Adolescent Characteristics, Knowledge, Hand Hygiene, Food Hygiene, and Dietary Patterns Associated with Typhoid Fever
Main Article Content
Erika Martining Wardani
Riezky Faisal Nugroho
Difran Nobel Bistara
Tata Mahyuvi
Typhoid fever remains a major public health issue in Indonesia, particularly among adolescents living in densely populated urban areas, where poor sanitation and the consumption of unsafe food increase the risk of exposure to Salmonella Typhi. This study analyzed the relationship between adolescent characteristics, knowledge, hand hygiene, food hygiene, eating habits, and a history of typhoid fever in Surabaya. An observational analytic study with a cross-sectional design was conducted involving 160 adolescents aged 13–18 years attending junior and senior high schools in Surabaya. Participants were selected using multistage random sampling. Data were collected using a validated structured questionnaire to assess adolescent characteristics, knowledge, hand hygiene, food hygiene, eating habits, and history of typhoid fever. Bivariate relationships were analyzed using the chi-square test, followed by multivariate logistic regression analysis to identify independent predictors. The results showed that a total of 54 adolescents (33.8%) reported a history of typhoid fever. Bivariate analysis showed a significant association between a history of typhoid fever and knowledge (p = 0.007), hand hygiene (p = 0.001), food hygiene (p < 0.001), and eating habits (p = 0.004), whereas age and gender did not show significant associations. Multivariate analysis revealed that poor food hygiene (aOR = 2.76; 95% CI: 1.37–5.58), poor hand hygiene (aOR = 2.41; 95% CI: 1.20–4.85), and poor eating habits (aOR = 2.18; 95% CI: 1.10–4.33) were independent predictors of a history of typhoid fever. Poor food hygiene, poor hand hygiene, and unhealthy eating habits are significant independent predictors of a history of typhoid fever among adolescents. School-based hygiene promotion and food safety interventions are recommended to reduce the risk of typhoid fever among adolescents in urban areas of Indonesia.
Francois Watkins, L. K., Shih, D. C., & Dorough, L. (2025). Typhoid and paratyphoid fever. In E. S. Halsey, K. M. Angelo, E. D. Barnett, L. H. Chen, C. Coyle, C. D. Ericsson, D. O. Freedman, S. M. Ostroff, K. Petersen, E. T. Ryan, M. Weinberg, S. Arshanapally, & M. C. Glynn (Eds.), CDC Yellow Book, 2026 edition: Health information for international travel. Centers for Disease Control and Prevention.
Boakye Okyere P, Twumasi-Ankrah S, Newton S, Nkansah Darko S, Owusu Ansah M, Darko E, Agyapong F, Jeon HJ, Adu-Sarkodie Y, Marks F, Owusu-Dabo E. Risk Factors for Typhoid Fever: Systematic Review. JMIR Public Health Surveill. 2025 Aug 28;11:e67544. doi: 10.2196/67544.
World Health Organization. (2026). WHO updates typhoid vaccine guidance. Weekly Epidemiological Record. healthmanagement.org
Yushananta P, Putri MFE. Household and Environmental Typhoid Fever Transmission in Bandar Lampung City, Indonesia: A Case-Control Study. JNMA J Nepal Med Assoc. 2024 Sep;62(277):564-569. doi: 10.31729/jnma.8744.
Akullian A, Ng'eno E, Matheson AI, Cosmas L, Macharia D, Fields B, Bigogo G, Mugoh M, John-Stewart G, Walson JL, Wakefield J, Montgomery JM. Environmental Transmission of Typhoid Fever in an Urban Slum. PLoS Negl Trop Dis. 2015 Dec 3;9(12):e0004212. doi: 10.1371/journal.pntd.0004212. Erratum in: PLoS Negl Trop Dis. 2016 Jan 04;10(1):e0004353. doi: 10.1371/journal.pntd.0004353.
Sanggul, A. R., & Patriawati, K. A. (2025). Determining factors of typhoid fever among elementary school children in Cijeungjing Village, Sumedang Regency, West Java. International Journal of Integrated Science and Technology, 3(12), 2463–2484. https://doi.org/10.59890/ijist.v3i12.246
Chung A, Vieira D, Donley T, Tan N, Jean-Louis G, Kiely Gouley K, Seixas A. Adolescent Peer Influence on Eating Behaviors via Social Media: Scoping Review. J Med Internet Res. 2021 Jun 3;23(6):e19697. doi: 10.2196/19697.
Caruso BA, Snyder JS, O'Brien LA, LaFon E, Files K, Shoaib DM, Prasad SK, Rogers HK, Cumming O, Esteves Mills J, Gordon B, Wolfe MK, Freeman MC. Behavioural factors influencing hand hygiene practices across domestic, institutional and public community settings: a systematic review and qualitative meta-synthesis. BMJ Glob Health. 2025 Sep 16;10(Suppl 7):e018927. doi: 10.1136/bmjgh-2025-018927.
Kim C, Goucher GR, Tadesse BT, Lee W, Abbas K, Kim JH. Associations of water, sanitation, and hygiene with typhoid fever in case-control studies: a systematic review and meta-analysis. BMC Infect Dis. 2023 Aug 29;23(1):562. doi: 10.1186/s12879-023-08452-0.
Asefa, L., Gemechu, T., Lemma, H. et al. Determinants of critical-time hand washing practices among mothers of under-five children in West Guji Zone, Ethiopia: a community-based cross-sectional study. BMC Pediatr 26, 341 (2026). https://doi.org/10.1186/s12887-026-06648-2
Ogutu EA, Ellis A, Rodriguez KC, Caruso BA, McClintic EE, Ventura SG, Arriola KRJ, Kowalski AJ, Linabarger M, Wodnik BK, Webb-Girard A, Muga R, Freeman MC. Determinants of food preparation and hygiene practices among caregivers of children under two in Western Kenya: a formative research study. BMC Public Health. 2022 Oct 6;22(1):1865. doi: 10.1186/s12889-022-14259-6.
Tran, T., Dat, V. H., Phuong, V. N., Tu, T. H. C., Duong, D. V., & Loc, H. H. (2024). Assessing urban street food safety among youth: The impact of road dust on potential microbial contamination risks to student health. Microbial Risk Analysis, 27–28, 100327. https://doi.org/10.1016/j.mran.2024.100327
Nortey AN, Amu H, Senu E, Effah A. Knowledge, Attitude, and Food Safety Practices among Street Food Vendors at a Metropolitan District in Ghana: A Cross-sectional Study. Int J Food Sci. 2024 Mar 8;2024:5553942. doi: 10.1155/2024/5553942.
Choudhury, S., Medina-Lara, A., Bi, A. Z., Ricarte, P., Morrish, N., & Veettil, P. C. (2026). Food Safety Knowledge, Attitude, and Practices (KAP) of Urban Consumers in Low-Income and Lower-Middle-Income Countries (LLMICs): A Scoping Review. Foods, 15(8), 1381. https://doi.org/10.3390/foods15081381
Sinai T, Axelrod R, Shimony T, Boaz M, Kaufman-Shriqui V. Dietary Patterns among Adolescents Are Associated with Growth, Socioeconomic Features, and Health-Related Behaviors. Foods. 2021 Dec 8;10(12):3054. doi: 10.3390/foods10123054.
Siviroj, P., Wungrath, J., & Ongprasert, K. (2024). Associated Factors of Dietary Patterns among Adolescents in the Rural Northern Region of Thailand: A Community-Based Cross-Sectional Study. Healthcare, 12(12), 1215. https://doi.org/10.3390/healthcare12121215
Wardani, E. M., & Nugroho, R. F. (2025). Relationship between eating patterns and typhoid incidence. Medicine and Community Health Archives, 3(7), 272–278.
Nuruzzaman, H., & Syahrul, F. (2016). Risk Analysis of Typhoid Fever Based on Personal Hygiene and Street Food Consumption Habit at Home. Jurnal Berkala Epidemiologi, 4(1), 74–86. https://doi.org/10.20473/jbe.V4I12016.74-86
Jatrana S, Hasan MM, Mamun AA, Fatima Y. Global Variation in Hand Hygiene Practices Among Adolescents: The Role of Family and School-Level Factors. Int J Environ Res Public Health. 2021 May 7;18(9):4984. doi: 10.3390/ijerph18094984.
Afritasari, S., Feronika, L., & Haniah, S. N. (2026). Association between knowledge of handwashing with soap and handwashing behavior among elementary school students in Pontianak, Indonesia. Napande: Jurnal Bidan, 5(2).
Rathi, K., Devi, N., Singh, B., Ayyagari, A., Kumar, V., Chaudhari, D. N., & Ahire, J. J. (2026). Microbial Risks in Food: Evaluation of Implementation of Food Safety Measures. Hygiene, 6(1), 12. https://doi.org/10.3390/hygiene6010012
Hadi H, Triastanti RK, Anggraeni D, et al. The Role of the School Food Environment in Improving the Healthiness of School Canteens and Readiness to Reopen Post COVID-19 Pandemic: A Study Conducted in Indonesia. Journal of Public Health Research. 2022;11(1). doi:10.4081/jphr.2021.2287
Hasan MR, Chowhan A, Khatun MR, Sultana Saema MM, Haque T, Shuchy SI, Chandra Pramanik S, Akther F. Food Safety, Hygiene, and Sanitation Practices Among University Campus Dining Personnel: An Institution-Based Cross-Sectional Study. J Nutr Metab. 2026 Jan 30;2026:7216438. doi: 10.1155/jnme/7216438.
Azanaw J, Gebrehiwot M, Dagne H. Factors associated with food safety practices among food handlers: facility-based cross-sectional study. BMC Res Notes. 2019 Oct 22;12(1):683. doi: 10.1186/s13104-019-4702-5.
Iyassu A, Laillou A, Tilahun K, Workneh F, Mogues S, Chitekwe S, Baye K. The influence of adolescents' nutrition knowledge and school food environment on adolescents' dietary behaviors in urban Ethiopia: A qualitative study. Matern Child Nutr. 2024 Jul;20 Suppl 5(Suppl 5):e13527. doi: 10.1111/mcn.13527.
Thorpe MG, Kestin M, Riddell LJ, Keast RS, McNaughton SA. Diet quality in young adults and its association with food-related behaviours. Public Health Nutr. 2014 Aug;17(8):1767-75. doi: 10.1017/S1368980013001924.
Guardia Zuñiga RC, Abad de Vite BV, Azañero Suarez A, Espino Carrasco DK, García Santos E, Lajo Aquise IE, Cachay Sánchez I. Educational Level Mediates the Relationship Between Knowledge and Preventive Practices in Multidrug-Resistant Tuberculosis Patients. Epidemiologia (Basel). 2025 Nov 6;6(4):75. doi: 10.3390/epidemiologia6040075.
Smith L, Butler L, Tully MA, Jacob L, Barnett Y, López-Sánchez GF, López-Bueno R, Shin JI, McDermott D, Pfeifer BA, Pizzol D, Koyanagi A. Hand-Washing Practices among Adolescents Aged 12-15 Years from 80 Countries. Int J Environ Res Public Health. 2020 Dec 27;18(1):138. doi: 10.3390/ijerph18010138.
Mazar, L., Rakhshanderou, S., Mohseni-Bandpei, A., & Ghaffari, M. (2026). Environmental health literacy: An exploratory conceptual redefinition and explanation structuralized from comprehensive multidisciplinary expert perspectives along with public insights. City and Environment Interactions, 29, 100285. https://doi.org/10.1016/j.cacint.2025.100285
Muche G, Tesfaw A, Bayou FD. Prevalence of typhoid fever and its associated factors among febrile patients visiting Arerti Primary Hospital, Amhara Region, north east Ethiopia. Front Public Health. 2024 Aug 16;12:1357131. doi: 10.3389/fpubh.2024.1357131.
Hu Y, Jia Y, Shen H, Zhang Y, Feng L. Knowledge, attitude, and practice of hand hygiene among clinical nurses in a tertiary hospital in China: a cross-sectional perspective. BMC Med Educ. 2025 Dec 4;25(1):1676. doi: 10.1186/s12909-025-08155-x.
Savant R, Singh RJ, Hazarika SC, Majumdar T, Dolma KG, Devi SI, Dutta TK, Lyngdoh V, Modi D, Roy S, Devi RM, Kylla H, Meru M, Das S, Roy S, Ramamurthy T, Das P, Das M. Knowledge, attitude, and practice towards food safety amongst school children, food handlers and consumers: protocol for a pre-post longitudinal study in North East India. Front Public Health. 2025 Oct 17;13:1643443. doi: 10.3389/fpubh.2025.1643443.
Kim EJ, Pai AJ, Kang NE, Kim WK, Kim YS, Moon HK, Ha AW. The effects of food safety education on adolescents' hand hygiene behavior: an analysis of stages of change. Nutr Res Pract. 2012 Apr;6(2):169-74. doi: 10.4162/nrp.2012.6.2.169.
Parvin MN, Rifat MMH, Papia SA. Knowledge, Attitudes, and Practices Regarding Typhoid Fever Among University Students in Bangladesh: A Cross-Sectional Study. Health Sci Rep. 2026 Jul 4;9(7):e72774. doi: 10.1002/hsr2.72774.
