Hubungan Status Imunisasi dan Pemberian ASI Eksklusif dengan Diare pada Balita: Sistematik Review

Abstract

Diarrhea remains one of the leading causes of morbidity and mortality among children under five worldwide, including in Indonesia. Incomplete immunization and the lack of exclusive breastfeeding are considered preventable risk factors associated with an increased incidence of diarrhea. This study aimed to analyze the relationship between immunization status, exclusive breastfeeding, and the incidence of diarrhea among children under five through a systematic review. A systematic literature search was conducted in Google Scholar, Garuda, PubMed, and ScienceDirect for articles published between 2015 and 2025 using the keywords immunization, exclusive breastfeeding, diarrhea, and children under five. A total of 20 eligible studies, comprising 15 national and 5 international journal articles, were critically appraised using standardized critical appraisal tools and synthesized narratively. The findings showed that 18 of the 20 reviewed studies reported a statistically significant association between incomplete immunization and/or the absence of exclusive breastfeeding and a higher incidence of diarrhea among children under five, with reported odds ratios generally ranging from 1.8 to 3.6. The remaining two studies found no significant association, possibly due to uncontrolled confounding factors such as sanitation and hygiene. Overall, the evidence indicates that complete immunization and exclusive breastfeeding are important protective factors against diarrhea. Therefore, strengthening immunization coverage and promoting exclusive breastfeeding through integrated primary healthcare programs should be prioritized to reduce the burden of diarrhea among children under five.