Risk Factors for Traveler’s Diarrhea (Bali Belly) in Foreign Tourists in Bali: A Narrative Review

Abstract

Traveler’s diarrhea is an acute diarrheal illness and one of the most frequently reported health problems among travelers visiting developing countries, including Indonesia. However, evidence regarding its risk factors in Bali remains scattered across multiple studies. This narrative review aimed to summarize the scientific evidence on risk factors for Traveler’s Diarrhea (Bali Belly) among foreign tourists in Bali. A literature search was conducted using ScienceDirect and ResearchGate for publications from 2016 to 2026 with the keywords “("traveler's diarrhea" OR "travellers' diarrhea" OR "travellers diarrhea" OR "Bali Belly") AND (Bali) AND (traveler OR traveller OR tourist*) AND ("risk factor*" OR determinant* OR exposure*)**”. Articles meeting the inclusion criteria were analyzed narratively. A total of 394 articles were identified through the literature search, and after title and abstract screening and duplicate removal, 10 studies met the inclusion criteria and were included in the review. The findings indicate that Traveler’s Diarrhea (Bali Belly) among foreign tourists in Bali is influenced by several risk factors, including consumption of contaminated food and beverages, eating outside hotels or from street vendors, poor food hygiene and sanitation, and traveler characteristics such as first-time visits to Bali or Southeast Asia and unfamiliarity with local food. The high occurrence of this illness may affect not only tourists’ health and travel experience but also the image of Bali as a tourist destination. Therefore, collaborative efforts involving the health, food safety, and tourism sectors are needed to improve hygiene and sanitation, strengthen traveler education, and enhance food safety monitoring to reduce the incidence of Traveler’s Diarrhea.