THE IMPLEMENTATION OF A CLEAN AND HEALTHY LIFESTYLE ON YOUNG CHILDREN AT PRIMA SAKINAH KINDERGARTEN

A Clean and Healthy Lifestyle needs to be accustomed from an early age so that children are maximally stimulated and away from disease. The purpose of this study was to find out in detail the clean and healthy lifestyle program implemented by Prima Sakinah Kindergarten and its supporting sanitation facilities and infrastructure. Prima Sakinah Kindergarten is one kindergarten that has implemented a Clean and Healthy Lifestyle Habituation program since 2003. Prima Sakinah Kindergarten also won first place in Healthy Schools at the Mustika Jaya district level, Bekasi. It became one of the early childhood education institution-level driving schools representing Bekasi. The method used in this research is naturalistic qualitative with data collection and data analysis using interview, observation, and documentation studies. The research subjects were 25 students of Prima Sakinah Kindergarten. Prima Sakinah Kindergarten implements the Clean and Healthy Lifestyle program well. The program includes washing hands with soap and running water, habituation of tooth brushing, urinating and defecating in the latrine, clipping nails, eating healthy, balanced, and nutritious food, water therapy, giving milk, disposing of garbage in its place, and sorting out waste, physical activity, and monitoring children's growth.


Introduction
Health is one of the most valuable blessings in human life. Health is the primary capital to carry out all activities. According to the World Health Organization (WHO), health is a state of complete physical, mental and social wellbeing and is not only free from disease and disability (Notoatmojo: 2007). It means that a person's health is not only measured from the physical, mental, and social aspects but is also measured from his productivity, where all aspects of life are very supportive of human health conditions.
There are 780 million people who do not have good sanitation worldwide. Diarrhea due to infection is widespread throughout developing countries. Most people die from diarrhea due to severe dehydration and fluid loss (WHO, 2013).
Data from the World Gastroenterology Organization Global Guideline shows that about two billion cases of diarrheal disease worldwide each year, and 1.9 million children under five years of age die each year. This amount is 18% of all deaths of children under five years and means that more than 5000 children die every day from diarrheal diseases. Of all child deaths due to diarrhea, 78% occur in Africa and Southeast Asia. Based on 2010 WHO data, in the Weekly Morbidity and Mortality Report (WMMR) IDP Husting and Crisis Affected Districts, Khyber Pakhtunkhwa, Pakistan, reported that from May 29 to June 4, 2010, of all patient visits, 12% of them suffered from diarrheal diseases and from of all patients suffering from diarrhea, 23% of patients are under-fives, of which 9% of all patients with diarrhea suffer from diarrhea.
The followings are the prevalence rate of diarrhea in Indonesia based on the results of primary health research (Riskesdas) in 2013, the prevalence of diarrhea for all ages was 3.5%, with the highest prevalence in Papua province being 14.7% and the lowest prevalence in Bangka Belitung province being 3.4%. Meanwhile, the prevalence of diarrhea in children under five, in general, is 6.7%, with the highest prevalence in the province of Aceh, namely 10.2%, and the lowest prevalence in the province of East Kalimantan namely 3.3% (Ministry of Health: 2013). The Basic Health Research (2013) results stated that the prevalence of diarrhea for all ages in West Java was 3.9%. Meanwhile, diarrhea under five in West Java province is 7.9% (Ministry of Health: 2013). One million thirty-two thousand two hundred eighty-four cases (West Java Provincial Health Office, 2016). One of the areas with relatively low diarrhea handling is Bekasi Regency, where based on the report, it was found that from the target of finding 10% of diarrhea cases, which amounted to 91,036, only 25,251 cases (27.74%) were handled (West Java Provincial Health Office, 2016).
Improving health care for children is very important because the quality of children is greatly influenced by health during the child's growth and development. Healthy children can learn well. So that health education is very strategic to be implanted at an early age considering that attitudes and behavior are relatively not formed at this age so that it will be easier to instill clean and healthy living behavior than adults. Instilling clean and healthy living behavior as early as possible is more likely to ensure people with good clean and healthy living behaviors when they grow up.
Young children need better health services because their immune systems are still low and easily infected or malnourished. Therefore, it is necessary to pay special attention to children regarding education and health monitoring in their development process. Through the implementation of Clean and Healthy Lifestyle education carried out by educational institutions for early childhood, it is hoped that someday they will implement a clean and healthy life when they grow up (Darajat, 2008).
The Clean and Healthy Lifestyle indicator in schools is a step to empower students, teachers, and the school community so that they can and are willing to carry out Clean and Healthy Behavior in creating healthy schools. Examples of Clean and Healthy Lifestyle in schools are washing hands with soap and running water, brushing teeth, consuming healthy food, using clean and healthy latrines, exercising regularly, eradicating mosquito larvae, throwing garbage in its place, and cutting nails (KEMENKES, 2016) Through the Clean and Healthy Lifestyle program implemented by educational institutions for early childhood, it is hoped that someday they will implement a clean and healthy life as an adult.
Prima Sakinah Kindergarten Bekasi is an example of a kindergarten implementing a Clean and Healthy Lifestyle program. Prima Sakinah Kindergarten also won first place in a healthy school award at the Mustika Jaya sub-district of Bekasi. Prima Sakinah Kindergarten in 2022 was chosen to be one of the driving schools for the Ministry of Education and Culture in the Early Childhood Education category, representing the Bekasi. Prima Sakinah Kindergarten has a particular program. The implementation of health programs that Prima Sakinah Kindergarten has carried out, including the application of Clean and Healthy Lifestyle, the program applied at school and home. Therefore, the purpose of this study is to discuss in more detail the implementation of the Clean and Healthy Lifestyle program as well as the supporting facilities and infrastructure owned by Prima Sakinah Kindergarten, Bekasi.

Methods
This research is naturalistic qualitative research. The term "naturalistic" indicates that the implementation of this research does occur naturally, as it is, in typical situations that are not manipulated by circumstances and conditions Copyright © 2021 | JECE | P-ISSN 2686-2492 emphasize descriptions naturally. Data retrieval or phenomenon networking carried out from reasonable conditions is known as "natural data retrieval." This nature will require the direct involvement of researchers in the field (Arikunto, 2007). Researchers function to describe, analyze, and provide information regarding implementing a clean and healthy lifestyle program at Prima Sakinah Kindergarten.
The source of data in this study is the subject where the data was obtained (Ibid: 2008). The data sources were the Principal of Prima Sakinah Kindergarten as the program policyholder, class teachers as program implementers, and 25 students implementing the Clean and Healthy Lifestyle program.
The researcher is the leading research instrument (Sugiyono, 2010). The techniques used in this research are observation, open interviews, and documentation studies. Explanation of each technique: 1) Interview, this research used semi-structured interviews. In this semi-structured interview, the interview first asks a series of structured questions, then one by one, it is deepened in extracting further information (Arikunto, 2007). Interviews were conducted in-person to obtain information about forms of health education for Clean and healthy lifestyle teachers taught, how methods and strategies are used, existing barriers and supports, and their hopes for health advancement for early childhood; 2) Observation, the observation method used is participant observation, namely observations made by taking part or involving oneself in the situation of the object under study (Ali, 1990). This method is used to see firsthand how teachers teach health values to early childhood, as well as to observe how the environmental conditions and the overall condition of students and how clean and healthy behavior they apply as a student response to health materials for Clean and Healthy Lifestyle that has been given; 3) Documentation, documentation is a complement to the use of observation and interview methods (Sugiyono: 2010) The data analysis process begins by examining all the data obtained from the interviews, observations, and documentation by organizing the data in the form of categories, describing it into units, synthesizing, compiling into patterns, choosing which ones are important to study, and making conclusions so that easy to understand.

Results and Discussion
Clean and Healthy Lifestyle is behavior and habits to maintain personal hygiene (hygiene) and the surrounding environment (sanitation), closely related to the principle of balanced nutrition, which includes maintaining personal and environmental hygiene, namely washing hands with soap and brushing teeth, after eating, taking care of nails to keep them short and clean, putting cutlery in its place, managing household waste. Physical activity and growth monitoring to maintain body health are also needed for early childhood. Activities that can be done are physical activity and monitoring children's growth. (Marliyati: 2019). According to the Clean and Healthy Lifestyle Program Guidelines, early childhood education to run this program must provide sanitation facilities and infrastructure such as latrine facilities and infrastructure in early childhood education, hand washing facilities with soap, water facilities, and infrastructure for drinking, sanitation, and hygiene needs. Waste management facilities and infrastructure in early childhood education and a healthy and safe play environment. In addition to providing facilities and infrastructure, early childhood education units have a program of habituation of clean and healthy living behavior, which includes habituation of urination and defecation behavior, habituation of washing hands with soap, habituation to dispose of garbage in its place, habit of drinking water and eating healthy food and maintaining a clean and safe environment. (Directorate of Early Childhood Education Development, Directorate General of Early Childhood Education and Community Education Ministry of Education and Culture, 2020). We know from the description above that the Clean and Healthy Living behavior program must be provided and carried out by the early childhood education unit. Not many academic units make Clean and Healthy Lifestyle programs complete and continuously carried out as a habit for children.
One of the early childhood education units with a complete Clean and Healthy Lifestyle program is Prima Sakinah Kindergarten. The research results conducted by researchers will describe in detail the facilities and infrastructure and the Clean and Healthy Lifestyle program implemented at Prima Sakinah Kindergarten.

Provision of toilets/latrines
Prima Sakinah Kindergarten has six toilets/latrines per the standard guidelines that have been set (Permendiknas No.24 of 2007), which has a roof made of lightweight and strong materials, waterproof walls, a minimum room area of 2 square meters, lighting and ventilation enough, there are scoops, buckets/tubs of water with a minimum volume of 20 liters of clean water, clothes hangers, trash cans in the toilets and doormats in front of the latrine doors. The middle part of the building consists of a channel in the shape of a goose's neck, the distance between the two footrests is according to the age of the Early Childhood Education children, there is no difference in the height of the toilet installation, a urinal for boys and the floor is made of non-slip material. Based on an interview with the principal, the bottom of the latrine building consists of a collection of feces and an infiltration tank.

Water Facilities and Infrastructure for Drinking Needs
Under law No.492/MENKES/PER/IV/2010 concerning Drinking Water Quality Requirements, drinking water is water that has been processed or without processing that meets health requirements and can be drunk directly. Prima Sakinah Kindergarten has provided bottled drinking water in the form of 4 gallons in each child's class.

Waste Management Facilities and Infrastructure
Waste management in Early Childhood Education is carried out by referring to the Ministerial Regulation Public Works of the Republic of Indonesia Number 03/PRT/M/2013, namely by limiting waste generation (Reduce), recycling waste (Recycle) Moreover, reuse the waste (Reuse). Sorting waste based on its type (at least based on its nature, organic and inorganic). Provide segregated bins, at least for organic and inorganic waste, robust, watertight, and closed. Trash cans can be made from used paint containers, buckets with lids, or other materials and are made in different colors between organic and inorganic waste bins. Cooperate with village government and TPS or TPS 3R for waste collection and transportation. Provide cleaning tools in brooms and tools to move garbage (dustpan). Prima Sakinah Kindergarten provides six places for garbage disposal divided into three parts, namely organic, inorganic, and dangerous. Children are accustomed to always throwing garbage according to its type. For waste management, Prima Sakinah Kindergarten has an Educational Waste Bank where children will be taught the application of the 3Rs, namely Reducing waste generation, recycling waste (Recycle), and reusing waste (Reuse). The use of used goods is also very much applied here, such as to make children's learning media using used goods that are no longer used, such as cardboard, bottle caps, plastic bottles, straws, used paper, and many others. Children are also accustomed to reusing inorganic waste during play activities in making a project or work to support environmental conservation. The cleaning equipment at Prima Sakinah Kindergarten is also complete, from palm fiber brooms, broomsticks, dustpan, duster, vacuum cleaner, glass cleaning equipment, glass

Habituation of urination and defecation in the latrine.
Human feces and urine have an unpleasant odor contain many germs. Defecation and urination in healthy latrines is one way to break the flow of disease transmission that originates from human feces and urine (Rest Room Association, 2014). Prima Sakinah Kindergarten has made a habit of urinating and defecating in clean latrines. This activity is called toilet training. Children are accustomed to urinating and defecating themselves and are taught to clean feces and urine when they are finished;

Nail clipping
Fingernails and toenails must be cared for to keep them short and clean to avoid germs that settle on untreated nails, and toenails can invite unpleasant odors, thereby reducing self-confidence (Marliyati, 2019). This habit is carried out at students' homes. Parents are asked to regularly cut their children's nails because there will be an inspection every Friday called clean Friday

Eat healthy Balanced nutrition and water therapy
According to (Kemenkes, 2014) in the Guidelines for balanced nutrition, the message of balanced nutrition for early childhood is to make it a habit for children to eat three times a day (morning, afternoon, and evening) with the family, starting with breakfast or breakfast. It is recommended that children always eat with their families to ensure that children eat healthy and nutritious foods. Expand protein-rich foods such as fish, eggs, tempeh, tofu, and meat. Protein is needed for the growth and development of children. Fish and eggs have good quality protein. Tempe and tofu are vegetable protein sources whose quality is good enough for children's growth and development. Keep in mind that milk is one source of protein whose benefits are the same as other protein sources. Expand vegetables and fruits high in vitamins, minerals, and fiber sources. Vitamins and minerals are needed for a healthy body because they play an essential role in growth and metabolism. Limit eating snacks that are too sweet, salty, and fatty. Sweet foods and drinks will reduce the child's appetite so that the child lacks the essential nutrients needed by his body to grow and develop. The habit of consuming foods and beverages with high levels of sugar, fat, and salt will also harm children's health and negatively impact their health when they grow up. Avoid consuming dyes and other harmful chemicals, flavors, preservatives, or artificial sweeteners. Take advantage of local food sources that are rich in nutrients. Drink water as needed. It is highly recommended not to get used to it. Children drink sweet or fizzy drinks because these drinks contain high sugar. The application in Prima Sakinah Kindergarten is to eat healthy food at school. Catering is provided whose food menu according to the above guidelines must be balanced nutrition. There are carbohydrates, protein, and sufficient fiber needs of children, and sufficient fat is not excessive. Suppose some children do not participate in catering at school. In that case, the children will bring their prepared lunches, packaged food, junk food, high-grade foods such as snacks sold in the market. Most children take part in catering at school because their nutrition is guaranteed. Food and the habit of drinking enough water according to the child's needs are also carried out. This habit is called White Water Therapy. This white water therapy is done before starting activities while eating and playing at school

Milk feeding
Milk is a product produced from livestock that functions as an energy source for the body's metabolism because it has complete nutrition such as carbohydrates, proteins, fats, vitamins, and minerals. In addition, milk has antibodies, namely immunoglobulins, suitable for a growing child's immune system (Alhuur, 2019). This program is carried out once a week in collaboration with the school committee, which provides milk to all students

Littering in the trash can and sorting out the trash
The habit of throwing garbage in the trash and keeping the environment clean, healthy, and safe must start early. This habit should be continued by students at home, with support from parents/caregivers (Directorate of Early Childhood Education Development, Directorate General of Early Childhood Education and Community Education, Ministry of Education and Culture, 2020). Implementation of the habit of disposing of waste in its place and sorting waste according to its type, starting with introducing children to 3 trash bins provided by the school, the first for organic waste or biodegradable waste, inorganic waste that cannot be decomposed

Physical Activity
Healthy and active living habits need to be instilled from childhood. Physical activity can prevent obesity. Physical activity can encourage gross and fine motor skills. Some examples of physical activities that early childhood can do are gymnastics, running, jumping, gardening, playing APE, cleaning classes (Marliyati, 2019). Prima Sakinah Kindergarten has made a habit of doing physical activities, such as before entering school there is a drop-off area for children from that area, children are accustomed to walking in dhikr, walking from the drop-down area to the school gate, before starting activities, it begins with a brain gym, during breaks the children are free to play. According to his wishes, some play ball, swing, slide, seesaw, and others. Children also get pickets to water the plants in the school garden every morning when the weather is sunny while basking in the morning sun

Child growth monitoring
Monitoring children's growth is done in several ways, namely weighing, measuring height, and measuring the child's head circumference. Getting in the habit of monitoring the child's weight and height every month to ensure their growth is still within normal limits. Ideal body weight is bodyweight that is proportional to height. Monitoring children's weight growth can be done using KMS. Characteristics of healthy children are gaining weight and height according to age (Notoatmojo, 2007). Monitoring the growth of children at Prima Sakinah Kindergarten is carried out every month by weighing the child's weight, measuring the child's height and head circumference. Then, it is analyzed according to age, usually using KMS and DDTK. After the analysis, it can be seen whether the child's growth is expected, lacking, or excessive. The analysis results at Prima Sakinah Kindergarten are the majority growing according to their age.

Conclusion
Clean and Healthy Lifestyle has been implemented at Prima Sakinah Kindergarten. It includes providing complete and adequate facilities and infrastructures such as clean toilets/latrines, suggestions for washing hands with soap, water facilities and infrastructure for drinking needs, waste management facilities, infrastructure, and a healthy and safe play environment. The Clean and Healthy Lifestyle program carried out included the habit of washing hands with soap and running water, habituation of tooth brushing, habituation of urinating and defecating behavior in latrines, clipping nails, eating healthy, balanced nutrition and