Henni Djuhaeni

Ecohealth System Dynamic Model as a Planning Tool for the Reduction of Breeding Sites

Dengue is still one of major health problem in Indonesia. Dengue transmission is influenced by dengue prevention and eradication program, community participation, housing environment and climate. The complexity of the disease coupled with limited resources necessitates different approach for prevention methods that include factors contribute to the transmission. One way to prevent the dengue transmission is by reducing the mosquitos breeding sites. Four factors suspected to influence breeding sites are dengue prevention and eradication program, community participation, housing environment, and weather condition. In order to have an effective program in reducing the breeding site it is needed to have a model which can predict existence of the breeding sites while the four factors under study are controlled. The objective of this study is to develop an Ecohealth model using system dynamic as a planning tool for the reduction of breeding sites to prevent dengue transmission with regard to dengue prevention and eradication program, community participation, housing environment, and weather condition. The methodology is a mixed method study using sequential exploratory design. The study comprised of 3 stages: first a qualitative study to 14 respondents using in-depth interview and 6 respondents for focus group discussion. The results from the first stage was used to develop entomology and household survey questionnaires for second stage conducted in 2036 households across 12 sub districts in Bandung City. Ecohealth system dynamic model was developed using data from first and second stages. Analyses used are thematic analysis for qualitative data; spatial, generalized estimating equation (GEE) and structural equation modeling for quantitative data; also average mean error (AME) and average variance error (AVE) for dynamic system model validation. System dynamic model showed that the most effective approach to eliminate breeding places was by ensuring the availability of basic sanitation for all houses. Weather factors such as precipitation can be compensated with the eradication of breeding sites activities which is conducted as scheduled and at the same time for the whole areas. Conclusion of this study is that dengue prevention and eradication program, community participation, and housing environment contributed to breeding places elimination influenced the existence of the breeding sites. The availability of basic sanitation and breeding places eradication program done timely and collectively are the most effective approach to eradicate breeding sites. Ecohealth dynamic system model can be used as a tool for the planning of breeding sites eradication program to prevent disease transmissions at city level.

PROTON PUMP INHIBITORS FOR STRESS ULCER BLEEDING PROPHYLAXIS IN CRITICALLY ILL PATIENTS: A COST ANALYSIS STUDY

Objective:Stress ulcer prophylaxis is generallyadministered for the prevention stress-related mucosal disease (SRMD) in critically ill patients. Proton Pump Inhibitors (PPIs) are most commonly prescribed in preventing bleeding from SRMD. Pantoprazole iv and omeprazole iv are the most effective, but clinically effective is not always efficient. Thisstudy aimed to investigate whether the most efficient PPIs for prophylaxis in ICU settings.Methods:An observational study was conducted on June 2014 with comparative design by using medical records in January 2012−November 2014 in a private hospital in Bandung City. Both retrospective and prospective data collection was performed in this study. Paired t-test analysis was used to compare average cost of the drugs with significant level p<0.05.Results:The results showed average cost of pantoprazole iv 458.142 IDR/patient and omeprazole iv 575.573 IDR/patient, there were significant differences of average drug cost between pantoprazole iv and omeprazole iv (p=0.0085).Conclusion:Both pantoprazole iv and omeprazole iv were effective but pantoprazole ivhad been found more efficient.

Berbagai Faktor yang Memengaruhi Kejadian Demam Berdarah Dengue di Kota Bandung

Abstract. Dengue haemorrhagic fever (DHF) incidence rate in Aceh Province for the past three years 2012-2014 were fluctuated from 51‰, 29 ‰ and 45 ‰. The most widely used larvacide to control larvae Ae. aegypti is temefos, in Indonesia 1% temefos (abate 1SG) started used in 1976, and since 1980 has been used for the eradication program of Ae. aegypti larvae. The intensive use of temefos will be not a problem until population were dominated by resistant individuals. The purpose of this study was to determine the status of susceptibility of Ae. aegypti larvae against temefos in three dengue fever endemic areas in Aceh. We conducted an observational study to examine the susceptibility of Ae. aegypti population in 3 districts of Aceh Province: Banda Aceh, Lhokseumawe and Aceh Besar. Entomological survey and larval collection was assigned. Larvae then reared in laboratory until third generation. Third and early fourth instars stage of Ae. aegypti larvae were used as test samples. Susceptibility test was undergo based on World Health Organization guidelines. Results shows that larva Ae. aegypti from Banda Aceh (100%) and Lhokseumawe (99%) districts was still susceptible, while Aceh Besar (97%) indicates tolerance to temefos 0,02%. In conclusion, temefos still effective to be used as larvicide for vector control in those three endemic of dengue fever in Aceh Province. The priority vector control program that can be suggested is put mosquito breeding place eradication called PSN as a proactive movement in community. Keywords : Aedes aegypti, temefos, susceptibility, insecticide, Aceh Abstrak. Angka insidensi demam berdarah dengue (DBD) di Provinsi Aceh tahun 2012-2014 berturut turut 51‰ menurun 29 ‰ dan meningkat kembali 45 ‰. Penggunaan larvasida temefos 1% (abate ISG) untuk mengendalikan larva Aedes aegypti sudah digunakan oleh program sejak 1976. Penggunaan larvasida tidak akan menjadi masalah sampai suatu populasi didominasi oleh individu-individu yang resisten. Tujuan dari penelitian ini adalah menentukan status kerentanan larva Ae. aegypti terhadap temefos di tiga kabupaten/kota endemis DBD di Provinsi Aceh. Penelitian observasional ini menggunakan desain potong lintang. Pengumpulan data dilakukan selama bulan Mei-Juni 2015 dengan lokasi penelitian di tiga Kabupaten/Kota yang tersebar di Provinsi Aceh, yaitu Kota Lhokseumawe, Banda Aceh dan Kabupaten Aceh Besar. Survei larva Ae. aegypti dilakukan pada 100 rumah terpilih di setiap kab/kota dengan pengamatan pada kontainer yang dapat menampung air di dalam dan luar rumah. Larva Ae. aegypti yang diperoleh kemudian dipelihara sehingga didapatkan nyamuk generasi ketiga. Spesimen uji yang digunakan adalah larva instar III dan atau IV awal berdasarkan metodologi WHO. Hasil uji terhadap temefos 0,02 ppm menunjukkan bahwa larva Ae. aegypti dari semua wilayah yang diteliti Kota Lhokseumawe (100%) dan Banda Aceh (99%) masih rentan kecuali di Kabupaten Aceh Besar (97%) sudah toleran terhadap insektisida tersebut. Kesimpulan penelitian adalah temefos masih layak digunakan sebagai larvasida dalam pengendalian vektor di tiga kabupaten/kota endemis DBD di Provinsi Aceh. Upaya pengendalian yang lebih utama diterapkan adalah Gerakan Pemberantasan Sarang Nyamuk (PSN) sebagai gerakan proaktif di masyarakat. Kata Kunci : Aedes aegypti, kerentanan, insektisida, temefos, AcehAbstract . Dengue Hemorrhagic Fever (DHF) reemerged as a significant public health problem, which reflects the difficulty in sustaining DHF control program. Community-based strategy to control Aedes aegypti breeding sites needs to be understood. The objective of this study is to understand contributed factors to DHF based on characteristics, the availability of basic sanitation, knowledge, perception, and attitude towards DHF prevention program. A survey conducted to 2035 households in 12 districts and 16 villages in Kota Bandung in April to June 2015 using stratified random sampling method. A questionnaire was administered to collect information on variables related to economic status, knowledge on DBD, risk perception and practices associated with Aedes aegypti breeding sites, also basic sanitation facilities. The analysis used was correlation and generalized estimating equation (GEE). Results showed that gender, basic sanitation availability, knowledge about dengue in general, knowledge about DHF symptoms, and perception about the disease contribute to dengue cases (p ≤ 0.05). The conclusion of this study is factors contributed to dengue cases were sex, education, basic sanitation, knowledge about dengue in general, knowledge about DHF symptoms and perception about the disease. Program planning should also include factors and the need for the local community. Keywords : knowledge, attitude, risk perception, basic sanitation, dengue Abstrak . Munculnya kembali Demam Berdarah Dengue (DBD) sebagai masalah kesehatan masyarakat yang utama menunjukkan sulitnya mempertahankan kelangsungan program pencegahan dan pemberantasan penyakit ini. Pengetahuan yang memadai mengenai DBD dan metode untuk mencegahnya harus dapat dimengerti oleh masyarakat sebelum mereka mau berpartisipasi aktif. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang mempengaruhi kejadian DBD di Kota Bandung. Penelitian ini merupakan survei pada 2035 rumah tangga di 12 kecamatan dan 16 desa di Kota Bandung pada Bulan Mei – Juni 2015 yang dilakukan dengan metode stratified random sampling. Kuesioner dipergunakan untuk mengetahui faktor-faktor karakteristik, pengetahuan mengenai DBD, persepsi risiko dan sikap dalam pemberantasan sarang nyamuk serta fasilitas sanitasi dasar. Analisis data menggunakan analisis korelasi serta Generalized Estimating Equation (GEE). Hasil menunjukkan jenis kelamin, pendidikan, ketersediaan sanitasi, pengetahuan umum mengenai DBD, pengetahuan mengenai gejala DBD, dan persepsi mengenai DBD menjadi faktor yang memberikan pengaruh terhadap kejadian DBD (p<0,005). Simpulan penelitian adalah faktor yang memengaruhi kejadian DBD di Kota Bandung adalah jenis kelamin, pendidikan tinggi, sanitasi, pengetahuan umum mengenai DBD, pengetahuan mengenai gejala DBD dan persepsi mengenai DBD. Perencanaan program sebaiknya mengikut sertakan faktor karakteristik lokal masyarakat. Kata Kunci : DBD, sanitasi dasar, persepsi, pengetahuan, pencegahanAbstrak. Penelitian ini bertujuan untuk menentukan tingkat risiko penularan DBD di wilayah endemis DBD di Kabupaten Bone, Kota Palopo dan Kota Makassar Provinsi Sulawesi Selatan. Penelitian dilaksanakan Bulan Mei-Juni 2015 pada rumah tangga secara sistematik sampling sebanyak 100 rumah pada setiap wilayah kerja puskesmas endemis DBD tertinggi di Kab. Bone (Watampone), Kota Palopo (Wara) dan Kota Makassar (Mangasa) Provinsi Sulawesi Selatan. Data dianalisis untuk menunjukkan indikator surveilans larva (HI, CI, dan BI) dan density figure. Data disajikan dengan jumlah larva berdasarkan jenis kontainer, persentase dan distribusi kontainer. Nilai ABJ ketiga puskesmas termasuk rendah Watampone: 53%, Wara: 54%, Mangasa: 68%. Persentase CI (angka container) larva tertinggi adalah Puskesmas Watampone (17, 78%), selanjutnya Wara (17,71%) dan Mangasa (15,47%). Berdasarkan perhitungan HI, CI dan BI, density figure dari ketiga kabupaten pada kategori sedang hingga tinggi dan Maya index menunjukkan tingkat risiko penularan DBD sedang. Hasil menunjukkan bahwa Density figure pada kontainer rumah tangga yang diperiksa sedang hingga tinggi. Kampanye pencegahan DBD yang kuat, deteksi kasus dari rumah ke rumah dan upaya persuasif yang mengedukasi mengenai hal ini penting dilakukan untuk meningkatkan kesadaran masyarakat agar ikut berpartisipasi dan lebih waspada terhadap DBD. Kata Kunci : DBD, larva, Aedes aegypti, kontainer, Maya Indeks Abstract. The aim of this research is to determine of transmission risk level of Dengue Hemorrhagic Fever (DHF) endemic area in District of Bone, Municipal of Palopo, and Municipal of Makassar, South Sulawesi province. Study held in May-June 2015 to 100 households by systematically sampling method in three highest local healthcare center work area in each endemic in District of Bone (Watampone), Municipal of Palopo (Wara), and Municipal of Makassar (Mangasa), South Sulawesi Province. Data analyzed to show the indicators of DHF surveillance (House Index, Container Index, and Breteau Index) and density figure. Data served with the number of larva in each inspected container, percentage and distribution of containers. Larval free house indices values of three local healthcare center were Watampone: 53%, Wara: 54%, and Mangasa: 68%. The highest container indices values were local healthcare center of Watampone (17.78%), Wara (17.71%) and Mangasa (15.47%) respectively. According to HI, CI and BI, density figure calculation, the study areas were categorized as moderate to high risk to DHF and the Maya index indicate the moderate risk to DHF transmission. Density figure of household water containers were moderate to high. Stronger campaign, door to door case detection and educating persuasive efforts concerning DHF case is important to be done in order to awaken the community awareness including stake holder to contribute to solve on DHF problem. Keywords : Dengue Hemorrhagic Fever, larva, Aedes aegypti, container, Maya index.