291-7.
WHO. (2017). Diarrhoeal disease: Key facts. WHO Fact Sheet. https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease.
WHO. (2021). Quality criteria for health national adaptation plans. World Health Organization. https://www.who.int/publications/i/item/9789240018983.
Yadav, A. (2026). Temperature extremes and stillbirth risk in Bihar , India : a panel data analysis , 2009 –. BMC Pregnancy and Childbirth, 26:121, 1–10. https://doi.org/10.1186/s12884-025-08620-x.
Yeh, D. Y., Leu, J. H., Ye, S., & Cheng, C. H. (2025). An intelligent autoregressive-distributed lag model: A climate-driven approach for predicting dengue fever incidence in Taiwan cities. Acta Tropica, 269(July). https://doi.org/10.1016/j.actatropica.2025.107761.
Zhang, X., Wang, Y., Zhang, W., Wang, B., Zhao, Z., Ma, N., Song, J., Tian, J., Cai, J., & Zhang, X. (2024). The effect of temperature on infectious diarrhea disease: A systematic review. Heliyon, 10(11), e31250. https://doi.org/10.1016/j.heliyon.2024.e31250.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Ika Dharmayanti, Rachmadhi Purwana, Dwi Hapsari Tjandrarini, Tri Edhi Budhi Soesilo

This work is licensed under a Creative Commons Attribution 4.0 International License.











