Comprehensive Child and Adolescent Nursing

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Traditional Method of Initial Diarrhea Treatment in

Children

Kristian Ade Chandra & Dessie Wanda

To cite this article: Kristian Ade Chandra & Dessie Wanda (2017) Traditional Method of Initial
Diarrhea Treatment in Children, Comprehensive Child and Adolescent Nursing, 40:sup1, 128-136,
DOI: 10.1080/24694193.2017.1386980

To link to this article: https://doi.org/10.1080/24694193.2017.1386980

Published online: 22 Nov 2017.

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 COMPREHENSIVE CHILD AND ADOLESCENT NURSING
2017, VOL. 40, NO. S1, 128–136
https://doi.org/10.1080/24694193.2017.1386980

Traditional Method of Initial Diarrhea Treatment in

Children
Kristian Ade Chandra and Dessie Wanda
Faculty of Nursing, Universitas Indonesia, Jalan Bahder Djohan Campus, Depok, Indonesia

ABSTRACT KEYWORDS
Diarrhea is the most common cause of death in children. For Curcumic; diarrhea; Guava
leaf; traditional medicine
diarrhea, home treatment should be administered by parents
to prevent diarrheal complications. The purpose of this
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research was to investigate the traditional method of diarrhea

treatment in Tegal regency, Central Java, Indonesia. A descrip-
tive study was conducted with the aim of describing the tradi-
tional method of home treatment for diarrhea in children. The
study sample included families with children who were experi-
encing or had experienced diarrhea and had received tradi-
tional medicine. The participants were randomly selected
based on cluster random sampling, and the results showed
that traditional diarrheal treatment involved the use of Psidium
guajava leaves, curcumic (turmeric), and tea. P. guajava leaves
and curcumic were processed by pounding or shredding and
then squeezing to obtain the extracts. Some of the respon-
dents also added salt to the mixture. Most traditional medicine
could be found in the garden or by purchase, and friends and
family were the most common information resources. Most
respondents assumed that traditional medicine was effective
to treat diarrhea. It is expected that this research can provide
information about diarrheal management by traditional
method in the community.

Introduction
Diarrhea is a common problem in almost every part of the world, and there
are still many occurrences of this disorder. Based on United Nations
International Children’s Emergency Fund (UNICEF, 2015) data, diarrhea
and pneumonia are the leading causes of death in children. In Indonesia,
based on the statistics of Primary Health Research (RISKESDAS; Badan
Penelitian dan Pengembangan Kesehatan, 2013), the incidence of diarrhea
is about 3.5%. This figure has decreased if we compare it with RISKESDAS’s
statistic for 2007, which showed an occurrence of 9.0%. However, this figure
is still quite high.
Diarrhea can lead to the disruption of body functions, especially dehydra-
tion, acid-base balance disorders like acidosis, and shock. Further

CONTACT Dessie Wanda dessie@ui.ac.id Faculty of Nursing, Universitas Indonesia, Jalan Bahder Djohan
Campus, Depok 16424, Indonesia
© 2017 Taylor & Francis
 COMPREHENSIVE CHILD AND ADOLESCENT NURSING 129

complications can result in death (Hinkle & Cheever, 2014). According to the
World Health Organization (WHO, 2013), actions to be taken in the case of
diarrhea in children include provision of fluids, zinc supplementation, and
for breastfeeding mothers, proceeding with breastfeeding. In addition to
these methods, individuals deal with diarrhea using alternative treatments,
such as traditional medicine (Pusat Data dan Informasi Kesehatan, 2011).
Traditional medication is usually administered by a group of people in a
society via the use of different types of roots or plants (Yalew, 2014). In some
countries, diarrhea is still treated in a traditional manner. In their study,
Mazumdar, Akter, and Talukder (2015) mentioned that people in tropical
regions, such as India, Bangladesh, Florida and the West Indies, use tradi-
tional medicine to treat diarrhea.
Traditional methods of diarrheal treatment are still found in several
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regions of Indonesia. In the Ethnographic Book Series on Maternal and

Child Health(Badan Penelitian dan Pengembangan Kesehatan, 2012), it
was maintained that several ethnic groups in Indonesia use traditional
methods to treat diarrhea. For instance, people of Mamasa ethnicity in
Mamasa Regency West Sulawesi, use Balinongko leaf extracts as a treat-
ment for diarrhea, while individuals of Dayak Siang Murung ethnicity in
Central Kalimantan treat diarrhea using boiled Cemahu wood. There are
also people of Javanese ethnicity in Gading Sari Village, Bantul
Yogyakarta, who use a turmeric and Injet mixture to treat diarrhea.
Traditional diarrhea treatment can also be found in the area where the
researchers reside. This traditional method of treating disease is described
in Government Regulation No. 103 of 2014 on Traditional Health Services.
In accordance with this, Tegal regency has developed a Traditional Herbal
Tour as a form of traditional health services. Therefore, the researchers
want to examine the traditional diarrhea treatment by parents in Tegal
regency.

Methods
This research uses a descriptive research method, as it aims to describe the
phenomenon and characteristics related to research subjects (Dharma, 2015).
The purpose of this study is to investigate the traditional home treatment
that parents used for diarrhea in children. The sample in this study was
randomly chosen using cluster sampling. First, the researchers determined
the place of research, which was located in the district of Balapulang, Tegal
regency. Next, the clusters to be used in the study were chosen. Finally, the
researchers determined the number of samples in a random fashion and
concluded that the sample the research required was 138 participants. The
sample was recruited based on the inclusion criteria, which were families
with children who were experiencing or had experienced diarrhea, and where
 130 K. A. CHANDRA AND D. WANDA

traditional medicine had been used to treat the disease. The sample in this
research included 138 respondents.
The researchers received informed consent from each respondent before
collecting the data. Respondents who were willing to participate in the study
were given a questionnaire and instructed to fill it in according to their
knowledge and experience in handling diarrhea using traditional methods.
The results were then presented in frequency distribution tables.

Results
Respondent characteristics
From the research, several respondent characteristics could be described. The
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average age of the 138 participants was 30.53 years (Table 1). The highest
educational level of 73.9% of the respondents was elementary school. The
other respondents were middle school or higher education graduates. The
respondents mostly consisted of housewives with no occupation (Table 2).

Characteristics of children with diarrhea

The characteristics of children were mainly related to age and gender in this
study. According to Table 3, most children were toddlers; and 50.7% were
boys, while 49.3% were girls.

Respondents’ level of knowledge about diarrhea

The knowledge in this research is about the definition of diarrhea, the
perception of diarrhea, and diarrhea treatment. Most respondents (53.6%)

Table 1. Respondent characteristics: Age.

Variable Mean SD Min-max 95% CI
Age of Respondent 30.53 6.27 20–50 29.47–31.59
Note. SD = standard deviation; CI = confidence interval.

Table 2. Respondent characteristics: Education and occupation.

Characteristic Frequency (n = 138) Percentage (%)
Education
Elementary School 102 73.9
Middle School 30 21.7
Higher Education 6 4.3
Occupation
Working 45 32.6
Not Working 93 67.4
Total 138 100
 COMPREHENSIVE CHILD AND ADOLESCENT NURSING 131

Table 3. Children’s characteristics.

Respondent Data Frequency Percentage (%)
Age
0–1 Years Old (YO; Neonate) 14 10.1
1–3 YO (Toddler) 71 51.4
4–5 YO (Preschool) 32 23.2
6–12 YO (School age) 19 13.8
12–18 YO (Teenager) 2 1.4
Total 138 100
Gender
Boy 70 50.7
Girl 68 49.3
Total 138 100

Table 4. Respondents’ knowledge level.

Knowledge Level Frequency Percentage (%)
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Good 12 8.7
Fair 52 37.7
Low 74 53.6
Total 138 100

had a low level of knowledge about diarrhea (Table 4). This is probably
because of the low education level most respondents held.

Types of traditional medicines and their share of use

Traditional medicines that were often used by the respondents included
guava leaves, turmeric, and black tea (Table 5). Guava leaves are used by
pounding with or without salt, turmeric by grating, and black tea by mixing
it with hot water.
In addition to the traditional medicine used, the respondents’ reasons for
using traditional medicine as diarrhea treatment were also examined, as well
as the effectiveness of traditional medicine (Table 6).
After processing the data, it was also found that 54% of respondents often
used traditional medicine to treat diarrhea. Table 7 and Table 8 list the
reasons and frequency of traditional medicine use. The traditional medicine
was obtained via purchase (31%) or by harvesting it from the front yard
(72.5%). The dominant source of information of this traditional method was
friends or family (Table 9).

Table 5. Types of traditional medicine.

Types of Traditional Medicine Processing Methods
Guava Leaves Pounding
Pounding and adding some salt
Turmeric Shredding and then squeezing
Black Tea Boil in water with tea
Other Pounding, shredding, and eating at once
 132 K. A. CHANDRA AND D. WANDA

Table 6. Effectiveness of traditional medicine.

Category Frequency Percentage (%)
Effective 62 44.9
Fairly Effective 67 48.6
Ineffective 9 6.5
Total 138 100

Table 7. Reason for using traditional medicine.

Reason Frequency Percentage (%)
Cultural Inheritance 31 22.5
Chemical Free 22 15.9
Initial Treatment 24 17.4
Organic and Safe 20 14.4
Effective 17 12.3
Other 24 17.4
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Table 8. Frequency of traditional medicine usage.

Category Frequency Percentage (%)
Often 75 54.3
Rarely 53 45.7

Table 9. Source of traditional medicine and information.

Source Frequency Percentage (%)
Traditional Medicine
Woods 2 1.4
Yard 100 72.5
Purchase 31 31
Others 5 3.6
Information
Friends/Family 126 91.3
Television 2 1.4
Magazine/Newspaper 2 1.4
Health Workers 8 5.8
Total 138 100

Discussion
On average, the age of the respondents in this study was 30.5 years, and most
respondents (73.9%) had a low educational level. In terms of socioeconomic
status, most respondents had no occupation or were only carrying out the
role of housewives; hence, they had no fixed income. These findings are in
line with the results of Agustina et al.’s (2013) research, in which, on average,
respondents had low socioeconomic and educational attributes. The fre-
quency of diarrhea was also compounded by other factors, such as poor
sanitation, population density, lack of clean water, and hygiene level. These
factors significantly contributed to the increase of diarrhea incidents.
In the results of the research, 51.4% of the patients were children in the
toddler age group. The results were in accordance with the study conducted
 COMPREHENSIVE CHILD AND ADOLESCENT NURSING 133

by Norsari (2012), who found that 51.8% of respondents were within the
toddler age group. In another study conducted by Primary Health Research
(RISKESDAS) in 2013, it was described that the highest number of diarrhea
incidents occurred at the age of 12–23 months. Children within the toddler
age group have great curiosity, and they are likely to put objects into their
mouth (mouthing). This can lead diarrhea-transmission agents to enter the
body through the mouth and digestive tract.
The results also showed that male children are slightly more likely to
experience diarrhea than female children. In this study, boys represented
50.6% of patients, whereas girls made up 49.4% of the sample group. This is
also in line with the study conducted by Norsari (2012), who reported 54.5%
male and 45.5% female patients.
The knowledge level of most respondents in the study was low (53.6%).
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Similar results were found in a study by Kusuma (2012) on the level of

knowledge concerning diarrhea and how mothers handle this problem in
infants in Beji, Depok. Another study of people’s level of knowledge about
diarrhea was carried out by Zulaeha (2014). In this study, it was found that
43% of respondents had low knowledge about diarrhea. In the present
research, most respondents showed a low level of knowledge about diarrhea,
and this may have been related to their level of education, which was
correspondingly low; education can affect one’s level of knowledge
(Notoatmodjo, 2003).
The use of traditional medicine for diarrhea in children is a cultural
practice preserved within the community. In this study, the respondents
mostly received information about diarrhea treatment from their relatives.
Common traditional medicines used included guava leaves, turmeric, and
black tea. There are also other types of remedies, such as Pegagan plants,
dysentery leaves (local names), and Indonesian bay-leaf (Syzygium polyan-
tum). These traditional medicines were used by respondents as an initial
treatment for diarrhea. Zulaeha (2014) reported that individuals opt to
conduct the diarrhea treatment themselves because they are trying to provide
an initial treatment at home for infants with diarrhea. If the treatment turns
out to be unsuccessful, the respondent will then take the child to the nearest
health center. Diarrhea treatment using guava leaves is also practiced in other
parts of the world, such as Latin America, South Africa, India, and China
(Gutiérrez, Mitchell, & Solis, 2008). Another type of treatment is using
turmeric, which is also used as a treatment in Bandar Lampung (Asep,
Niniek, Awliyanti, Arie, & Aditya, 2014). Diarrhea treatment using turmeric
has also been found in Thailand, as described by Tangjitman, Wongsawad,
Kamwong, Sukkho, and Trisonthi (2015). In addition to guava leaves and
turmeric, respondents also treat diarrhea using black tea. Tea is also used as a
diarrhea treatment by people of the Nias ethnic tribe (Badan Penelitian dan
Pengembangan Kesehatan, 2012). Beyond the Nias ethnicity, the use of tea as
 134 K. A. CHANDRA AND D. WANDA

a diarrhea treatment has also been found in other countries, such as Iran
(Doustfatemeh et al., 2017).
Traditional medicines used by respondents were processed using several
different methods, such as pounding, grating, and mixing with water.
Traditional ingredients, such as guava leaves and turmeric, were smoothed
by pounding and grating, mixed with a little water, and then squeezed.
The extracts were then given to the children. Many of the respondents also
added some salt in the processing of guava leaves. Black tea was made by
mixing the tea with hot water. Processing traditional medicine was also
described by De Wet, Nkwanyana, and Van Vuuren (2010) These
researchers found that traditional medicine processing usually involves
crushing the ingredients, for example, by mixing leaves or roots with
water or even cooking them.
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According to the respondents, traditional medicine usage was effective

(44.9%) or fairly effective (48.6%); the remainder considered it ineffective.
This measurement is based on the symptoms of diarrhea and feces con-
sistency after exposure to traditional medicine. The respondents perceived
that there are no side effects associated with using traditional medicine.
This is in line with their rationale for using traditional medicines, as they
perceive them as organic and chemical free. If the treatment did not prove
effective and the patients did not recover from diarrhea, respondents
would bring the child to the nearest health professionals, such as doctors,
midwives, or professionals at the community health center. This is in
accordance with Zulaeha’s (2014) findings. This research showed that
people try to use traditional medicine as an initial treatment at home; if
it is not successful, the child will then be immediately brought to the
nearest health center.

Conclusion
Based on the results of this study, it can be concluded that most children’s
diarrhea treatments by parents in Tegal regency use natural ingredients, such
as guava leaves, turmeric, and tea. Traditional medicine is used after being
smoothed by pounding, grating, or mixing with water. People often use
traditional medicine because of its natural characteristics and families’ cul-
tural practices; it is used as initial diarrhea treatment at home for children.
The respondents had received most of their information about traditional
medicine from their family or friends.

Funding
This work was supported by the Directorate of Research and Community
Engagement, Universitas Indonesia (373/UN2.R3.1/HKP.05.00/2017).
 COMPREHENSIVE CHILD AND ADOLESCENT NURSING 135

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