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CLEAN AND HEALTHY LIFESTYLE BEHAVIORS AND HEALTHY HOUSING INFLUENCED THE INCIDENT OF ACUTE RESPIRATORY INFECTION IN CHILDHOOD

Introduction: Based on preliminary surveys in this study, it was found 86.7% of respondents suffered from accute respiratory infection experienced 4 times reinfection within 3 months and 50% of respondents rarely consumed balanced nutritious food. Aims: to find the correlation between clean and healthy lifestyle behaviours, healthy housing and the frequency of accute respiratory infection in children under the age of 1-4 years. Method: a cross-sectional study was used by involving mothers or caregivers with infants aged 1-4 years in Malang Regency. A questionnaire was applied as research instrument. Result: Statistical analysis shows that there is a significant correlation between family members who smoke (p-value=0.021) and the level of home density (p-value=0.03) with the frequency of acute respiratory tract infections in toddlers. While the relationship of other variables such as the sex of children under five (p-value=0.799), clean and healthy lifestyle behaviour: delivery at primary health care (p-value=0.084), exclusive breastfeeding(p-value=0.940), routinely visiting Integrated Healthcare Center (p-value=0.396), hand washing behaviour (p-value=0.523), consuming healthy food (pvalue=0.247), and infant’s activity(p-value=0.096), healthy housing: ventilation (p-value=0.396) and lighting (p-value=0.767) have no a significant correlation with incident of accute respiratory infection in infants . Conclusion: There is a correlation between family members who smoke and the level of home density with the frequency of accute respiratory infection in children under the age of 1-4 years


Introduction
Acute Respiratory Infection is a disease mostly affectedon children in the age of 5-14 years, the prevalence of infected between men and women seems almost the same, namely 510,714 and 506,576 respectively. Housing is an influential factor, where more people in urban areas are infected than in rural areas 1 . This disease is caused by a small substance (smaller than bacteria) -called virus -that causes infection and transmitte from one person to another through coughing or sneezing 2 .
Clean and Healthy Behavior are all attitudes towards health carried out on the basis of personal awareness which makes the family and all members able to help themselves in the health sector and have an active role in community activities. The main purpose of making the Clean and Healthy Behavior movement is to improve the quality of health through the process of awakening people from ignorance 3 .
According to WHO (2001), a house is a physical structure or building for shelter, where the environment is useful for physical and spiritual health and social conditions both for the health of families and individuals 4 . Healthy housing have criteria to prevent the occurrence of acute respiratory tract infections consisting of: the walls of the house, the floor of the house, air ventilation, residential density and lighting must be in accordance with the requirements of a healthy home so that humidity does not occur. Healthy housing factors can prevent the growth of a variety of bacteria and pneumonia viruses 5 .

Bangladesh J Medicine 2021; 32 : 19-24
Based on preliminary survey, approximately 86.7% of respondents suffered from acute respiratory infections 4 times in the last 3 months, and 50% of them consumed balanced nutritious food in low levels. The study aims to find the relationship between clean and Healthy Behavior, Healthy Housing and the frequency of accute respiratory infaction in children under the age of 1-4 years.

Method
Participant A cross sectional with observational analytic approach was used in this study. The population was children aged under 5 years in Sumber Mlaten sub-village, Kalirejo sub-district, Lawang sub-district, East Java in 2019. The sample was taken using the total sampling method and meets the inclusion criteria which include: families of children aged 1-4 years who are willing to become respondents (mother/caregiver/other family), present during data collection.

Data Collection and Analysis
The research instrument was a questionnaire that had been tested for validity which included data on parental education, parental occupation, and sex of children under five years, infection status, clean and healthy lifestyle behaviours, and criteria for a healthy home referring to the Republic of Indonesia Ministry of Health (2016). The research period was from 8 December 2019 to 14 December 2019.
The data analyzed using a bivariate test with chi-square test and contingency coflication test to determine the correlation between clean and healthy lifestyle behaviours, Healthy Homes and accute respiratory infection in Children aged under five years. The data was analysed using statistical software program Statistical Package for the Social Science (SPSS) version 17.0 (SPSS.Inc., Chicago, IL).

Ethics Statement
This study was approved by the Ethics Committee of the Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.

Result
The socio-demographic data included basic variables of mother or cargiver and children. Participants who have aged between 18-35 years and having primary school history have the percentage as much as 60.8% and 41.2%, respectively. Meanwhile, the number of participants were mostly unemployed status about 82.4%. The highest children age in this study was 2 years, namely 35.3% and female's children were the majority of children which counted as many as 56.9%. The immunization status were dominated by children who have completed immunization status, namely 94.1%. Table 1 represented three variable which divided into clean and healthy lifestyle behaviours, healthy housing and incidence of accute respiratory infection in children within 3 months. According to clean and healthy lifestyle behaviours, it revealed that about 98% of participants visited primary health care as the method to deliver their children, 52.9% of paticipants have no given exclusive breastfeeding to their children. Moreover, approximately 84.3% of participants were routinely visiting integrated healthcare center, 68.8% of participants had gotten used to washing their hands using clean water. All participants declared that they had provided enough nutrition for their children (100%) and almost all participants have a settled job (86.3%). The smoking at home was done by 76.5% of

Discussion
Bivariate analysis showed that there was no significant relationship between hands washing behavior with the incidence of acute respiratory infections in children aged 1-4 years. This is in accordance with previous studies which produced a significant relationship between the incidences of acute respiratory infections with hand washing behavior 6 . Acute respiratory infections is the leading cause of death for children under five and hand washing habits can reduce respiratory infections by more than 50% 7,8 .
We found as many as 31 children under five (61%) had acute respiratory infections in the last 3 months who actively played both outside and inside the house. The finding indicates that there is no positive effect of playing activity with the incidence of acute respiratory infections in children under the age of 1-4 years. This is contrast with study that revealed a relationship between physical activity and morbidity, especially in the respiratory tract. The results of the study explained that subjects who did less activity were more susceptible to illness or often experienced pain compared to those who did many activities 9 . Regular physical activity is one way to maintain the immune system. Various studies have confirmed the beneficial effect of exercise activities on the components of the

Experiencing accute respiratory infection in infant
Within last 3 months immune system. Regular physical activity also teaches the body to distribute blood better to muscles during activity 10 . Physical activity and regular exercise and sufficient quantities, can help maintain optimal health for those concerned 11 .
The results showed that there was no significant influence between regularly visiting integrated healthcare center and acute respiratory infection in children under five in Sumber Mlaten Hamlet. This contradics with other studies that the incidence of acute respiratory infection in infants and regular visiting to integrated healthcare center have a signification of attachment 12 . Visiting integrated healthcare center is a form of Community-Based Health Efforts which manage and organize from, by, for and with the community in organizing health development, in order to empower the community and provide facilities to the community in obtaining basic health services. To accelerate the reduction in maternal and infant mortality rates 13 .
In this study, we found that the correlation between breastfeeding and acute respiratory infection was not significant. The results of this study are consistent with research in 2011 which showed that there was no relationship between exclusive breastfeeding and the incidence of acute respiratory infection in children aged 6 months to 24 months 14 . However, this study differs from other studies that there is a relationship between duration of exclusive breastfeeding exclusively with acute respiratory infections 15 . Breastfeeding has a protective effect of acute respiratory infection during the first year, but with increasing age of children under five years the level of immunoglobulin in breast milk will decrease so that if breastfeeding is given longer does not have much effect on body resistance to overcome microorganisms that cause acute respiratory infection 16 .
Smoking habits of parents showed highly likely affected the incident of acute respiratory infection in children as exposuring to cigarette smoke. This data is supported by previous studies that shows that there is a positive influence between exposure to cigarette smoke to acute respiratory infection in children under five [17][18][19] . Basically, smoking is one of the risk factors for acute respiratory infection in children under five, especially in East Java which had prevalence of acute respiratory infection at 6.4%, while in Malang Regency the prevalence of acute respiratori infection was 4.3% 20 . According to WHO (2008), the adverse effects of cigarette smoke on Passive smokers are greater than active smokers. Sidestream smoke or side smoke caused by the activity of passive smokers, is proven to contain more tobacco burners than mainstream smoke. This side smoke is proven to contain carbon monoxide 5 times larger, tar and nicotine 3 times, ammonia 46 times, nickel 3 times, nitrosamine as a cause of cancer levels reached 50 times greater in side smoke compared with the main smoke levels 4 .
These results indicate no significant effect on childbirth in health professionals and the incidence of acute respiratory infection in children under five. Women treated by traditional healers do not tend to get good early breastfeeding initiation so that neonates can lose important nutrients in clostrum which may cause health problems in the future 21 . Childbirth performed by health professionals, doctors, midwives or paramedics has a stake in the prevention of infections and other hazards that can threaten the safety of babies and mothers 13 placenta does not come out, bleeding and infant death. However, due to ignorance of information, participants did not realize that the impact was very dangerous to their health 22 .
Population density in house has significant association with incident of acute resoiratory infection in children and another have proven the similar result as this finding 23 . Mostly of respiratory problems, such as acute respiratory infection, were affected with overcrowding, indoor and poor condition of the houses 23 .
The results of the bivariate interpreted that there is no significant correlation between lighting with acute respiratory infection incident in children under five. This finding is contrast with previous study in Indonesia which showed the significant correlation between indoor air pollution including lighting source in home, and incident of acute respiratory infection in children under five years 18 . A healthy housing requires sufficient light, both artificial lighting and natural lighting from the sun 24 .
The type of floor has no associated with acute respiratory infection in children under five and this is different from study that revealed the variable of the type of house floor which cumulatively can be interpreted to have a significant relationship between the type of floor with the incidence of acute respiratory infection in children under five 24 . The same thing was expressed in study in Talaud Islands Regency which proved the type of house floor affected the incidence of acute respiratory infection in children under five. As houses with ceramic or tile floor types tend to be better because they are easy to clean and not damp. Conversely, only casted floors tend to be damp, not waterproof, and can be a breeding ground for bacteria or viruses that cause acute respiratory infection 25 .

Conclusion
In the criteria for a healthy home, there is a relationship between the points of population density and smoking points in the house with the incidence of accute respiratory infection in children under five.
Funding Statement: This study has no granted funding from any institution.

Conflic of Interest:
All authors declare that there is no conflict interest in this study and publication.