Uncovering the spatial link between environmental risks, diarrhea incidence, and health service accessibility
DOI:
https://doi.org/10.61511/eam.v3i1.2025.1946Keywords:
diarrhea, environmental risk, GIS , healthcare accessibility, spatial disparitiesAbstract
Background: This study investigates spatial disparities between healthcare capacity, hospital accessibility, and environmental risk of diarrhea in West Java Province. Using a combination of Geographic Information System (GIS), network-based travel-time modeling, Principal Component Analysis (PCA), and clustering, the research identifies mismatches high-risk areas and low-access healthcare infrastructure. Spatial overlay reveals that districts such as Tasikmalaya, Garut, and Cianjur experience dual vulnerabilities—limited healthcare reach and elevated environmental risk indicators. Methods: PCA was used to reduce multicollinearity among six environmental and socioeconomic variables, including access to sanitation, drinking water, latrine type, and poverty level. After excluding three extreme outliers, 24 districts were clustered using PCA-derived composite scores. The clusters were overlaid with hospital accessibility maps from service area analyses (≤30 and 31–60 minutes). PCA explained 80.4% of the total variance. Findings: The results show that 3 out of 27 districts, such as Tasikmalaya, Garut, and Cianjur; exhibited critically low hospital bed ratios, and over 50% of their population is located outside the 30-minute service area of a hospital. PCA-based clustering revealed four spatial risk typologies, with Cluster 4 (extreme outliers) representing the highest composite risk from poor sanitation, communal latrines, and high poverty. These findings underscore a spatial mismatch between environmental vulnerability and healthcare accessibility. Conclusion: Integrated spatial planning is urgently needed in high-risk, low-access areas, combining infrastructure expansion with digital health solutions. Novelty/Originality of this article: This study introduces a spatial typology of diarrhea risk in West Java by integrating PCA and GIS-based accessibility, and aligns its recommendations with Indonesia’s national health policy frameworks (RPJMN 2025–2029 and PP No. 28/2024) to support data-driven, equitable public health interventions.
References
Alum, E. U., Obeagu, E. I., & Ugwu, O. P. C. (2024). Enhancing quality water, good sanitation, and proper hygiene is the panacea to diarrhea control and the attainment of some related sustainable development goals: A review. In Medicine (Vol. 103, Issue 38, p. e39578). https://doi.org/10.1097/MD.0000000000039578
Aprianoor, P., & Muktiali, M. (2015). Kajian Ketimpangan Wilayah di Provinsi Jawa Barat. Teknik PWK (Perencanaan Wilayah Kota), 4(4), 484-498. https://doi.org/10.14710/tpwk.2015.9809
Arief, M. H., Afandi, K., Kustin, K., Arifin, I. F., & Laily, N. F. (2023). Analisis Spasial Aksesibilitas Fasilitas Kesehatan di Kabupaten Jember. Jurnal Minfo Polgan, 12(2), 1764–1771. https://doi.org/10.33395/jmp.v12i2.12984
Badan Pusat Statistik. (2024a). Jumlah Perceraian Menurut Provinsi dan Faktor tahun 2023. https://www.bps.go.id/id/statistics-table/3/YVdoU1IwVmlTM2h4YzFoV1psWkViRXhqTlZwRFVUMDkjMw==/number-of-divorces-by-province-and-factors--2022.html?year=2023
Badan Pusat Statistik. (2024b). Profil Kesehatan Ibu dan Anak 2024. https://www.bps.go.id/id/publication/2024/12/31/a919c55a72b74e33d011b0dc/profil-kesehatan-ibu-dan-anak-2024.html
Badan Pusat Statistik. (2024c). Provinsi Jawa Barat dalam Angka 2024. https://jabar.bps.go.id/id/publication/2024/02/28/35ffe2d35104b39feb577e8f/provinsi-jawa-barat-dalam-angka-2024.html
Badan Pusat Statistik. (2025). Jumlah Penduduk Miskin (Ribu Jiwa) Menurut Provinsi dan Daerah tahun 2024. https://www.bps.go.id/id/statistics-table/2/MTg1IzI=/jumlah-penduduk-miskin-ribu-jiwa-menurut-provinsi-dan-daerah.html
Barwanto, L. A., & Ramadhan, A. (2024). Identifikasi pola demografi di Provinsi Jawa Barat dengan spatial autocorrelation: Mempersiapkan momentum puncak bonus demografi. Creative Research Journal, 10(01), 1-16. https://doi.org/10.34147/crj.v10i1.327
Boeing, G., Higgs, C., Liu, S., Giles-Corti, B., Sallis, J. F., Cerin, E., ... & Arundel, J. (2022). Urban design, transport, and health 3 Using open data and open-source software to develop spatial indicators of urban design and transport features for achieving healthy and sustainable cities. Lancet global health, 10, e907-918. https://doi.org/10.1016/S2214-109X(22)00072-9
Chandrashekhar, Y., Alexander, T., Mullasari, A., Kumbhani, D. J., Alam, S., Alexanderson, E., ... & Narula, J. (2020). Resource and infrastructure-appropriate management of ST-segment elevation myocardial infarction in low-and middle-income countries. Circulation, 141(24), 2004-2025. https://doi.org/10.1161/CIRCULATIONAHA.119.041297
Chowdhury, J., & Ravi, R. P. (2022). Healthcare Accessibility in Developing Countries: A Global Healthcare Challenge. Journal of Clinical & Biomedical Research, 1–5. https://doi.org/10.47363/JCBR/2022(4)152
Del Pinto, M., Chmutina, K., Palaiologou, F., & Bosher, L. (2024). The Role of the Spatial Network in Urban Disaster Risk Variations: Reimagining the Notion of Spatial Vulnerability at the Urban Scale. International Journal of Disaster Risk Science, 15(3), 303–316. https://doi.org/10.1007/s13753-024-00554-w
Dinas Kesehatan Provinsi Jawa Barat. (2024). Profil Kesehatan Provinsi Jawa Barat Tahun 2023. https://diskes.jabarprov.go.id/profilkesehatan
Dwi, A., Mubasyiroh, L.-R., Laksmiarti, T., Nurhotimah, E., & Sukoco, S.-N. E. (2016). Aksesibilitas Pelayanan Kesehatan di Indonesia. PT Kanisius.
Effendi, D. E., Handayani, S., Nugroho, A. P., Ardani, I., Fitrianti, Y., Karlina, K., & Latifah, C. (2024). The Significance of Physician-Patient Communication on Telemedicine Patients’ Health Outcomes: Evidence from Indonesia. Health Communication, 39(10), 1932–1941. https://doi.org/10.1080/10410236.2023.2247852
Elliott, P., & Wartenberg, D. (2004). Spatial epidemiology: current approaches and future challenges. Environmental health perspectives, 112(9), 998-1006. https://doi.org/10.1289/ehp.6735
Fahira, N. N., Sihaloho, E. D., & Siregar, A. Y. M. (2021). Pengaruh konsumsi air dan keberadaan fasilitas sanitasi terhadap angka diare pada anak-anak di Indonesia. Jurnal Epidemiologi Kesehatan Komunitas, 6(2), 286–292. https://doi.org/10.14710/jekk.v6i2.10871
Fariza, A., Basofi, A., & Aryani, M. D. (2021). Spatial Mapping of Diphtheria Vulnerability Level in East Java, Indonesia, using Analytical Hierarchy Process - Natural Break Classification. Journal of Physics: Conference Series, 1803(1). https://doi.org/10.1088/1742-6596/1803/1/012009
Fatkhullah, M., Habib, M. A. F., & Nisa, K. K. (2022). Identifikasi dan manajemen risiko untuk mereduksi kerentanan pada masyarakat. Ekonomi, Keuangan, Investasi Dan Syariah (EKUITAS), 3(4), 856–867. https://doi.org/10.47065/ekuitas.v3i4.1529
Futri, I., & Naruetharadhol, P. (2025). Open innovation’s effects on Indonesia’s digital health market and related societal issues. Cogent Arts and Humanities, 12(1). https://doi.org/10.1080/23311983.2025.2457819
Goodchild, M. F. (2007). Citizens as Sensors: Web 2.0 and The Volunteering of Geographic Information. Geofocus, 7, 8–10. www.flickr.com
Hafwi, L., Fauzi, N., Martini, M., Udijono, A., & Hestiningsih, R. (2023). Hubungan penerapan sanitasi total berbasis masyarakat dengan kejadian diare anak balita di wilayah kerja Puskesmas Sumbang I. Jurnal Riset Kesehatan Masyarakat, 2023, 4. https://doi.org/10.14710/jrkm.2023.19
Handayani, D., Junadi, P., & Achadi, A. (2019). The readiness of resources the implementation of maternal health services indicators for the minimum services standards in Depok West Java Indonesia. Indian Journal of Public Health Research and Development, 10(5), 1363–1367. https://doi.org/10.5958/0976-5506.2019.01120.3
Haningrum, D. S., Sabri, L. M., & Firdaus, H. S. (2023). Kajian Penilaian Kualitas Data VGI (Voluntered Geographic Information: OpenstreetMap) Untuk Keperluan Tata Ruang (Studi Kasus: Kota Semarang). Jurnal Geodesi Undip, 11(4), 123-130. https://doi.org/10.14710/jgundip.2022.35821
Huda, M., & Najicha, F. U. (2023). Analisis ketentuan perancangan tata ruang wilayah yang baik berdasarkan Undang-Undang Nomor 26 Tahun 2007. Jurnal Hukum POSITUM, 8(1), 96-110. https://doi.org/10.35706/positum.v8i1.9508
Husna, S., & Purwandari, T. (2023). Analisis pemetaan faktor penyebab diare di Jawa Barat menggunakan metode K-Means clustering. Seminar Nasional Statistika Aktuaria II. http://prosidingsnsa.statistics.unpad.ac.id/
Jannah, M., Susanti, R., & Ismail AB. (2023, August). Faktor yang memengaruhi kejadian diare pada balita di indonesia dengan menggunakan regresi data panel. In Prosiding Seminar Nasional Matematika dan Statistika (Vol. 3, No. 01, pp. 168-182). https://jurnal.fmipa.unmul.ac.id/index.php/SNMSA/article/view/1181
Khairunnisa, D. F., Zahra, I. A., Ramadhania, B., & Amalia, R. (2020). Faktor risiko diare pada bayi dan balita di Indonesia: A Systematic Review. In Prosiding Seminar Nasional Kesehatan Masyarakat 2023 (Vol. 1, No. 1, pp. 172-189). https://conference.upnvj.ac.id/index.php/semnashmkm2020/article/view/1060
Komar, Z., Lestari, K., Meiliana, A., & Mukti, A. G. (2022). Evaluation of clinical pharmacy services in community health centres to support Indonesian health programme in West Java Indonesia. Pharmacy Education, 22(2), 278–283. https://doi.org/10.46542/pe.2022.222.278283
Kondolele, Y. B., Rahmatia, & Mustari, B. (2023). Analisis Determinan Kualitas Lingkungan Hidup di Pulau Jawa. Jurnal Ekonomika dan Dinamika Sosial, 2(2), 45-65. http://journal-old.unhas.ac.id/index.php/jeds/article/view/28100
Mamouei, M., Zhu, Y., Nazarzadeh, M., Hassaine, A., Salimi-Khorshidi, G., Cai, Y., & Rahimi, K. (2022). Investigating the association of environmental exposures and all-cause mortality in the UK Biobank using sparse principal component analysis. Scientific Reports, 12(1). https://doi.org/10.1038/s41598-022-13362-3
Mas'udah, I. (2023). Pemetaan aksesibilitas pelayanan gedung fasilitas kesehatan di Kabupaten Bojonegoro. Jurnal Vokasi Teknik Sipil, 1(2), 32-39. https://ejournal.unesa.ac.id/index.php/viteks/article/view/54958 McGrail, M. R., & Humphreys, J. S. (2009). The index of rural access: An innovative integrated approach for measuring primary care access. BMC Health Services Research, 9. https://doi.org/10.1186/1472-6963-9-124
Muhajjar, M., Rahardjo, M., & Dewanti, N. A. Y. (2016). Analisis spasial hubungan kualitas lingkungan dengan kejadian diare pada balita di Kecamatan Genuk Kota Semarang. Jurnal Kesehatan Masyarakat, 4(3), 807-816. https://doi.org/10.14710/jkm.v4i3.13609
Nabila, C., & Hendrawan, D. I. (2025). Water quality and degradation rate analysis: Assessing pollution and environmental impact for effective management, West Java. Applied Environmental Science, 2(2). https://doi.org/10.61511/aes.v2i2.2025.1480
Natsir, I. (2025, April 13). Masalah Infrastruktur, Pendidikan & Kesehatan Program dari Paslon Bupati-Wakil Bupati Tasikmalaya Cecep-Asep. Pikiran Rakyat. https://www.pikiran-rakyat.com/news/pr-019235671/masalah-infrastruktur-pendidikan-kesehatan-program-dari-paslon-bupati-wakil-bupati-tasikmalaya-cecep-asep?page=all
Noviyanti, D., Pravitasari, A. E., & Sahara, S. (2020). Analisis perkembangan wilayah Provinsi Jawa Barat untuk arahan pembangunan berbasis wilayah pengembangan. Jurnal Geografi, 12(01), 280. https://doi.org/10.24114/jg.v12i01.14799
Nugroho, A., Adi, M. S., & Nurjazuli, N. (2023). Spatial analysis of environmental conditions in the incidence of leptospirosis in Kebumen Regency. Jurnal Kesehatan Lingkungan Indonesia, 22(2), 170–178. https://doi.org/10.14710/jkli.22.2.170-178
Pauley, G. (2023). Bridging the Healthcare Gap: Challenges and Prospects in Developing Countries Corresponding Author*. Perspective Health Economics and Outcome Research, 2023, 1. https://doi.org/10.4172/jdrp.23.9(5).036
Pertiwi, T. S. (2019). Penggunaan sistem informasi geografis (sig) untuk pemetaan kerentanan wilayah berdasarkan faktor risiko kejadian diare pada balita. Journal of Information Systems for Public Health, 4(3), 30-39. https://doi.org/10.22146/jisph.25852
Prakoso, I. D. (2020). Hubungan antara akses air minum dan sanitasi layak dengan kejadian diare di Jawa Timur. Jurnal Berkala Epidemiologi, 8(1), 42–49. https://doi.org/10.20473/jbe.v8i12020
Pratama, A. W. C. (2022). Analisis pola dan keterjangkauan fasilitas pelayanan kesehatan masyarakat terhadap permukiman di kabupaten Sukoharjo [Skripsi]. Universitas Muhammadiyah Surakarta.
Puntub, W., Greiving, S., & Birkmann, J. (2024). Framework for collaborative local climate adaptation scenario development- nexus between climate resilience, public health service and spatial planning. International Journal of Climate Change Strategies and Management. https://doi.org/10.1108/IJCCSM-09-2023-0110
Putri, N. K., Wulandari, R. D., Syahansyah, R. J., & Grépin, K. A. (2021). Determinants of out-of-district health facility bypassing in East Java, Indonesia. International Health, 13(6), 545–554. https://doi.org/10.1093/inthealth/ihaa104
Redaksi Teras Jabar. (2024, November). Zulkifly Chaniago soroti kesenjangan infrastruktur di Jawa Barat. Teras Jabar. https://terasjabar.co/2024/11/10/zulkifly-chaniago-soroti-kesenjangan-infrastruktur-di-jawa-barat/
Sadiq, K., Mir, F., Jiwani, U., Chanar, S., Nathwani, A., Jawwad, M., Hussain, A., Rizvi, A., Muhammad, S., Habib, M. A., Soofi, S. B., Ariff, S., & Bhutta, Z. A. (2023). Risk factors for acute diarrhoea in children between 0 and 23 months of age in a peri-urban district of Pakistan: A matched case-control study. International Health, 15(3), 281–288. https://doi.org/10.1093/inthealth/ihac022
Saputra, A. Y., Rustiadi, E., & Rindayati, W. (2022). Perkembangan dan karakterisasi desa-desa pegunungan Jawa Tengah. Journal of Regional and Rural Development Planning, 6(1), 1–13. https://doi.org/10.29244/jp2wd.2022.6.1.1-13
Sarilita, E., Putri, A. K., Faza, A. G., Mulyahati, H. N., Anandita, J. P., Annina, N. E., Hermalina, N. A., & Sahda, Z. P. (2023). oral health education for school children and capacity building of local community health workers in Cleft Care: An experience of student-led community service in a West Java Village. Gateways, 16(1). https://doi.org/10.5130/ijcre.v16i1.8594
Selamet, I. (2024, September 9). Cianjur Masih Kekurangan RS, Terbuka untuk Investasi Kesehatan. Detik Jabar. https://www.detik.com/jabar/berita/d-7532301/cianjur-masih-kekurangan-rs-terbuka-untuk-investasi-kesehatan
Siswantoro. (2024). Pengaruh ketersediaan infrastruktur terhadap ketimpangan pendapatan di Provinsi Jawa Barat. Creative Research for West Java Development, 10(1).
https://doi.org/10.34147/crj.v10i1.342
Snyder, J. P. (1987). Map Projections—A Working Manual. Chs, 1(4), 5. https://doi.org/10.3133/pp1395
Sunaryo. (2015, December 9). Analisis spasial untuk penyakit berbasis lingkungan. In Seminar Nasional Upaya Pengendalian Penyakit Berbasis Wilayah Poltekes Kemenkes Semarang di Purwokerto.
https://repository.dinus.ac.id/docs/ajar/ANALISIS_SPASIAL_UNTUK_PENYAKIT_BERBASIS_LINGKUNGAN
Susanti, R. (2025, February 17). Curhat Warga Pelosok Garut Sulit ke Rumah Sakit, 6 Jam Perjalanan dan Ditolak. Kompas. https://www.kompas.com/jawa-barat/read/2025/02/17/155324488/curhat-warga-pelosok-garut-sulit-ke-rumah-sakit-6-jam-perjalanan-dan
The Center for Data and Information Technology. (2024). The statistics of primary school year 2023/2024. Ministry of Primary and Secondary Education of the Republic of Indonesia. https://data.kemendikdasmen.go.id/publikasi/p/pauddasmen-buku-statistik/statistik-sekolah-dasar-sd-tahun-2023-2024
Van Bemmelen, R. W. (1949). The geology of Indonesia (Vol. IA). Government Printing Office.
Victora, C. G., Barros, A. J. D., França, G. V. A., da Silva, I. C. M., Carvajal-Velez, L., & Amouzou, A. (2017). The contribution of poor and rural populations to national trends in reproductive, maternal, newborn, and child health coverage: analyses of cross-sectional surveys from 64 countries. The Lancet Global Health, 5(4), e402–e407. https://doi.org/10.1016/S2214-109X(17)30077-3
Wardhana, A., Kharisma, B., & Hanifah, H. (2020). Infrastruktur dan Pertumbuhan Ekonomi Kabupaten dan Kota Jawa Barat. E-Jurnal Ekonomi Dan Bisnis Universitas Udayana, 313. https://doi.org/10.24843/eeb.2020.v09.i04.p01
WHO. (2023). Sanitation. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/sanitation
WHO. (2025, March 28). Universal Health Coverage (UHC). World Health Organization. https://www.who.int/News-Room/Fact-Sheets/Detail/Universal-Health-Coverage-(Uhc)
Yudono, A., Afrianto, F., & Hariyanto, A. D. (2023). The Evaluation of geographical health facilities structure in Makassar City, Indonesia. International Journal of Environmental Research and Public Health, 20(6). https://doi.org/10.3390/ijerph20065210
Zhao, W. Z., Wang, J. Y., Zhang, M. N., Wu, S. N., Dai, W. J., Yang, X. Z., & Wang, H. G. (2025). Global burden of diarrhea disease in the older adult and its attributable risk factors from 1990 to 2021: a comprehensive analysis from the global burden of disease study 2021. Frontiers in Public Health, 13, 1541492. https://doi.org/10.3389/fpubh.2025.1541492
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