ORIGINAL ARTICLE Bali Medical Journal (Bali Med J) 2016, Volume 5, Number 1: 152-156 P-ISSN.2089-1180, E-ISSN.2302-2914 152 Open access: www.balimedicaljournal.org and ojs.unud.ac.id/index.php/bmj CrossMark Published by DiscoverSys INTRODUCTION Traveler’s diarrhea is the most common disease of tourists who visit developing countries, including Indonesia. Te prevalence of diarrhea on tourists in Peru reported as 24% and as many as 9.836 people from 7.937.654 tourists sufer from diarrhea. 1 While data of traveler’s diarrhea on tourists of Indonesia has not much been published. Bali is one of island in Indonesia and a favorite tourist destination especially for international tour- ists. Bali tourism ofce reported that the number of foreign tourists who visit Indonesia and Bali in 2009 was 6.323 and 2.229 million people, respec- tively, and this trend continue to increase as much as 23% until the end of 2011. 2 Te increase in tourist visits also accompanied with the increase incidence of infectious diseases including the incidence of traveler’s diarrhea on tourists. According to preliminary survey on hospi- tal as the sample, the incidence of traveler’s diarrhea on tourists who visit hospitals in Bali was 5% from 2429 cases of diarrhea. Tere is still a probability in which the incidence of traveler’s diarrhea increases if the survey was performed on all clinics in Bali. High incidence of traveler’s diarrhea in foreign tourists will afect to the amount of international tourist’s visits and indirectly afect on the economy of Bali communities for the feld of tourism is one source of income in Bali. Te government, in this case is Health Department, has implemented prevention eforts through the implementation of infectious diseases prevention program and sanitary supervision of public areas including restaurants and hotels, but the results were not optimal. Te programs only able to suppress the incidence of diarrhea by 50.7%. 2 Tere are several factors that afect traveler’s diarrhea incidence that is environmental factors, host, and agent. Environmental condition for inter- national tourists, especially in hotel and restaurants, are reported clean but not in several places in Bali. Tourists also tend to consume foods in unhygienic areas so it is likely to be infected with bacteria. Host factors that afect the incidence of diarrhea are age, eating and drinking habits, socioeconomic, coun- try of origin, areas visited, prophylactic history or other preparation before visit. According to survey, the average age of international tourists who visit Bali was 30 years old. Te incidence in female was higher than male which is 51.2% and 4.8%, respec- tively. Te incidence of traveler’s diarrhea mostly from Europe with 37.6%, Australia 31.9%, Asia 22.6%, and American continent 2.8%. 2 Tis study aimed to determine risk factors of traveler’s diarrhea on foreign tourists in Bali. METHODS Tis study used case control design. Te study population was foreign tourists who visit through ABSTRACT Background: Traveler’s diarrhea is the most common disease of tourists who pay a visit to developing country. Bali is one of island located in Indonesia where the number of tourists visit from various countries continue to increase. This study aimed to evaluate risk factors of traveler’s diarrhea incidence on foreign tourists in Bali. Methods: A case control study performed on 137 foreign tourists who visit Bali through Ngurah Rai International Airport, Denpasar, Bali. Case and control group selected with convenience method, 35 samples and 102 samples for case and control group, respectively. Traveler’s diarrhea incidence determined based on interview. All data analyzed descriptively and analytically with univariate and multivariate analysis. Results: Risk factors of traveler’s diarrhea on foreign tourists in Bali were tourist’s age, length of stay, and hand washing behavior. Conclusions: The incidence rate of traveler’s diarrhea is related with environment sanitation, so it may be advisable to health authority, especially Puskesmas (primary health services), to encourage environmental sanitation monitoring program on public areas such as markets, stalls, inns, and hotels. Keywords: traveler’s diarrhea, case control, risk factors, tourists. Cite This Article: Ani, L., Suwiyoga, K. 2016. Traveler’s Diarrhea Risk Factors on Foreign Tourists in Denpasar Bali-Indonesia May and August 2013. Bali Medical Journal 5(1): 152-156. DOI:10.15562/bmj.v5i1.284 * Correspondence to: Luh Seri Ani, Department of Community and Preventive Medicine, Faculty of Medicine Udayana University, Denpasar, Bali, Indonesia luhseriani@yahoo.com 1 Department of Community and Preventive Medicine, Faculty of Medicine Udayana University, Denpasar, Bali, Indonesia 2 Urogynecology and Reconstruction Division, Department of Obstetrics and Gynecology, Faculty of Medicine Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia Traveler’s diarrhea risk factors on foreign tourists in Denpasar Bali-Indonesia Luh Seri Ani, 1* Ketut Suwiyoga 2