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3/30/2021 Editorial Team | INDONESIAN JOURNAL OF HEALTH SCIENCES RESEARCH AND DEVELOPMENT (IJHSRD)

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Indonesian Journal of health sciences research and development is a double-blind peer-reviewed international journal. The frequency is monthly from 2019. It deals with all aspects of health sciences including Community Medicine, Public Health, Epidemiology, Occupational Health, Environmental Hazards, Clinical Research, and Public Health Laws, pharmacology biotechnology, health instruments, nursing, clinical psychology and covers all medical specialties concerned with research and development for the masses. The journal strongly encourages reports of research carried out within the Indonesian continent and South East Asia.

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Chief of Editor : DrPH. Tasnim, SKM, MPH

Managing editor : 1. La Djabo Buton, SKM, M.Kes

2. Azlimin, SKM, MM

3. Noviati, SKM.,MPH

4. Muhammad Isrul, S.Si., M.Si, Apt

5. La Ode Hamrin, S.Si., M.T

6. Tiara Mayang Pratiwi Lio, S.Ked., M.Si

7. Putu Suri, A.Md.Keb, SKM, M.Kes

8. Lisnawati, S.Kpe, Ns., M.Kep

9. Iksan, SKM.,M.Kes

10. Jamal Buton, SKM

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2. Ass. Prof. Gouranga Dasvarma (Australia)

3. Prof. Dr. Rusli Bin Nordin (Malaysia)

4. Prof. Dr. Abdul Rachman Ayub (Malaysia)

5. DrPH. Tasnim, SKM, MPH (Indonesia)

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7. Dr. Vikram Nirajan (Ireland, India)

8. Dr. Ayesha AlRifai (Palestine)

9. Ass. Prof. Dr. Roy Rillera Marzo (Malaysia)

10. Fairuz Fadzilah Rahim (Malaysia)

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CONTENTS

Volume 2, Number 1 August 28, 2020

1. THE RELATIONSHIP BETWEEN INCOME AND ACCESS WITH PAYMENT REGULATIONS OF HEALTH INSURANCE FOR SELF-FINANCING MEMBERS IN PUUWATU PRIMARY HEALTH CARE CENTRE IN KENDARI CITY ...... 1 Sri Mulyani

2. FACTORS RELATING TO THE PERFORMANCE OF HEALTH WORKERS IN ABELI CITY HEALTH CENTER, KENDARI CITY...... 9 Sartini Risky MS, Wa Ode Nova Noviyanti Rachman, Muhammad Ikhsan Akbar

3. DETERMINANT FACTORS OF UNDERNUTRITION IN PETOAHA VILLAGE: PATH ANALYSIS...... 15 Fitri Rachmillah Fadmi, La Djabo Buton

4. FACTORS RELATING TO THE UTILIZATION OF NCD INTEGRATED POST...... 22 Hadafiah, Sunarsih, Erwin Azizi Jayadipraja, Putu Suri Saraswati, Sartini Risky

5. COMMUNITY-LED HEALTH PLANNING MODEL FOR VILLAGE HEALTH TEAM :A CASE STUDY IN INDONESIA...... 27 Tasnim Tasnim

6. RELATIONSHIP OF WATER AND WATER RESERVOIRS WITH THE PRESENCE OF AEDES AEGYPTI LARVAE IN PUUWATU PUBLIC HEALTH CENTER WORKING AREA KENDARI CITY...... 33 Titi Saparina L,Noviati

7. THE EFFECT OF VIDEO AND SIMULATION COUNSELLING ON CHILDREN'S KNOWLEDGE ABOUT HAND WASHING USING SOAP IN THE PRIVATE VOCATIONAL SCHOOL OF LAMBANDIA DISTRICT EAST KOLAKA DISTRICT...... 39 Nur Ahmad, Tasnim Tasnim, Herianto Wahab

8. THE RISK OF KNOWLEDGE, SMOKING AND PATIENT’S CONTACT ON TUBERCULOSIS DISEASE IN PUUWATU HEALTH CENTRE IN KENDARI CITY...... 46 La Djabo Buton, Fitri Rachmillah Fadmi

Mulyani, S. DOI: 10.36566/ijhsrd/Vol2.Iss1/17 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718

Research Article Open Access

THE RELATIONSHIP BETWEEN INCOME AND ACCESS WITH PAYMENT REGULATIONS OF HEALTH INSURANCE FOR SELF-FINANCING MEMBERS IN PUUWATU PRIMARY HEALTH CARE CENTRE IN KENDARI CITY

Sri Mulyani Department of Public Health Mandala Waluya Kendari Health Science, Kendari, Southeast Sulawesi Province, Indonesia

Corresponding Author: Sri Mulyani Email: [email protected]

Abstract Background: The number of Health Insurance members in Puuwatu Primary Health Care Centre in 2016 contributed 204 people with arrears of Self-Financing In Health Insurance about 86 people (42.2%) and in 2017 driving membership was 246 people based on data up to June 2017 that arrears contacted 112 people (45, 5%). The purpose of the study was to study the relationship of knowledge and attitudes with regular pay in Self-Financing In Health Insurance membe rs in Puuwatu Primary Health Care Centre, Kendari City. Methods: This type of quantitative research with a cross-sectional study design. The population of all Self-Financing In Health Insurance members who work and have income inPuuwatu Primary Health Care Centre receives 106 people. Samples were taken by the Proportional Random Sampling technique taken 84 people. Results: The statistical test results use the Chi-square test, receive a value of ρ

Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 1

Mulyani, S. DOI: 10.36566/ijhsrd/Vol2.Iss1/17 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 RESULT Table 2. Bivariate Analysis Results The results of the univariate analysis Regulations Of in table 1 show that the majority of male Health Insurance p- respondents were 46 respondents (54.8%), For Self-Financing valu Variable had a high school education of 53 Members e respondents (63.1%), had the most regular Irregular Regular irregularities in paying Self-Financing In n % n % Health Insurance members contributions 54 Income respondents (64.3%), had less income about Less 46 88,5 6 15,3 0,00 the regularity of paying contributions to Self- 2 Enough 8 25,0 84,0 0 Financing In Health Insurance members by 4 54 respondents (64.3%) and access to ease of Acces regularity of paying contributions to Self- Difficult 45 84,9 8 15,1 0,00 Financing In Health Insurance members 2 Easy 9 29,0 71,0 0 were 53 respondents (63.1% ). 2 Table 1. Results of univariate analysis The results showed that the income Variable n % variable was 46 (88.5%) respondents with Sex low income and 8 (25%) respondents with Woman 38 45.2 sufficient income that were not officially Man 46 54.8 paid. Furthermore, 6 (15.3%) respondents School with low income and 24 (84%) respondents Junior high school 13 15.5 with sufficient income regularly pay fees. Senior High School 53 63.1 Whereas in the access variable there were 45 College 18 21.4 (84.9%) respondents with difficult access Pprofession and 9 (29%) respondents with easy access who did not normally buy contributions. Employee 55 65.5 Furthermore, there were 8 (15.1%) Entrepreneur 29 34.5 respondents with difficult access and 22 Regulations Of Health (71%) respondents with young access who Insurance For Self- regularly pay fees. Bivariate analysis results Financing Members using Chi-square analysis based on Irregular 54 64,3 Continuity Correction value ρ

DISCUSSION The results of the study obtained respondents with less income but regularly pay Self-Financing In Health Insurance members contributions, because they have an awareness of paying dues, meaning that not only income can cause a Self-Financing In Health Insurance members participant to pay dues but can be caused by other factors such Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 4

Mulyani, S. DOI: 10.36566/ijhsrd/Vol2.Iss1/17 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 as insufficient income to pay each month, of this study can indicate that the economic other factors as often using BPJS for status determines the ability of a person to treatment so that it becomes a necessity and pay dues as a participant of wages workers. obedient to the provisions must pay dues. The higher the economic status of a person, Whereas respondents with sufficient income the greater the ability of a person to pay but do not regularly pay contributions, this is dues. Conversely, the lower the economic because they have never used Self-Financing status of a person, the smaller the ability of In Health Insurance and paid contributions participants to continue to routinely pay the continuously every month, another reason dues Self-Financing In Health Insurance. because of uncertainty in employment and Case studies show that payment problems private worker income makes the informant are more complex than they might appear at decide not to pay or stop paying. Economic first and can damage the program if not limitations in the family are stated to be the thought through properly. If payments do not cause of arrears in arrears payments because flow in a timely or irregular manner, then there are other more pressing needs such as this can reduce activeness as an insurance the need for school/tuition fees for children participant. the causal factor that determines and other basic necessities causing the the regularity of participants in paying is low exclusion of payment for health insurance. In income(9). Independent participants with addition, it shows that Self-Financing In low income, prioritize their income to meet Health Insurance members who have less their daily needs that are routine, such as income tend to regularly pay dues because food costs, education costs, electricity, and the amount is greater than irregular ones, water payments and other costs, while for based on this means that income is the cause health costs, independent participants tend to of Self-Financing Health Insurance members not prioritize because they are still in good in paying dues. health. Conversely, independent participants The results of the statistical test with high incomes, in addition to being able found that there was a significant to allocate their income for daily needs are relationship between income and the also able to pay for health costs so they can regularity of paying contributions to Self- make regular contribution payments every Financing In Health Insurance members. month(10). The results of the study showed This shows that income is the cause of a that households with more children could large number of Self-Financing In Health reduce the purchasing power of insurance Insurance members who do not regularly pay because the households were wary of a surge fees. A person's income plays an important in costs beyond the daily consumption cost. role in the height of one's awareness of In addition, the status of respondents as an regularity in paying the National Health informal sector worker or an employee Insurance contributions. Low income can instead of a wage recipient makes an income reduce the regularity of the community in every month received uncertain. It is paying contributions to the National Health different from the formal sector workers who Insurance because there are still many needs are generally managed by the organization, that must be met by families so there is no where they work the payment of dues allocation of income used by participants to directly deducted from the salary. pay these contributions. High incomes and Meanwhile, informal sector workers must have a high level of welfare above and above manage their own dues so that they are have a high level of compliance in paying considered to be incriminated for participants National Health Insurance contributions. The with a lot of family members and not results of other studies revealed that in supported by economic ability. In line with general, the regularity of insurance payments the research which mentions that the depends on family income(7, 8). The results household size has a positive relationship Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 5

Mulyani, S. DOI: 10.36566/ijhsrd/Vol2.Iss1/17 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 sustainability as a business activity that aims REFERENCES to obtain the prosperity of the current 1. Ministry of Health of Republic of generation without reducing the rights of Indonesia. A guidance for health future generations to get the same welfare. insurance participant. Jakarta: Ministry thus ease of access to payments is very of Health of Republic of Indonesia RI. influential in the regularity of insurance 2014 (Indonesia). payments(17). Ease of access is also 2. Ministry of Health of Republic of obtained from geographical conditions that Indonesia. The regulation between are not too broad which will facilitate access Secretary of Health Ministry of for independent participants. Payment Republic of Indonesia and Directure of channels available such as payments via Health Insurance Number 3 in 2016 internet banking can be accessed directly for about Technical guidance for payment independent participants who use of basic need commitment in FKTP. smartphones. Although some areas are far Jakarta: Ministry of Health of Republic from where the payment of contributions is of Indonesia RI. 2016 (Indonesia). made, transportation services such as 3. Health Department of South East motorcycle taxis also provide easy access for Sulawesi Province. Health profile of independent participants to go to the canal Southeast Sulawesi Province in 2018. payment channels (18). Kendari: Health Department of South East Sulawesi Province; 2019.(Indonesia). CONCLUSION 4. Health Department of Kendari City. Based on the results of the study, it Health profile of Kendari City in 2018. can be concluded that there is a relationship Kendari: Health Department of between income and access to the regular Kendari City; 2018.(Indonesia). payment of contributions from Self- 5. Puuwatu Health Centre. Puuwatu Financing In Health Insurance members. it Health Centre Profile in 2018. means that income and access are the causes Puuwatu: Puuwatu Health Centre; of regular payment of contributions from 2019. (Indonesia). Self-Financing In Health Insurance members 6. Bowling A. Research methods in in Puuwatu Primary Health Care Centre, health: investigating health and health Kendari City. services: McGraw-hill education (UK); 2014. ACKNOWLEDGMENT 7. Ha Y, Cancian M, Meyer DR. The The author conveys with the utmost regularity of child support and its respect, expressing his unlimited thanks. A contribution to the regularity of big thank you to the author also to the income. Social Service Review. Mandala Waluya Foundation for giving us 2011;85(3):401-19. the opportunity to carry out the education, 8. Kramer B, Kunst D. Intertemporal research, and community development of choice and income regularity: Non- tertiary education especially in education. fungibility in a lab-in-the-field Related parties are the participants of the experiment. 2018. BPJS Mandiri community in Puuwatu 9. Singh D, Negin J, Otim M, Orach CG, Primary Health Care Centre, Kendari City. Cumming R. The effect of payment Thank you for the availability of time and and incentives on motivation and focus location during the study, and all parties for of community health workers: five their motivation and support.. case studies from low-and middle- income countries. Human resources for health. 2015;13(1):58. Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 7

Mulyani, S. DOI: 10.36566/ijhsrd/Vol2.Iss1/17 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 10. Ahyani A. Factors which influence to 18. Akbar MI. Study of National Health payment for health insurance members Insurance Program implementation in in Boyolali Health Insurance centre. Muna Distirct. Jurnal Kesehatan Surakarta: Muhammadiyah Surakarta Masyarakat Celebes. 2020;1(03):21 7- University; 2018. (Indonesia). 17 (Indonesia). 11. Dror DM, Hossain SS, Majumdar A, Koehlmoos TLP, John D, Panda PK. What factors affect voluntary uptake of community-based health insurance schemes in low-and middle-income countries? A systematic review and meta-analysis. PLoS One. 2016;11(8). 12. Javan-Noughabi J, Kavosi Z, Faramarzi A, Khammarnia M. Identification determinant factors on willingness to pay for health services in Iran. Health economics review. 2017;7(1):40. 13. Izza N. Colective payment system for self-financing member in payment obedience in Health Insurance in Malang District. Buletin Penelitian Sistem Kesehatan. 2019;22(1):44-53 (Indonesia). 14. Nugraheni R, Kirana GR. The analysis quality of service and patient satisfaction participants of health BPJS in interior services in hospital X of Kediri City. Journal of Global Research in Public Health. 2018;3(1):9-17. 15. Abnur A. Analysis on BPJS Kesehatan from Various Disciplines. Global Review of Islamic Economics and Business. 2015;2(3):159-71. 16. Intiasari AD, Trisnantoro L, Hendrartini J. Factors affecting delaying premium payment of National Helath Iinsurance members in informal sector in Banyumas District. Public Health.2014; 2(1): 1-6 (Indonesia). 17. Oktaviono YH, Tambunan DB, editors. The effect of Hospital X’s participation in Health Insurance program on its service quality and financial performance. The Fifth International Conference on Entrepreneurship; 2018 (Indonesia).

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Risky, S., Rachman, W. O. N. N. ,& Akbar, M. I. DOI: 10.36566/ijhsrd/Vol2.Iss1/23 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718

Research Article Open Access

FACTORS RELATING TO THE PERFORMANCE OF HEALTH WORKERS IN ABELI CITY HEALTH CENTER, KENDARI CITY

Sartini Risky MS1, Wa Ode Nova Noviyanti Rachman2, Muhammad Ikhsan Akbar3

1,2,3Departement Of Publich Health, Stikes Mandala Waluya Kendari, Southeast Sulawesi Province, Indonesia

Corresponding Author: Muhammad Ikhsan Akbar Email: [email protected]

Abstract Background : Public health center is the spearhead for improving the welfare of the community in the health sector. The health worker's skill needs to be optimized and can be seen from the results of their work, in the form of mastery of science and technology, as well as skills in implementing and providing health services. This is evident from the last three months' report on community visits, namely, in December 2016 the number of visits was 138 people, in January 2017 fell to 108 visits and in February 2017 dropped dramatically 93 visits. The purpose of this study was to determine the relationship of discipline, motivation, and training with the performance of health workers in the Abeli Community Health center. Methods: This type of research is quantitative with a cross-sectional study design. The population in this study was 42 people with a total sampling technique with a total sample of 42 people. The analytical method uses the Chi-Square statistical test and the Phi coefficient (ⱷ). Results : Based on the results of the study, there is a strong relationship between discipline and the performance of health workers with a value of X2 Calculation = 17,835 and a phi-efficiency test (ⱷ) = 0.651. There is a strong relationship between motivation and the performance of health workers with a value of X2 Calculation = 16,481 and the tested coefficient phi (ⱷ) = 0.626. There is a moderate correlation between training and health worker performance with X2 Calculation value = 10.299 and the phi coefficient test (ⱷ) = 0.495. Conclusion: For the health, institutions are suggested to increase the health worker's knowledge by increasing towards more discipline, high motivation, and more training in order. Eventually, the quality of human resources and health organizational performance will increase.

Keywords : performance, discipline, motivation, training

Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 9

Risky, S., Rachman, W. O. N. N. ,& Akbar, M. I. DOI: 10.36566/ijhsrd/Vol2.Iss1/23 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 INTRODUCTION and reward employees fairly so they can Health development organized by the provide satisfaction. Public health center is carried out to support From the results of the initial interview the achievement of national health with the head of the Public Health Center, it development goals through increasing is known that there are still complaints from awareness, willingness, and ability to live a the public about health services that are healthy life for everyone who lives in the considered unsatisfactory. This is evident working area of the primary care center to from the results of observations by realize the highest level of health(1). To researchers that the lack of work discipline realize the highest degree of health, one of identified from the number of hours worked the efforts carried out is to improve the is wasted usually working hours begin at quality of health services that is equitable 08.00 and the low level of knowledge of and affordable. improving the quality of officers about work related to health health services is largely determined by services. This has an impact on the level of existing human resources, especially health community visits, namely in December 2016 workers(2). the number of visits was 138 people, then in The community health center is the January 2017 it dropped to 108 visits and in spearhead for improving the welfare of the February 2017 it dropped dramatically to community in the health sector. To improve only 93 visits (7). The results of research service quality and coverage of a work area, conducted by (8) that one of the causes of the it is necessary to optimize the performance decline in the number of visits was due to the of health workers following their main tasks lack of satisfaction felt by patients after and functions(3). Ilyas (4)explains that getting health services at the health center. In performance is the appearance of the work of addition to stimulating health workers to personnel both quality and quantity in an carry out their main duties, the head of the organization where performance is the public health center Abeli pursues a policy appearance of individuals and workgroups. by giving assignments in the form of training Personnel who are functional and structural, to encourage improving the performance of but also to the entire range of personnel in health workers, skills, and discipline to the organization. According to Ikhsan Akbar increase the motivation of health workers. & Risky MS(5), in carrying out its main Based on the problem above, the tasks, health workers are required to provide researcher is interested in conducting maximum services that can provide research entitled "Factors relating to the satisfaction for people who need services. performance of health workers in Abeli City The work abilities of health workers Health Center, Kendari City" need to be optimized and can be seen from the results of their work, in the form of METHOD mastery of science and technology, as well as This research is a quantitative study skills in implementing and providing health with a cross-sectional design. The population services. Besides, a health worker must have in this study was all health workers who the driving force within himself to carry out served in the Abeli Public Health center by routine tasks in health care institutions by sampling using a total sampling technique utilizing the knowledge he has and with a total of 42 health workers. This is experience gained based on his tenure. because the population is relatively small, According to Azwar (6) employees namely less than 100 people. The analytical contribute to the organization in the form of method uses the statistical test, the Chi- abilities, expertise and skills possessed, Square test, and the Phi test. while the organization is expected to reward

Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 10

Risky, S., Rachman, W. O. N. N. ,& Akbar, M. I. DOI: 10.36566/ijhsrd/Vol2.Iss1/23 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 RESULT (7.1%), poor discipline was a poor The results of the table 1 showed that performance as many as 22 respondents of the 40 respondents, dominated by female (52.4%). Based on the results of Chi-Square sex by 76.2%, it means that the number of statistical tests show that the value of male respondents consisted of 13 people X2Calculation= 17,835> X2table = 3,841 with a percentage of 23.8%. The age of which means there is a relationship between respondents of Abeli Health center discipline and the performance of health employees is dominated by age over 25 years workers in the health center in Abeli. The as much as 90.5% and 9.5% under 25 years. results of the phi coefficient test (ⱷ) = 0.651 For the education level in this study, the indicate that discipline has a strong highest was S1 as many as 23 people relationship with the performance of Abeli (54.8%) and the lowest was S2 as many as 5 Health center workers. The results showed people (11.9%). Whereas for the highest that out of 42 respondents, high motivation level of work of employees of the Abeli and sufficient performance were 14 Health center in Kendari City, the highest respondents (33.3%), high motivation and number of respondents was > 2 years of less performance were 6 respondents work with 38 people (90.5%) and (14.3%), low motivation and enough respondents with a length of work ≤ 2 years performance were 2 respondents (4.8%), low were 4 people (9.5%). motivation and underperforming as many as 20 respondents (47.6%). From the results of Table 1. Characteristics Respondents the Chi-Square statistical test shows that the Characteristics n(42) % value of X2Calculation= 16,481> X2table = Gender n % 3,841 which means there is a strong Male 29 76.2 relationship between motivation and Female 13 23.8 performance. The results of the phi Age n % coefficient test (ⱷ) = 0.626 indicate that < 25 Years Old 4 9.5 motivation has a strong relationship with the > 25 Years Old 38 90.5 performance of Abeli Health center workers. Education n % The results showed that of the 42 DIII 6 14.3 respondents, the training was quite sufficient, S1 23 54.8 as many as 11 respondents (26.2%), the S2 5 11.9 training was quite underperforming, as many Etc 8 19.0 as 5 respondents (11.9%), the training lacked Length of working n % enough performance by 5 respondents ≤ 2 years 4 9.5 (11.9%), the training was underperforming > 2 yers 38 90.5 as much as 21 respondents (50.0%). Chi- Source: Primary data 2017 Square statistical test results show that the value of X2Calculation= 10,299> X2table = The results of table 2 show that of 42 3,841 which means there is a relationship respondents, good discipline was a quite between training and performance. The good performance by 13 respondents results of the phi coefficient test (ⱷ) = 0.495 (31.0%), good discipline was a poor indicate that the training has a moderate performance by 4 respondents (9.5%), relationship with the performance of Abeli discipline was not good enough performance Health center workers. was enough as many as 3 respondents

Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 11

Risky, S., Rachman, W. O. N. N. ,& Akbar, M. I. DOI: 10.36566/ijhsrd/Vol2.Iss1/23 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718

Tabel. 2 Relationship Of Discipline, Motivation and Training With The Performance Of Abeli Health center Health Officers The performance Total Statistic test Variable 2 2 Good Less (X Calculation≥ X table) n % N % n % Discipline Good 13 31. 4 9.5 17 40.5 17.835 ≥ 3.841 0 Phi = 0.651 Less 3 7.1 22 52.4 25 59.5 Motivation High 14 33. 6 14.3 20 47.6 16.481 ≥= 3.841 3 Phi = 0.626 Low 2 4.8 20 47.6 22 52.4 Training Good 11 26. 5 11.9 16 38.1 10.299 ≥ = 3.841 2 Phi = 0.495 Less 5 11. 21 50.0 26 61.9 9 Source: Primary Data in 2017

DISCUSSION which is a benchmark for the level of work Work discipline is a tool used by performance of officers. Others say that managers to communicate with employees so discipline is good but their performance is that they are willing to change behavior as lacking by 4 respondents (9.5%), this is well as a company regulation and applicable because officers have arrived on time and social norms (9). Chi-Square statistical test come home on time but they rarely take part results show that the value ofX2Calculation= in contributing to each activity, and some 17,835> X2table = 3,841 which means there respondents also said that discipline is not is a relationship between discipline and good but the performance is sufficient as performance. The results of the phi many as 3 respondents (7.1%), this is coefficient test (ⱷ) = 0.651 indicate that because there are still many officers who do discipline has a strong relationship with the not wear neatly office uniforms at the performance of health workers at Abeli Primary health care but they still show their Health Center in 2017. activeness and ability in carrying out and The results of the study obtained completing the tasks they entail. The results respondents' answers about discipline. of this study are supported by previous Showed that the majority of respondents said research (10) that there is a positive and that their discipline was not as good as 25 significant relationship between discipline respondents (59.5%). This is caused by Abeli and employee performance. Primary health care workers having no time Motivation is the willingness to make discipline, they arrive longer and go home high-level efforts to achieve organizational earlier than the specified hours, this can be goals that are conditioned by the ability of seen from the presence at work that still the business to satisfy the needs of several shows low work discipline. Discipline is an individuals (11). Chi-Square statistical test attempt made to create a situation in a work results show that the value of environment that is orderly, efficient, and X2Calculation= 16,481> X2table = 3,841 effective through the regulatory system which means there is a relationship between Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 12

Risky, S., Rachman, W. O. N. N. ,& Akbar, M. I. DOI: 10.36566/ijhsrd/Vol2.Iss1/23 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 motivation and performance. The results of majority of respondents said that the training the phi coefficient test (ⱷ) = 0.626 indicate was lacking as many as 26 respondents that motivation has a strong relationship with (61.9%). This is caused by Abeli Health the performance of health workers at Abeli Center health workers who have a level of Health center in 2017. knowledge and skills and ability to carry out The results obtained by respondents' the work provided is still low, meaning that answers about motivation, the majority of if the training factor is lacking, it is clear the respondents said that motivation is low, as performance is also lacking due to many many as 22 respondents (52.4%). This is due tasks and responsibilities that must be to unpleasant work situations and conditions, completed. Then some respondents said that then there are some respondents saying that the training was sufficient but their motivation is high but their performance is performance was lacking, namely as many as lacking as many as 6 respondents (14.3%). 5 respondents (11.9%), this was caused by so that the quantity of work performed by carrying out the tasks in the team as a staff and the ability of health workers to collaboration to complete the work. carry out their tasks is not yet optimal, this Respondents who responded to the training has an impact on the performance of health lacked sufficient performance, namely as workers who do not reach the target. health many as 5 respondents (11.9%), this was workers, but officers are aware of human because only a large portion attended the needs that people will never feel enough and training but they still tried to increase their satisfied with what they have, therefore the knowledge through learning, but as health salary received does not have an impact on workers were aware of the importance of their declining performance. The results of training to increase knowledge and skills. this study are supported by previous research This is following the opinion of Payama J. (12) which states that there is a positive and Simanjuntak (14)which states that training is significant relationship between motivation part of an investment in human resources and employee performance. According to (human investment) to improve the ability (13)states that the factors that influence the and work skills, and thus can improve achievement of performance are the factors performance. of ability (ability) and motivation (motivation). CONCLUSION Training organizers should try to carry The health institutions are suggested to out quality and accredited training, which is increase the health worker's knowledge by training that meets established standards so increasing towards more discipline, high that after attending training officers have motivation, and more training in order. knowledge and skills that are useful and can Eventually, the quality of human resources be implemented in carrying out tasks in the and health organizational performance will field so that the performance of health increase workers can improve. From the chi Square, statistical test results show that the value of ACKNOWLEDGMENT X2Calculation= 10,299> X2table = 3,841 The author expresses with great which means there is a relationship between respect, expressing his unlimited thanks. training and performance. The results of the Thank you very much to the author as well to phi coefficient test (ⱷ) = 0.495 indicate that the Mandala Waluya Foundation for training has a moderate relationship with the allowing us to carry out the education, performance of health workers at Abeli research, and community development of Health center in 2017. higher education. Related parties are public The results obtained by respondents' health office Kendari and Public Health answers about training, showed that the center of Abeli. Thank you for the Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 13

Risky, S., Rachman, W. O. N. N. ,& Akbar, M. I. DOI: 10.36566/ijhsrd/Vol2.Iss1/23 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 availability of time and location during the environment on performance through study, and all parties for their motivation and job satisfaction on the employees of support. the Balapulang District Health Center . in Tegal Regency. Multiplier: Jurnal REFERENCES Magister Manajemen. 2016;1(1). 1. Ministry of Health of the Republic of 11. Robbin SP. Organizational Behavior, Indonesia. Healthy Paradigm Towards Concepts, Controversy, and Healthy Indonesia2011. Application. edition I, editor. Jakarta: 2. Ministry of Health of the Republic of PT Prenhalindo; 2004. Indonesia. Guidelines for Establishing 12. Salam A. The Influence of Healthy Province Indicators and Organizational Culture, Leadership and Healthy Districts or Cities2012. Motivation on Performance: Case 3. Akbar MI. Analysis of the needs of Study at PT. PLN (Persero) Service general practitioners in Public Health Area and Yogyakarta Network. JESI Centres using health workload method. (Jurnal Ekonomi Syariah Indonesia). Public Health of Indonesia. 2016;3(1):49-62. 2020;6(2):63-9. 13. Mangkunegara PA. Human Resource 4. Ilyas S. Performance, Theory of Management: PT. Remaja Rosdakarya; Assessment & Research. Jakarta: 2009. Center for Economic Health Studies 14. Simanjuntak PJ. Management and FKM UI; 2011. Performance Evaluation. Jakarta: 5. Ikhsan Akbar M, Risky MS S. Institute of Publishing, Faculty of Relationship of Speed of Obtaining Economics, University of Indonesia; Service, Friendly and Polite Attitude of 2005. Health Officers Towards Satisfaction of Inpatients in North Buton District General Hospital. MIRACLE Jounral of Public Health. 2020;3(1):11-7. 6. Azwar A. Introduction to Health Administration 2 E, editor. Jakarta: PT. Binapura Aksara; 2010. 7. Abeli Community Health Center. Abeli Health Center Health Profile: Kendari City Abeli; 2017. 8. Saputra T, Marlinda P, Sufi W. The Effect of Transformational Leadership Style on the Effectiveness of the Performance of West Sidomulyo Inpatient Health Center in Pekanbaru City. Jurnal Niara. 2018;9(1):13-23. 9. Rosmawati S, Jermawinsyah A. The Effect of Work Ethics, Work Discipline and Employee Commitment on Employee Performance at Aro Puskesmas in Muara Bulian District. Exist: Scientific Journal of Economics and Business. 2018;9(2):153-60. 10. Aziz MA. The influence of work motivation, work discipline and work Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 14

Fadmi, F. R., & Buton, L. D. DOI: 10.36566/ijhsrd/Vol2.Iss1/25 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718

Research Article Open Access

DETERMINANT FACTORS OF UNDERNUTRITION IN PETOAHA VILLAGE: PATH ANALYSIS

Fitri Rachmillah Fadmi1, La Djabo Buton2 1,2Departement Of Publich Health Stikes Mandala Waluya Kendari, Southeast Sulawesi Province, Indonesia

Corresponding Author: Fitri Rachmillah Fadmi Email : [email protected]

Abstract

Background : Nutrition is still a public health problem in Indonesia. Good nutritional intake cannot be provided by children, because of the mother's knowledge, family income, and nutritional intake. Analysis of the factors that influence nutrition in children under five in Petoaha Village. Methods: This type of research is an analytic observational with cross-sectional study design. The population and sample in this study were under nutrition data in Petoaha Village. Results :The results of the path analysis show that the model fits the data with a value of RMSEA = 0.000 <0.10. Furthermore, based on the pathway with the estimation model and the t calculation shows that four factors are interrelated based on the tcalculation> 1.96, namely between income and under nutrition getting tcalculation n = 3.25; knowledge by under nutrition obtained tcalculation = 5.06; knowledge of nutritional intake was obtained by tcalculation = 2.10 and malnutrition intake, tcalculation = 2.16. Conc lusion: It is hoped that it can become an information reference for policymakers in implementing preventive and promotive efforts from an early age to the community in overcoming under nutrition.

Keywords : under nutrition, path, analysis

Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 15

Fadmi, F. R., & Buton, L. D. DOI: 10.36566/ijhsrd/Vol2.Iss1/25 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 INTRODUCTION both indicate that both the medium-term Nutrition is a determinant of the development plan targets for program quality of human resources. Foods that are achievement improvement of nutrition by given daily must contain nutrients as needed, 20% and the target of the Millennium to support optimal growth and can prevent a Development Goals in 2015 18.5% have deficiency disease, poisoning, and the been achieved. But there are still disparities emergence of diseases that can interfere with between provinces that need to be dealt with children's survival(1). Nutrition problems are problems that are specific in vulnerable health problems of a person or community areas. According to the Head of Health caused by the imbalance in fulfilling their research department of the Ministry of needs for nutrients obtained by food. Health, Trihono said that from 2013 The Undernutrition that occurs in the first two basic health research data the tendency in years of life is permanent, it cannot be each province in 2013 to be underweight was recovered even though the nutritional needs 19.6%, up from 18.4%. While the region in the next period have been met. One of the with the highest number of malnourished most worrying nutritional problems that children under five is NTT around 34%(8). occur in society is the problem of Undernutrition problems also occur malnutrition(2). The Global Situation based in Southeast Sulawesi Province. Data from on World Health Organization (WHO) data the Southeast Sulawesi Provincial Health in 2017 shows that the number of child Office shows that cases of undernutrition in deaths under the age of 5 reaches 5.9 million 2014 reached 250 cases, although this worldwide(3). India in 2011 which number decreased compared to 2013, which accounted for 38% of the global stunting was 333 cases. Whereas in 2015 burden (nearly 62 million children) undernutrition cases still reached 245 cases. underlines the difficulty of reducing Cases of undernutrition are found in all malnutrition in India. Meanwhile, UNICEF districts and cities in Southeast Sulawesi reports that as many as 167 million preschool Province(9). Data from the KendariCity children in the world who are underweight Health Office shows that in 2016 the number are mostly in South Asia. (4). of undernutrition cases reached 75 cases, Another point suggests that per capita then decreased in 2017 with 48 cases and in fixed income (or economic growth) 2018 with 45 cases. However, the problem of employed in India between 1992 and 2006 undernutrition in Kendari City remains a was not approved in Nutritional Wealth very concerning health problem even though Reduction(5). In parallel, support the in the last 3 years there has been a significant momentum to make direct investments in decrease because it is still the first in the programs and interventions aimed at number of undernutrition cases in Kendari nutrition (for example, contributing, City, with the highest case being the working providing supplementary food, micro- area of the Nambo Community Health nutrition, and providing therapeutic and Center. The increase in cases in 3 years supplementary foods), health (for example, occurred from 2016 to 2018 in the work area discussing and managing infectious diseases) of the Nambo Community Health Centre and water, sanitation, and cleanliness with the highest number of cases in Petoaha programs (WASH)(6, 7). Village(10). Basic health research data shows that Based on the above case the in Indonesia the prevalence of malnourished researchers tried to examine how to find out children under five is 4.9% and the lack of nutrition by looking at the undernutrition is 13% or nationally the mother's knowledge, family income level, prevalence of under-five children with mother's parenting. In this study, a statistical undernutrition and under-nutrition is 17.9%, analysis will be examined that can detect the Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 16

Fadmi, F. R., & Buton, L. D. DOI: 10.36566/ijhsrd/Vol2.Iss1/25 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 magnitude of the influence of these factors independent variable. The dependent on the incidence of undernutrition. One variable is malnutrition. While the statistical analysis that can be used to independent variables include the mother's analyze the cause and effect relationships of knowledge, family income level, parenting several variables is path analysis. style, history of exclusive breastfeeding, Path analysis is the development of a health service utilization. Data analysis was regression model used to test the suitability carried out by path analysis in analyzing the of the correlation matrix against two or more relationship pattern between variables which causal models compared by researchers aims to determine the effect, either directly which are usually depicted in the form of a or indirectly, of a group of independent single-headed circle and arrow indicating the variables on a dependent variable.(13) cause. Regression is carried out on each variable in the model as a relationship to one RESULT another indicated by the model as a cause. Descriptive analysis results show that The regression weights predicted by the the majority of respondents aged 31-35 years model are compared with the observed with a total of 13 respondents (21%), correlation matrix for the variables, and the educated junior and senior high school with a goodness of fit statistic is calculated. The total of 23 respondents each (37.1%), have most suitable model of two or more models toddlers with nutritional status of 39 is selected by the researcher as the best respondents (62.9 %), nutritional intake of model for theoretical progress. (11). The under-fives with underweight by 25 analysis is used to describe and test the respondents (40.3%), low family income model of the relationship between variables with 28 respondents (45.2%), low maternal in the form of cause and effect (correlation knowledge with 30 (48.4%) respondents and and causality). Correlation means the the majority of parenting mothers are also statistical relationship between a set of low 27 (43.5%) respondents. variables that causes a conclusion. The The results of the path analysis in relationship is described in the form of a path figures 1 and 2 show that the X2 value is diagram to facilitate the formulation of used to test how close the result of the theory into the form of a path model. Model alleged matrix to the original data matrix. specifications are needed in examining the The smaller the measurement value, the relationships of several variables in the path better the model used. X2calculation model, as in the case of homepage obtained is 0.77 with p-value = 0.37887>a, regression(12). This study aims to determine then the model is fitted with the data. This the path analysis of the incidence of means that the input matrix with the undernutrition infants in Petoaha Village, estimated matrix does not differ so that the Nambo District, Kendari City. model is fitted with the data. Furthermore, from the output obtained RMSEA value = METHOD 0,000. RMSEA values are statistical This type of research is analytic measures that must be met in a model match observational with a cross-sectional design, test. RMSEA value is said to be good if the namely research that measures the value is smaller than 0.05, reasonable if it is independent variable and the dependent smaller than 0.08. thus it was concluded that variable on the object of research at the based on the RMSEA value obtained, the same time. The population in this study were model was said to be fit. The magnitude of all data on under-five nutrition in Petoaha the influence of the indicators from the Village, Nambo District, Kendari City. largest to the smallest in a row can be seen in The research variables in this study Table 1. consisted of the dependent variable and the Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 17

Fadmi, F. R., & Buton, L. D. DOI: 10.36566/ijhsrd/Vol2.Iss1/25 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Table 1. Contributions of indicators

Dependent Variable IndependentVariable Contribution tcalculation Mother's Knowledge 0,49 3,25 Under nutrition Family Income 0,30 5,06 Nutrition intake 0,20 2,16 Mother's Knowledge 0,28 2,10 Nutrition intake Family Income 0,01 0.07

DISCUSSION practices and also have a higher status in the Under nutrition analysis is based on family. In addition, it is known that better maternal knowledge, income, nutritional economic conditions will improve the intake, and parenting. In addition, different standard of living for families, allowing them characteristics such as geographical to care for children(17).The mothers’ distribution that indicate nutritional problems knowledge and competence as care provider between regions will cause different health have a key role in the nutritional outcome qualities in each region(14).The results and growth of children.Lack of mothers’ obtained significant correlations obtained knowledge may be the reason of poor between maternal knowledge, income, feeding practices. Assistance and guidance of nutritional intake, and parenting with the mothers can benefit them in the better incidence of under nutrition. Significant utilization of available resources for the correlation is the correlation between direct health of their children(18). It is assumed and indirect effects through path thatthe mothers who have true nutritional analysis(15). knowledge prefer right foods for The knowledge path to under themselves and for their children(19).In nutrition obtained a tcalculation = 5.06> 1.96, addition, the knowledge and awareness of with an effect of 49%.This shows that mothers in breastfeeding is very closely sufficient knowledge has a positive influence related to the nutritional condition of on under nutrition. Mother's knowledge and infants(20).The findings from this study can education are someof the factors that can improve our understanding of the role of determine the nutritional status of a family, mothers who have good knowledge about because education can help to get nutrition against under nutrition. Mother's information about nutritional health.Thus on knowledge in choosing types of food, the knowledge pathway to nutritional intake, feeding and health care is very important in the value of tcalculation = 2.10> 1.96 was producing good nutrition for her obtained, with an effect of 28%. This shows children(21). that knowing has enough positive influence The family income channel for under on nutrient intake.This relates to the theory nutrition obtained tcalculation = 3.25> 1.96 which says that a person's level of nutritional with a influence of 30%, this indicates that knowledge influences attitudes and sufficient income has a positive influence on behaviors in choosing food that determines under nutrition. The same research results whether or not someone easily understands finds that household income affected child the benefits of the nutritional content of the nutritional status significantly through the food consumed(16).A mother's educationis the mechanisms of community, household, risk factor to under nutrition.This is because parental and individual factors(22).Low educated mothers will better know and income has always been a background to understand the health and nutritional health and nutrition issues. The results conditions of their children. Thus the child showed that found a relationship between will get better care, have better hygienic socio economic status and nutritional

Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 18

Fadmi, F. R., & Buton, L. D. DOI: 10.36566/ijhsrd/Vol2.Iss1/25 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 status(23). Most of the family income factors metabolism. Food needed by humans to are related to socioeconomic status, although support growth, maintain life, and carry out the father's income is not earned, the physical activity. If food consumption is less mother's income and household monthly than the body's needs, then the food reserves food expenses are significant risk factors. In needed in the body that are stored in muscles addition, children whose mothers have less and fat will be used. This lack of intake takes than secondary education are at a higher risk time in a long period of time it will be of malnutrition than those whose mothers reduced in the body and lack of other have an education beyond primary school substances(27).Continued weight loss will level.(24). Low income will affect many cause under nutrition which will result in things such as food consumption patterns stunted growth and development processes. become less nutritious, so with health care, Other impacts that can arise a person easily the cost of illness cannot afford, and if sick infected with infectious diseases and do not immediately seek treatment. One of decreased academic achievement. While the causes of low family income is the level excessive food consumption can lead to of education that is too low. The level of weight gain and if it continues it will cause education, especially mother's education can obesity and the risk of degenerative diseases. affect the quality of childcare, while also This good nutritional status is inseparable affecting the degree of health because the from the value of adequate nutrition element of maternal education is very (energy). A healthy child in a good influential on changes in attitudes and nutritional state because enough quality food healthy living behavior. A higher level of experiences body growth with body weight education will make it easier for people to according to age is called healthy weight. In absorb information and implement it in their other words, a good nutritional status can be daily behavior and style. Poverty is also a seen from the good AKE value(28). condition that is described as a lack of income to meet the most basic necessities of CONCLUSION life such as food, clothing, shelter and others. The conclusion of this study is the One result of the lack of job opportunities is knowledge pathway to under nutrition has an the low income of the people(25).Areas with effect of 49%. This shows that sufficient high population density tend to haveslums, knowledge has a positive influence on under hygiene, bad nutrition causes many families nutrition. Mother's knowledge and education with low incomes.An increase in families is one of the factors that can determine the with low incomes will causefulfilment of nutritional status of a family, because nutrition becomes difficult to reach soimpact education can help with information about on under nutrition(26). nutrition. family income to under nutrition Pathway of nutrient intake to has an effect of 30%. Family income can Underweight Nutrition obtained tcalculation = guarantee a baby's nutritional status will be 2.16> 1.96, this shows that income has a better, if the income is large enough to meet positive influence on under nutrition. the nutritional needs of the family. The According to Sobotka and Forbes(2019), nutritional intake pathway for under nutrition nutritional status is released directly by the has an effect of 20%. A healthy child in a level of energy consumption obtained from good nutritional state because enough quality carbohydrates, proteins, and fats. Energy food experiences body growth with body needed for growth, interaction, food use and weight according to age is called healthy activities. It takes energy created by fats and weight. fats, while proteins need to provide amino acids for the synthesis of cell proteins and hormones and enzymes to measure Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 19

Fadmi, F. R., & Buton, L. D. DOI: 10.36566/ijhsrd/Vol2.Iss1/25 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 REFERENCES 13. Riadi E. Aplikasi LISREL untuk 1. Soekirman. Taking the Indonesian penelitian analisis jalur. Yogyakarta: nutrition history to leap into betterment CV Andi Offset. 2013. of the future generation: development 14. Fadmi FR, Mulyani S, Buton LD. of the Indonesian Nutrition Guidelines. Geographically Weighted Regression Asia Pacific Journal of Clinical (GWR) Approach in the Modeling of Nutrition. 2011;20(3):447-51. Malnutrition and the Influencing 2. Merryana Adriani S, Kes M. Pengantar Factors in Muna Regency. Indian gizi masyarakat: Prenada Media; 2016. Journal of Public Health Research & 3. Unicef. WHO, World Bank Group Development. 2018;9(6). (2017) Levels and trends in child 15. Rodrigues WN, Colodetti TV, Martins malnutrition. USA: UNICEF, WHO & LD, Brinate SVB, Tomaz MA, do World Bank Group. 2017. Amaral JFT. Nutritional components 4. Gupta P, Zhao D, Guallar E, Ko F, of growth of Arabica coffee genotypes Boland MV, Friedman DS. Prevalence cultivated under different levels of of glaucoma in the United States: the phosphorus fertilization studied by 2005–2008 national health and path analysis. Australian Journal of nutrition examination survey. Crop Science. 2015;9(12):1214. Investigative ophthalmology & visual 16. Mulyati T, Ginting FR, Bahagiawati H, science. 2016;57(6):2905-13. Aizahroni A. Hubungan antara 5. Corsi DJ, Subramanyam MA, Pengetahuan tentang Anemia dengan Subramanian S. Commentary: Asupan Gizi pada Ibu Hamil dengan Measuring nutritional status of Resiko Terjadinya Anemia dalam children. International journal of Kehamilan di Puskesmas Kecamatan epidemiology. 2011;40(4):1030-6. Kembangan, Jakarta Barat Periode 10- 6. Koletzko B, Bhatia J, Bhutta ZA, 18 Desember 2007. Ebers Papyrus. Cooper P, Makrides M, Uauy R, et al. 2018;13(4):169-76. Pediatric nutrition in practice: Karger 17. Ahmed T, Roy S, Alam N, Hossain Medical and Scientific Publishers; MI. Determinants of undernutrition in 2015. children under 2 years of age from 7. Black RE, Alderman H, Bhutta ZA, rural Bangladesh. Indian pediatrics. Gillespie S, Haddad L, Horton S, et al. 2012;49(10):821-4. Maternal and child nutrition: building 18. Kaleem R, Adnan M, Naveed S. momentum for impact. The Lancet. Association of mothers’ socio- 2013;382(9890):372-5. demographic characteristics with their 8. Penelitian B. Riset kesehatan dasar knowledge and practices about (Riskesdas) 2013. Lap Nas. complementary feeding. Journal of 2013;2013(1):384. Fatima Jinnah Medical University. 9. Tenggara DKPS. Profil Kesehatan 2018;12(2). Provinsi Sulawesi Tenggara Tahun 19. Yabancı N, Kısaç İ, Karakuş SŞ. The 2018. Kendari: Dinas Kesehatan effects of mother’s nutritional Provinsi Sulawesi Tenggara. 2019. knowledge on attitudes and behaviors 10. Kendari DKK. Profil Dinas Kesehatan of children about nutrition. Procedia- Kota Kendari. 2018. Social and Behavioral Sciences. 11. Garson GD. Path analysis: Statistical 2014;116:4477-81. Associates Publishing Asheboro, NC; 20. Syeda B, Agho K, Wilson L, 2013. Maheshwari GK, Raza MQ. 12. Sarwono J. Analisis Jalur (Path Relationship between breastfeeding Analysis). Jakarta: Gramedia. 2011. duration and undernutrition conditions Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 20

Fadmi, F. R., & Buton, L. D. DOI: 10.36566/ijhsrd/Vol2.Iss1/25 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 among children aged 0–3 Years in Pakistan. International Journal of Pediatrics and Adolescent Medicine. 2020. 21. Fadare O, Amare M, Mavrotas G, Akerele D, Ogunniyi A. Mother’s nutrition-related knowledge and child nutrition outcomes: Empirical evidence from Nigeria. PloS one. 2019;14(2). 22. Wu Y. What is known about children's undernutrition and health levels in China–An empirical analysis from 1991 to 2009. Children and Youth Services Review. 2019;96:372-80. 23. Bhandari S, Ghosh M, Bose K. Socio- Demographic Characteristics and Prevalence of Under Nutrition among Adult Sabars of Bankura District, West Bengal, India. International Journal of Advancement in Life Sciences Research. 2019:1-10. 24. Owoaje E, Onifade O, Desmennu A. Family and socioeconomic risk factors for undernutrition among children aged 6 to 23 Months in Ibadan, Nigeria. The Pan African medical journal. 2014;17. 25. Saputra W, Nurrizka RH. Faktor demografi dan risiko gizi buruk dan gizi kurang. Makara kesehatan. 2012;16(2):95-101. 26. Fadmi FR, Mulyani S. ANALISIS FORECASTING PADA JUMLAH KASUS GIZI BURUK DI PROVINSI SULAWESI TENGGARA TAHUN 2019-2023. Preventif Journal. 2019;4(1). 27. Sobotka L, Forbes A. Basics in clinical nutrition: Galen; 2019. 28. Ayogu RN, Afiaenyi IC, Madukwe EU, Udenta EA. Prevalence and predictors of under-nutrition among school children in a rural South-eastern Nigerian community: a cross sectional study. BMC public health. 2018;18(1):587.

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Hadafiah, Sunarsih, Jayadipraja, E. A., Saraswati, P. S., & Risky, S. DOI: 10.36566/ijhsrd/Vol2.Iss1/15 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718

Research Article Open Access

FACTORS RELATING TO THE UTILIZATION OF NCD INTEGRATED POST

Hadafiah1*, Sunarsih2, Erwin Azizi Jayadipraja3, Putu Suri Saraswati4, Sartini Risky5

1,2,3,4,5Mandala Waluya College of Health Sciences Kendari, Southeast Sulawesi, Indonesia

Corresponding Author: Hadafiah Email :[email protected]

Abstract

Background: Indonesia has the highest prevalence of Non-Communicable Disease (NCD)in 2013. NCD which is always listed in the top 10 diseases in Southeast Sulawesi is hypertension and diabetes mellitus. NCD Integrated Post is an effort to detect and overcome the early presence of NCD threat factors. However, there has been a decrease in the prevalence of integrated post visits from 2017 to 2018 at the Barangka Public Health Centre. The purpose of this study was to analyze the utilization of NCD Integrated Post in the work area of Barangka Health Centre in Buton Regency. Methods: This type of research uses a cross-sectional study design. This study was conducted from November to December 2019. The population in this study were all people in the work area of Barangka Health Centre, Buton Regency in 2018 with ages> 15 to 59 years, namely 3,584 people. The number of the samples was 134 respondents. A questionnaire was used as the method of data collection. Results: The results showed that the chi square of cadre support X2 count =36,460> X2 table value = 3,841 and health status is X2 count = 32,308> table X2 value = 3,841. Therefore, all variables are influencing the utilization of NCD Integrated Post. Conclusion: Health status and cadre influenced significantly the community in utilizing NCD Integrated Post at the Barangka Health Centre in Buton Regency.

Keywords: NCD; Integrated Post; Health Status; Cadre Support

Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 22

Hadafiah, Sunarsih, Jayadipraja, E. A., Saraswati, P. S., & Risky, S. DOI: 10.36566/ijhsrd/Vol2.Iss1/15 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 INTRODUCTION attitudes, beliefs, values, individual In today's world changes in the characteristics), enabling factors (i.e. incidence of disease take shape marked by readiness, government law in preparing epidemiological transitions. Non- health-related facilities) whereas (skills and communicable diseases undergo a distance to health service) are reinforcing transitional form change, which was factors(9). Preliminary Survey conducted at originally controlled by infectious diseases. the location of researchers obtained As the frequency of non-communicable information that the average level of diseases (NCD) develops (1). World Health education is still lacking community Organization data which explains that as knowledge about the integrated post is still many as fifty-seven million (63%) mortality low, some people will get sick and there will rates and thirty-six million (43%) morbidity be no counseling from health workers. rates are referred to as Non-communicable Diseases (2). METHOD In Indonesia in 2013 the highest This type of research uses a cross- prevalence of NCD(3). NCD which is always sectional study design(10). This study was listed in the top 10 diseases in Southeast conducted from November to December Sulawesi is hypertension and diabetes 2019. The population in this study were all mellitus. For 2015, hypertension was ranked people in the work area of Barangka Health second with a total of 19,743 cases, while Centre, Buton Regency in 2018 with ages> diabetes mellitus was ranked fifth with a 15 to 59 years, namely 3,584 people.From total of 3,206 cases(4). the calculation of the samples, the obtained By involving empowerment and sample at a minimum of 134 samples(11). A developing the role of the community is a questionnaire was used as the method of data strategic way to prevent various risk factors collection(12). early(5). Services that involve the role of the community with promotiveand preventive efforts are NCD Integrated Post activities to RESULT detect and address early the existence of The results of statistical tests obtained NCD threat factors systematically(6). Based the value of chi-squareX2 count on data from the Buton District Health =36,460>table X2 value = 3,841. This shows Office in 2018 the distribution of NCD that H0 was rejected and Ha was accepted, Integrated Post for the Buton District meaning that there was a relationship amounted to 41 consisting of 14 Primary between cadre support and the use of Health Centre (7). Barangka Community NCDIntegrated post in Barangka Health Health Center as the most public health Centre, Buton Regency. The results of center and integrated post with the number, statistical tests obtained the value of chi- in Buton Regency, is 11 integrated posts. squareX2 count =32,308>table X2 value = Based on data obtained from the Barangka 3,841. This shows that H0 was rejected and Primary health Center that in 2017 there Ha was accepted, meaning that there was a were 255 visitors to integrated posts with a relationship between health status and the prevalence of 44.2%. In 2018, 248 people utilization of NCD Integrated Post in were visiting integrated post with a Barangka Health Centre, Buton Regency. prevalence of 43.5%. This shows that the Distribution of cadre support prevalence of visits decreased from 2017 to relationships with the use of NCD Integrated 2018(8). Post in Barangka Health Centre, Buton The behavior of individuals visiting Regency are as follows: health services is determined by three aspects. i.e. priority aspects (i.e. knowledge, Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 23

Hadafiah, Sunarsih, Jayadipraja, E. A., Saraswati, P. S., & Risky, S. DOI: 10.36566/ijhsrd/Vol2.Iss1/15 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718

Table 1 Distribution of cadre support relations with the Utilization of NCD Integrated post in the Barangka Health Centre of Buton Regency Utilization of NCD Integrated Post Total Cadre support Statistic test Enough Less

n % n % n % Enough 45 70.3 19 29.7 64 100 X2 count = 36,460 Less 13 18.6 57 81.4 70 100 ρ value = 0,000 X2 table = 3,841 Total 58 43.3 76 56.7 134 100 α = 0.05

The distribution of the relationship between health status and the utilization of NCD

Integrated Post in Barangka Public Health Centre, Buton Regency, are as follows:

Table 2 Distribution of the relationship of health status with the Utilization of NCD Integrated Post in Barangka Health Centre, Buton Regency Utilization of NCD Integrated Post Total Health status Statistic test Enough Less

n % n % n % NCD sufferers 51 63.0 30 37.0 81 100 X2 count = 32,308 NCD sufferers 7 13.2 46 86.8 53 100 ρ value = 0,000 X2 table = 3,841 Total 58 43.3 76 56.7 134 100 α = 0.05

DISCUSSION carry out activities related to NCD integrated post(15). Relationship between cadre support and The results of statistical tests utilization of NCD Integrated Post in obtained the value of chi-square X2 count Barangka Health Centre, Buton Regency =36.460>table X2 value = 3,841. This shows The role of cadres is one of the that H0 was rejected and Ha was accepted, supporting factors that play a role in health meaning that there was a relationship behavior because it is a behavioral between cadre support and the utilization of accompanying factor that gives effect and NCD Integrated Post in the Barangka Health contributes to the permanent or Centre of Buton Regency. The relationship disappearance of behavior (13). The shows that cadre support is one of the factors implementation of NCD Integrated post is that influence the community in utilizing carried out by existing health cadres (14)or NCD Integrated Post. Thus the better the several people from each support of cadres in providing counseling group/organization/institution/workplace about the NCD Integrated Post-program, the who are willing to hold NCD Integrated post more people who are interested in utilizing with the criteria of having a minimum of NCD Integrated Post. high school education, willing and able to Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 24

Hadafiah, Sunarsih, Jayadipraja, E. A., Saraswati, P. S., & Risky, S. DOI: 10.36566/ijhsrd/Vol2.Iss1/15 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 According to researchers the lack of results of this study comparable Sasongko's cadre initiative in inviting public health in an research (2019) that based on the results of Integrated post also caused a lack of cross-tabulation between the health status of community motivation to visit. Therefore, respondents with the use of NCD Integrated they need to monitoring and evaluation of Post, p-value 0,000 was obtained because p- the implementation of the integrated health value <0.05 then H0 was rejected, which post so that the quality of service becomes means there is a significant relationship better. The results of this study are in line between the health status of elderly women with Ratna Sari's research (2018) that the with the use of NCD Integrated Post in the Chi-Square test results were obtained p-value working area of the Cilongok Health of 0,000 which means there is a relationship Centre(20). between cadre support and the utilization of NCD Integrated Post in the work area of the CONCLUSIONS Primary Health Centre in Setiabudi District, South Jakarta City(16).. Health statusis one of the factors that influence the community in utilizing Relationship between health status and NCD Integrated Post. Other than that, cadre utilizationNCD Integrated Post in support is also a factor influencing the Barangka Health Centre, Buton Regency utilization of NCD Integrated Post in Every person who feels themselves Barangka Public Health Centre, Buton healthy even though they are not medically Regency.Because the utilization of NCD sure they are healthy is a proof to show a Integrated Post is still very low, so efforts are healthy perception(17). On the contrary, needed to increase utilization through people feel sick and lying weak, they were promotion and counseling about the benefits able to carry out their activities at that of Integrated post, increase socialization time(18). New communities take advantage regarding NCD Integrated Post schedules, when the community can no longer work increase cadre capabilities with training and activity and feel sick. if taking the carry out monitoring and evaluation. recommended behavior then the benefits to be enjoyed are related to feeling (perceived) REFERENCES and useful (benefit)(19). 1. WHO. Global Status report on The results showed that of 81 noncommunicable Disease 2014. respondents have health status as NCD Airlangga UniversityPress. 2010. sufferers there are still 30 respondents (37.0%) using Integrated post less. This is 2. WHO. Global status report on caused by respondents choosing their noncommunicable diseases 2014: World alternative to seek treatment or seek a place Health Organization; 2015. of treatment where they have heard or felt 3. Ministry of Health. Health Profile 2015. that their other theme is healed and healthier Indonesia Health Profile than visiting the integrated post. Year2015;2015:125. (Indonesia) There is a relationship between health 4. Health Office of Southeast Sulawesi status and the utilization of NCD Integrated Province. Health Profile of Southeast Post in Barangka Primary Health Centre, Sulawesi Province. Southeast Sulawesi: Buton Regency. The relationship shows that Health Office of Southeast Sulawesi health status is one of the factors that Province; 2015. (Indonesia) influence the community in utilizing NCD Integrated Post. Thus, the more people 5. Jayadipraja EA, Prasetya F, Azlimin A, suffering from NCD who are interested in Mando WOSY. Family Clean And utilizing NCD Integrated health Post. The Healthy Living Behavior And Its Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 25

Hadafiah, Sunarsih, Jayadipraja, E. A., Saraswati, P. S., & Risky, S. DOI: 10.36566/ijhsrd/Vol2.Iss1/15 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Determinant Factors In The Village Of Balitbang RI Ministry of Health. Labunia, Regency Of Muna, Southeast 2013;2013:110-9. (Indonesia) Sulawesi Province Of Indonesia. Public 16. Sari R, Putri SE, Herdi H, Hamuddin B. Health of Indonesia. 2018;4(1):39-45. Bridging critical discourse analysis in 6. Saraswati PS. Correlation Of media discourse studies. Indonesian EFL Supervision, Opportunities For Journal. 2018;4(2):80-9. Advancement And Job Safety With 17. Wallston KA, Wallston BS, Smith S, Satisfaction Of Puskesmas Employees Dobbins CJ. Perceived control and In North Konawe District. Indonesian health. Current Psychology. Journal Of Health Sciences Research 1987;6(1):5-25. And Development (Ijhsrd). 2019;1(1):9- 21. 18. Deutsch A. The mentally ill in America- A History of their care and treatment 7. Health Office of Buton. Health Profile from colonial times: Read Books Ltd; of Buton. Buton: Buton Health Office; 2014. 2018.(Indonesia) 19. Abdullah NRA, Jason WLC, Nasruddin 8. PHC of Barangka. Health Profile of AB. Pachydermoperiostosis: a rare PHC Barangka. Publika. 1918;5(5). mimicker of acromegaly. (Indonesia) Endocrinology, Diabetes & Metabolism 9. Bennet F, J. Community Diagnosis and Case Reports. 2017;2017(1). Health Program. Journal of Pitutur 20. Sasongko HP, Nanda FD, Fitriyati F, Psychology. 1987;vol. 1, no. 1, hlm. 57- editors. Community Knowledge Level 67.(Indonesia) About The Utilization Of Integrated 10. Mackey A, Gass SM. Second language Coaching Pos Of Noncomunicbale research: Methodology and design: Disease (Posbindu Ptm) With The Routledge; 2015. Prevalence Of Noncommunicable 11. Misra RP. Research Methodology: a Disease At Age 15–59 In Working Area Hand Book: Concept Publishing Of Wonosobo Health Center In Srono Company; 1989. Banyuwangi 2018. Procceeding the 4th International Nursing Conference; 2019. 12. Ebert JF, Huibers L, Christensen B, Christensen MB. Or web-based questionnaire invitations as a method for data collection: cross-sectional comparative study of differences in response rate, completeness of data, and financial cost. Journal of medical Internet research. 2018;20(1):e24. 13. Poland BD, Green LW, Rootman I. Settings for health promotion: linking theory and practice: Sage Publications; 1999. 14. Somanathan A, Finkel E, Arur A. Strengthening Integrated Care in Central and Eastern Europe. World Bank; 2019. 15. Ministry of Health. Basic health research; RISKESDAS. Jakarta: Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 26

Tasnim, T. DOI: 10.36566/ijhsrd/Vol2.Iss1/19 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718

Research Article Open Access

COMMUNITY-LED HEALTH PLANNING MODEL FOR VILLAGE HEALTH TEAM :A CASE STUDY IN INDONESIA

Tasnim Tasnim College of Mandala Waluya Kendari Health Science, Kendari, Southeast Sulawesi Province, Indonesia

Corresponding Author: DrPH. Tasnim, SKM.,MPH Email: [email protected]

ABSTRACT Background: An effective health planning is a root of success to cope with public health problems in the village. Communities in the village have resources to solve the problem. However, they do not have the skill to cope with their problem. This qualitative study is to analyze the process of community-led health program planning. Methods: This qualitative method using Participatory Rural Appraisal Approach which recruited village communities and government from April to August 2016 in Lambusa and Lebojaya Villages, Konda Sub-district in Southeast Sulawesi Province, Indonesia. Data analysis used interpretive analysis. Results: This study found that there were several steps to empower village communities to develop village health planning. Firstly, socialization about the process and establishing a Village Facilitator Team. Then, The VFT was be trained to increase their knowledge and skill about the village health program planning. The final step is a community meeting to identify the causes of illness and death and developing the village health program for dealing with the causes. Conclusion: community-led health planning process can be implemented in the village to increase the quality of the village health program, especially in the remote or village areas.

Keywords : Community, Planning, Health, Village

Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 27

Tasnim, T. DOI: 10.36566/ijhsrd/Vol2.Iss1/19 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 INTRODUCTION development program, but they are a subject Health planning is a part of health of the health development process in their program management which has an area. For example, the community can important role to develop a health policy(1). identify their own health problems. They can The planning needs data and facts which are also solve their health issues because they accurate and valid, so the health program can have resources. However, some of them, cope with health issues. As reported by the especially in the villages, do not have the Indonesian Health Ministry (2) Indonesia skill to identify, synthesize, and develop faces health development challenges such as health planning based on the evidence in high health status disparities between their area. Therefore, this study investigates economic social level within regions. the model of community-led health planning Another challenge is the double burden of process to increase village communities' diseases between communicable and non- health status in Konda Sub-district of South communicable diseases. For example, Konawe District, Indonesia. communicable diseases such as Lungs Tuberculosis, Malaria, Diarrhoea, Acute METHOD Respiratory Infection, and Avian Flu This qualitative study used a increase. The non-communicable diseases Participatory Rural Appraisal Approach also increase such as diabetes mellitus, (PRA) to understand the model of the stroke, hypertension, and cancer (2). community-led health planning process. This Konda sub-district is part of the approach had been used to increase poor South Konawe District in Southeast Sulawesi communities and women's participant to Province, Indonesia where the health involve in the village development program department had public health issues. For in Southeast Sulawesi, South Sulawesi, Bali, example, the numbers of the infant mortality and West Nusa Tenggara since 2002 (4). rate was the highest than other sub-district in This case study was conducted in 2 villages South Konawe District in 2016, namely 8 in Konda Sub-district of South Konawe babies death per 1000 life birth compared to District, namely Lebojaya and Lambusa 1 baby death in Lainea and Atari Jaya Sub- Villages from April 20, 2016, to August 11, districts (3). Based on the Health Department 2016. This study recruited several of the staff of South Konawe's report, the highest infant members in the Village government, Village mortality rate in Konda was caused by and sub-village women organizations, and Tetanus Neonatorum, low birth weight, and village leaders. This study used several steps nutrition deficiency during pregnancy (3). to identify the model of community-led Besides that, the number of under-five years Health Planning process, such as olds deaths was also higher in Konda in socialization, training, and community 2016, namely 8 per 1000 life birth compared meetings in the villages. The data were to 3.4 per 1000 life birth of Palangga Sub- analyzed with the use of interpretative district. This was because of pneumonia, analysis. diarrhea, and dengue hemorrhagic fever. For example, the prevalence of diarrhea which RESULT could be treated was 13 % in Konda Sub- This qualitative study found important district, compared to 68% of West aspects and steps during the village Ranomeeto Sub-district in 2016. community-led Health planning process. The The condition shows that the health steps include establishing the village development program has not been effective facilitator team (VFT), training for the VFT, to deal with public health issues in Konda identification of the general village Sub-district. As we have known a condition, identification of the specific community is not an object of the health causes of illness and death, and development Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 28

Tasnim, T. DOI: 10.36566/ijhsrd/Vol2.Iss1/19 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 of the activities of solving the illness and goals, outcomes, and activities (as illustrated death causes. The final step is developing the in figure 1). village health programs which divided into

Establishing the village Facilitator team (VFT)

Training the VFT

Identification of general village condition

Identification of the Identification of the causes of illness causes of deaths

Activities to cope with the causes

Outcome 1 Outcome 2 Outcome 3 Outcome 4

Goal

Figure 1. The steps to develop the Community-led Health Program Planning

1. Establishing Village Facilitator Team This training aimed to increase the (VFT) VFT's knowledge and skill to develop the This step needed several processes village health program. The training was including socialization the objective of conducted for 3 days and involved health this study. During the socialization, professionals from Konda Primary Health identification of people who were Care Services as trainers. To achieve the appropriate to be the VFT members. This aim of this training, so the course activity was conducted through an included some knowledge, such as agreement between the people who attain arrangement wellbeing criteria of the socialization activity. This step finally households based on the socio-economic agreed to select 12-15 people in the VFT status; mapping the household based on which consisted of village government, the wellbeing criteria; identification about village and sub-village women the causes of communities' illness and organization members, village community death; and arrangement the village health leaders, village young organization programs for the next year (as illustrated members, and representation of Konda in figure 2 and 3). Primary Health Care Services. Therefore, Arrangement of the criteria of the the numbers of the VFT member of household wellbeing was used to map for Lebojaya village were 15 people and 12 each sub-village. The criteria included 3 people in Lambusa Village. levels of the socio-economic status, 2. Training for the Village Facilitator namely rich, medium, and poor. The Team's members socio-economic status criteria included house construction, the ownership for Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 29

Tasnim, T. DOI: 10.36566/ijhsrd/Vol2.Iss1/19 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 clean and safe water, sanitary latrine, Lambusa Village are farmers and home drainage, and accessibility to schools, industrialist at the small level. health centers, and markets. The participants were divided into each sub- village to map the household socioeconomic status, so they were easy to identify for each household. The participants also were facilitated to identify causes of illness and deaths. Based on those cases, the participants were facilitated to think about the solution or activities which could solve those problems. Then, all of the activities were grouped into specific Figure 2. Lambusa Village Health programs. In the final activity, they Program Planning in 2017 – 2018 thought about the goal of the village health program. This was based on the specific programs which were agreed upon by all participants. At the end of the training was the matrix of the village health programs for the next year. However, the matrix still needed to be further fixed for the next step. 3. The Village Health Programs After training, the VFT needed to fix the matrix about the village health Figure 3. Lebojaya Village Health programs. They conducted a meeting Program Planning in 2017 - 2018 between them and the village government to fix it and arrange operational programs, DISCUSSION budgeting and monitoring, and evaluation This study has suggested that the programs. This study found there was a Community-led health program planning in similarity in the village health programs the village can be implemented effectively to between Lebojaya and Lambusa Villages develop effective health programs. (Figures 1 and 2). Principally, application of the steps of the The similar activities included Community-led health program planning increasing the community's health should be acceptable for other villages in knowledge, improving the environmental Indonesia because those have been familiar health facilities, and increase poor activities in Indonesia, such as socialization families' income. Those three main and training. Generally, the aim of aspects became the next one-year health socialization activity is to give understanding program because some of the areas in about particular objectives, ideologies, Lebojaya and Lambusa are countryside norms, or customs for communities before and about 40.5% of families were poor in they decide to participate in social activity Lambusa and 53.4% in Lebojaya. (5). There will be an interaction between Therefore, some of the countryside communities during the socialization communities cannot build sanitary latrines process. Interaction between participants can and drainages. The main livelihood of the pursue communities' intention to involve in communities in both Lebojaya and the next process. Therefore, during the socialization process, the facilitator needs to Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 30

Tasnim, T. DOI: 10.36566/ijhsrd/Vol2.Iss1/19 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 create a good atmosphere for all participants processes of the village health program and present detail process which they will planning. The training participants are do. Each participant must be introduced to introduced with the participatory rural each other through the ice-breaking session approach, in which the participants involved at the beginning process. This could create a actively in all of the training processes. good atmosphere for participants and could Involvement the participants in the training build solid teamwork because at the end of was started from making the wellbeing the socialization process will be established criteria of the household's socioeconomic Village Facilitator Team (VFT). status, mapping the households, The VFT becomes a representative of identification of illness and death causes, the village communities who will organize thinking about the solution, and making a the village health program planning. decision about the village health programs. Therefore, the VFT must be selected from all The participatory rural approach is an easy levels of village communities. This study has method for participants who have low found the composition of the VFT, namely education, but they have had huge social from the village government, village, and activity experiences in their village. Even sub-village women organization members, though the participants had under an village community leaders, village young educational level, but this process can create organization members, and representation of sustainability for village development (10). Konda Primary Health Care Services. As we The PRA method can give balanced benefits know that appropriate teams can produce between information that is gotten, time, ideas that can overcome the issues, for cost, and truth (10). Hence, the training can example, health issues (6). This study also be adopted by other villages to develop found that 12-15 people in the team become village health programs. In terms of price is effective. These team numbers include in the cheaper because the training can be done in small team. The small size in the team can be the village government building. However, easy to collaborate with the team members. its result can be valid and sustainable. Effective collaboration becomes the prior Implementation of the village health aspect to accomplish all development programs can be done by the village activities in the village health program communities because they have planned their planning (7). High motivation also can be own programs based on their health resulted from an effective team (8). The problems and the potential to solve those characteristics of the team members problems. including the average age and education are also significant in terms of personal high CONCLUSION mobilization. The team members' high Village communities in Lebojaya and Mobilization becomes an important Lambusa villages can prove that they can prerequisite to be successful in social plan their own health programs. The results activity. As suggested in Tasnim and also can be valid because the information Lusida's study (9), communities who were comes from their own village. They active had higher mobilization, and understand clearly what is happened timely motivation in the social activities in the regarding illness or death in their village. villages was under-45 years old. They also Each process can be learned positively, passed from Senior High School (9). People namely started from socialization, who had rest times will be preferable such as establishing the village facilitator team, widow, single or mothers who have no more training, and community's meetings. All of than two children the processes of the community-led health The village facilitator team must be program planning can be done easily by the trained because they will be a leader in all village communities. This is clear that the Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 31

Tasnim, T. DOI: 10.36566/ijhsrd/Vol2.Iss1/19 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 model can be applied by other villages to Mataram: Mitra Samiya, Australian plan their health programs. Health Government - ACCESS; 2005. practitioners in the Health Department at the 5. Templin TJ, Richards KAR. C. H. district level and in Primary Health Care McCloy Lecture: Reflections on Service must motivate and facilitate the Socialization Into Physical Education: village government to implement the An Intergenerational Perspective. programs which they have made. Research Quarterly for Exercise and Sport. 2014;85:431-45. CONFLICT OF INTEREST There is no conflict of interest to disclose. 6. Mao A, Mason W, Suri S, Watts DJ. An experimental study of team size ACKNOWLEDGMENT and performance on a complex task. My sincere and special thanks go to the PLOS ONE. 2016;11(4):1-22. Ministry of Research, Technology, and 7. Mason W, Watts DJ. Collaborative Higher Education of the Republic of learning in networks. Proceedings of Indonesia for financial support in this study. the National Academy of Sciences. Many thanks are devoted to Communities in 2012;109(3):764-9. Lebojaya and Lambusa Villages for participation in this study. Lastly, I would 8. Littlepage G. Effects of group size and like to thank's to Mandala Waluya Health task characteristics on group Science College for motivation to take this performance: A test of Steiner's model. study. Personality and Social Psychology Bulletin. 1991;17(4):449-56. REFERENCES 9. Tasnim T, Lusida MI. The model of 1. Fretheim A, Munabi-Babigumira S, supervision for impermanent food Oxman AD, Lavis JN, Lewin S. sellers by women volunteer in Kendari Support tools for evidence-informed City Indonesia. Indian Journal of policymaking in health 6: Using Public Health Research & research evidence to address how an Development. 2018;9(10):209-14. option will be implemented. Health Research Policy and Systems. 10. Campbell JR. Participatory rural 2009;7(1):1-11. appraisal as qualitative research: Distinguishing methodological issues 2. Ministry of Health of Republic of from participatory claims. Human Indonesia. Health Profile of Indonesia Organization. 2001;60(4):380-9. in 2015. Jakarta: Ministry of Health of Republic of Indonesia; 2016. 3. Health Department of South Konawe District. Health Profile of South Konawe District in 2016,. In: District HDoSK, editor. Andoolo: Health Department of South Konawe Department; 2017. 4. Oka IN, Aryawa IGB, de Rosario YB, Triana C, Hamid, S.A., Widimulyani S, et al. CLAPP community-led assessment and planning process: Menuju kepemimpinan rakyat.

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Saparina L, T., & Noviati. DOI: 10.36566/ijhsrd/Vol2.Iss1/24 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718

Research Article Open Access

RELATIONSHIP OF WATER AND WATER RESERVOIRS WITH THE PRESENCE OF AEDES AEGYPTI LARVAE IN PUUWATU PUBLIC HEALTH CENTER WORKING AREA KENDARI CITY

Titi Saparina L1,Noviati2 1,2Departement Of Publich Health Stikes Mandala Waluya Kendari, Southeast Sulawesi Province, Indonesia

Corresponding Author: Titi Saparina Email : [email protected]

Abstract Background : Aedes aegypti mosquitoes like to put their eggs in clean water so it is necessary to pay attention to the condition of the shelter of the water to always be closed because the water reservoir is in a closed condition it is less likely for the larvae to breed. Based on observation of 5 patient's house got mosquito larvae at water reservoir, other than that water reservoir left open and water quality slippery. This study aims to determine the relationship between water and aqueduct collection in the presence of Aedes aegypti larvae in the Work Area of Puuwatu Health Centre inKendari. Methods: This type of research is a quantitative research with cross sectional study approach. The population is 265 and the sample is 72 respondents using random sampling technique 2 Results: The results in this study indicate that the statistical water storage test results X count 2 2 2 36.217 > X table 3.841 and water channel value X count 16,774 > X table 3,841. So it is conclu ded that there is a connection of water reservoirs and waterways with the presence of Aedes aegypti larvae in the Work Area of Puuwatu Health Centre in Kendari. Conclusion: Suggested to the family should pay attention to environmental sanitation that can provide breeding place mosquito larvae breeding such as water and water ditch. In addition, the family must adjust the area of the house with the number of occupants in the house.

Keywords : Water Shelter, Water Channel, Mosquito larvae

Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 33

Saparina L, T., & Noviati. DOI: 10.36566/ijhsrd/Vol2.Iss1/24 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 INTRODUCTION breaking the chain of Aedes aegypti The public health center is as one of mosquito breeding which is a vector of the first-level health service facilities has an dengue disease starting from larvae. The importantrole in service and disease number of residents in a house can affect the prevention (1). Dengue Hemorrhagic Fever availability of clean water that is used for is a disease that is a public health problem daily needs, if the water needs of family because the impact is not only limited to members are insufficient it will have the economic impacts but also from a social potential for the community to collect water perspective. The impact from the social in reservoirs. The habit of storing water for aspect in question is the loss experienced by household needs which includes barrel, someone suffering from DHF including one whether made of clay, cement or ceramic as of his family, the loss can be in the form of a well as water reservoir drums that are not sense of discomfort, family panic, and even tight and if not supported by the the death of family members who will later implementation of 3M, it will become a have an impact on the broader problem of breeding ground for Aedes aegypti larvae (5) low life expectancy (2). Aedes aegypti mosquitoes like to lay Dengue fever is now endemic in their eggs in clean water so it is necessary to more than 100 countries in Africa, America, pay attention to the conditions of the water the Eastern Mediterranean, Southeast Asia reservoir whether closed or not because if the and the Western Pacific. America, Southeast water reservoir is in a closed condition then Asia and the Western Pacific are the regions it is less likely for larvae to breed. In that have the most severe dengue epidemics addition, the number of water reservoirs also in the world. The incidence of DHF has affects the existence of larvae because the grown dramatically throughout the world in more water reservoirs used by the the past few decades. More than 2.5 billion community, the more potential places for people or more than 40% of the world's larvae (6) population are at risk of suffering from DHF. Based on the preliminary study of WHO estimates that currently there may be researchers obtained data, the number of 50-100,000,000 dengue infections worldwide dengue patients in 2014 was 6 cases, each year and an estimated 500,000 cases of increased in 2015 to 30 cases, increased DHF require hospitalization each year, most dramatically in 2016 to 265 cases. Based on of which are children with 2.5% deaths (3) observations of 5 houses, mosquito larvae The number of patients reported in were found in water reservoirs, besides that Indonesia in 2012 was 90,245 cases with 816 the water reservoir was left open and the deaths (IR = 37.37 per 100,000 population water quality was slippery. and CFR = 0.90%). The highest number of DHF cases and DHF deaths per province in METHOD 2012 was in West Java Province which was This research is a quantitative 19,663 cases and 167 deaths. The DHF research with cross sectional study approach. morbidity rate per province in 2012 was <53 Cross Sectional Study or cross-sectional per 100,000 population. There are 11 study is research conducted by measuring provinces that have a DBD morbidity rate variables at one particular time. above the national target in 2012, namely the Measurement of variables in a cross sectional provinces of Central Sulawesi, Bangka study is not limited to be precise at the same Belitung, Jambi, South Kalimantan, Central time, but it means that each subject is only Java, Riau, East Java, West Kalimantan, subjected to one measurement, without Riau Islands and North Sulawesi.(4) follow-up. The population in this study is One form of DHF control carried out that all sufferers of DBD in 2016 amounted is by conducting larvae surveys aimed at to 265 people. The sample is as a whole of Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 34

Saparina L, T., & Noviati. DOI: 10.36566/ijhsrd/Vol2.Iss1/24 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 the subjects studied and is considered to be respondent characteristics data related to age, the entire population. The number of samples education and job Table 1 shows that of the is calculated based on the sample formula for 72 respondents, the most was the age group a small population of 72 people with a 51- 60 years which amounted to 24 simple random sampling technique. The respondents (33.3%), while the lowest was analytical method using bivariate analysis the age group > 60 years amounted to 6 was conducted to test whether there was a respondents (8.3%). Of the 72 respondents relationship between the independent the number of respondents based on the variable and the dependent variable using the highest education was Elementary School chi-square statistical test (chi-square) using Education, namely 28 people (39%) while the significance limit α = 0.05.Presentation the smallest number of respondents was of data is done after the data is processed and those with junior high school and senior presented in tabular form and presented secondary schools each of 13 people (18%). accompanied by an explanation Of the 72 respondents, the most respondents' (narrated).(7) jobs were farmers amounting to 34 people (47.2%), and the least number of Civil RESULT Servants were 12 people (16.7%). Based on the research results obtained from 72 research samples related to

Table 1. Characteristics of Respondents Age, Education and Job In Puuwatu Public Health Centre, in Kendari City in 2017

Characteristics n (40) % Age (Years) 21- 30 8 11.1 31 - 40 14 19.5 41 - 50 20 27.8 51 - 60 24 33.3 >60 6 8.3 Total 72 100 Education Primary School 28 39 Junior High School 13 18 Senior High School 13 18 College 18 25.1 Total 72 100 Job Farmers 34 47.2 Entrepreneur 26 36.1 Civil servants 12 16.7 Total 46 100 Source : Primary Data in2017

Table 2 shows that of the 72 whose water reservoirs fulfilled the respondents there were 29 respondents in the requirements for no larvae and 6 people category of water reservoirs fulfilling the (8.3%) whose water reservoirs fulfilled the requirements there were 23 people (31.9%) requirements but there were larvae. While of

Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 35

Saparina L, T., & Noviati. DOI: 10.36566/ijhsrd/Vol2.Iss1/24 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 the 43 respondents in the category of water and 6 people (8.3%) whose waterways storage did not meet the requirements there fulfilled the requirements but there were were 4 people (5.6%) whose water reservoirs larvae. While of the 50 respondents in the did not meet the requirements but there were category of waterways not meeting the no larvae and 39 people (54.2%) whose requirements there were 11 people (15.3%) water storage did not meet the requirements whose water channels did not meet the for larvae.Based on the results of statistical requirements but there were no larvae and 39 tests with a calculated X2 value of 33.292 > people (54.2%) whose water channels did X2 table 3.841 and φ = 0.709, it can be not meet the requirements for larvae.Based concluded that Ho is rejected and Ha is on the results of statistical tests with a accepted, thus there is a strong relationship calculated X2 value of 14.679 > X2 table with the presence of Aedes aegypti larvae in 3.841 and φ = 0.483, it can be concluded that the Puuwatu Health Centre in Kendari City. Ho is rejected and Ha is accepted, thus there Table 2 shows that out of 72 respondents, is a moderate correlation between the there were 22 respondents in the category of waterways and the presence of Aedes aegypti waterways fulfilling the requirements, there larvae in the Puuwatu Public Health Centre were 16 people (22.2%) whose water in Kendari City. channels met the requirements for no larvae Table 2. The relationship of water reservoirs and water disposal to the presence of Aedes aegypti larvae in the Work Area of Puuwatu Health Centre, Kendari City

The existence of Larvae There Is No There Is Total Statistic Test Variable

n % n % n % Water reservoirs Qualify 23 31.9 6 8.3 29 40.3 X2 count : 33.292 2 Not eligible 4 5.6 39 54.2 43 59.7 > X Tab : 3,841 Total 27 37.5 45 62.5 72 100 Drainage Qualify 16 22.2 6 8.3 22 30.6 X2 count : 14.679 2 Not eligible 11 15.3 39 54.2 50 69.4 > X Tab : 3,841 Total 27 37.5 45 62.5 72 100 Source : Primary Data 2017

DISCUSSION reservoirs can become breeding grounds to Water Reservoir (TPA) consists of become adult mosquitoes so that they can water storage in the house and water storage become dengue vectors. One of the water outside the home. Water reservoirs in the reservoirs in the house that is often found is a house are buckets / basins, barrels, jars and bathtub (8) bathtubs / lavatories. Whereas the outdoor The results showed that of 72 water reservoirs are cans of flower vases, respondents there were 29 respondents in the fish ponds, and others. The existence of category of water reservoirs fulfilling the water reservoirs inside and outside the house requirements there were 23 people (31.9%) is very influential on the presence or absence whose water reservoirs fulfilled the of Aedes aegypti larvae, even the water requirements of no larvae and 6 people Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 36

Saparina L, T., & Noviati. DOI: 10.36566/ijhsrd/Vol2.Iss1/24 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 (8.3%) whose water reservoirs fulfilled the washing furniture, food ingredients, and so requirements but there were larvae. While of on. This water is often calledgray water the 43 respondents in the category of water which contains a lot of soap or detergent storage did not meet the requirements there andmicroorganisms that cause various were 4 people (5.6%) whose water reservoirs diseases. One cause of disease did not meet the requirements but there were frommicroorganisms exists in wastewater. no larvae and 39 people (54.2%) whose These microorganisms will be carried by water storage did not meet the requirements vectors or insects to be infected with humans for larvae.Tubs are the most commonly through food anddrinks. To break the chain found landfill larvae because almost every of the disease needed a channeldisposal of respondent's house has a bathtub, the wastewater (SPAL) households that meet the community's habit of always filling water in requirementshealth (12) the tub making it possible for water to stay for a long time and the community's habit to CONCLUSION clean the tub when it looks dirty and just Based on the results of the study, it throwing away the water alone does not can be concluded that there is a relationship brush the surface of the tub making it between income and access to the regular possible for mosquito eggs to remain(9). The payment of contributions from Self- condition of closed and open landfill also Financing In Health Insurance members. it affects the breeding of mosquito larvae. means that income and access are the causes Hasyimi stated that one of the causes of of regular payment of contributions from water reservoirs became mosquito breeding Self-Finacing In Health Insurance members grounds was that water reservoirs were not in Puuwatu Primary Health Care Centre, closed because if the water reservoirs used Kendari City. were open it would make it easier for Aedes aegypti mosquitoes to lay their eggs in the ACKNOWLEDGMENT landfill.(10) The author conveys with utmost According to soegijanto, wastewater respect, expressing his unlimited thanks. A is a liquid that comes from households, big thank you to the author also to the industry, and other public places and Mandala Waluya Foundation for giving us usuallycontain ingredients or substances that the opportunity to carry out the Education, can endanger human lifeas well as disrupting research and community development environmental sustainability (11) especially in Puuwatu Health Centre . Thank The results showed that of 72 you for your support, time and location respondents there were 22 respondents in the during the study, and all parties for their category of waterways fulfilling the motivation and support. requirements there were 16 people (22.2%) . whose water channels met the requirements REFERENCES for no larvae and 6 people (8.3%) whose 1. Akbar MI. Akbar MI. Analysis of the waterways fulfilled the requirements but needs of general practitioners in Public there were larvae. While of the 50 Health Centres using Helath Workload respondents in the category of waterways not Method. Public Health of Indonesia. fulfilling the requirements, there were 11 2020;6(2):63-9. people (15.3%) whose water channels did 2. Bustan, R. Factors relating to the not meet the requirements but there were no implementation of DHF by the larvae and 39 people (54.2%) whose water community in the working area of the channels did not meet the requirements for Padang City Kuranji Public Health larvae. Domestic waste water comes from Center in 2007 Padang: FK Unand. water used for bathing, washing clothes, and 2007. (Indonesia) Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 37

Saparina L, T., & Noviati. DOI: 10.36566/ijhsrd/Vol2.Iss1/24 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 3. Wisfer, Easy Ways to Beat Dengue Fever. Jakarta: Kompas Book Publisher. 2013. (Indonesia) 4. Department of Health RI. Behavior and Life Cycle of Aedes Aegypti Mosquito is very important to know in carrying out activities to eradicate mosquito nests, including periodic larvae monitoring. Jakarta: Ministry of Health Republic of Indonesia. 2004. (Indonesia) 5. Department of Health RI. Jumantik Monitor (Jumantik) One of the Roles of Community Participation in the Management of Dengue Hemorrhagic Fever (DHF). 2004. (Indonesia) 6. Suroso Dengue Hemorrhagic Fever. Situation and Eradication Program in Indonesia Seminar and Workshop on Various Aspects of Dengue and its Countermeasures. Depok: UI. 2012. (Indonesia) 7. Sugiono. Combination Research Methods. Bandung: Alfabeta. 2016. (Indonesia) 8. Department of Health RI. Instructions on the Implementation of the Eradication of Dengue Mosquito Nest (PSN-DBD) by the Monitors Monitors (Jumantik). Jakarta: DG PPM-PLP. 2004. (Indonesia) 9. Department of Health RI. Behavior and Life Cycle of Aedes Aegypti Mosquito is very important to know in carrying out activities to eradicate mosquito nests, including periodic larvae monitoring. Jakarta: Ministry of Health Republic of Indonesia. 2004. (Indonesia) 10. Erniwati. Stop Dengue Hemorrhagic Fever. Bogor. Cita Insan Madani. 2014. (Indonesia) 11. Wisfer, Easy Ways to Beat Dengue Fever. Jakarta: Kompas Book Publisher. 2013. (Indonesia) 12. Gilot, Tria Hasbi Akbar. Health Promotion Media for Dengue Fever Tropical Disease by the Surabaya. 2005. (Indonesia) Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 38

Ahmad, N., Tasnim,T., & Wahab, H. DOI: 10.36566/ijhsrd/Vol2.Iss1/26 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718

Research Article Open Access

THE EFFECT OF VIDEO AND SIMULATION COUNSELLING ON CHILDREN'S KNOWLEDGE ABOUT HAND WASHING USING SOAP IN THE PRIVATE VOCATIONAL SCHOOL OF LAMBANDIA DISTRICT EAST KOLAKA DISTRICT

Nur Ahmad1, Tasnim Tasnim2, Herianto Wahab3

1,2,3Magister of Public Health Study Program, College of Health Sciences Mandala Waluya Kendari, Southeast Sulawesi, Indonesia

Corresponding Author: Nur Ahmad Email : [email protected]

Abstract

Background: Washing hands with soap is wrong for school children due to the child's lack of knowledge which is caused by a lack of exposure to information from schools, especially learning materials about proper and correct hand washing. School-age children are an age that is prone to various diseases, such as diarrhoea and worms. in 2018 the number of cases of diarrhoea in East Kolaka was 593. The largest cases of diarrhoea in East Kolaka District were in Lambandia District, with 187 cases of diarrhoea, the majority of which occurred in school- age children. To find out the effect of video and simulation counselling on children's knowledge about washing hands with soap at the Lambandia District Elementary School, East Kolaka. Methods: This study uses a quantitative research design with a quasi-experimental research design. This research was conducted in three SDN Lambandia District. The study population was school children with a sample of 70 children who were divided into two experimental groups and one control group. Sampling was done by a proportionate random sampling method. Result: The findings show from statistical tests that there is an effect of video and simulation on children's knowledge. This can be seen from p-value both of them are 0.000 <α = 0.05. Conclusion: There was an effect of video screening and simulation on children's knowledge about washing hands with soap at the Lambandia District Elementary School, East Kolaka Regency

Key words: counselling, video, simulation, hand washing

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Ahmad, N., Tasnim,T., & Wahab, H. DOI: 10.36566/ijhsrd/Vol2.Iss1/26 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 INTRODUCTION diarrhoea in East Kolaka District were in Washing Hands with Soap (CTPS) Lambandia District, with 187 cases of is the act of cleaning hands using soap under diarrhea, the majority of which occurred in running water which aims to keep the hands school-age children. (14). The results of an clean(1). Washing hands with soap is an interview with a teacher at an elementary effort to prevent disease(2). Hands are the school in Lambandia District showed that the main medium for transmitting disease- habit of washing hands in children was still causing germs(3). Hands are often the agents low, this was due to the absence of special that carry germs and cause pathogens to pass facilities for washing hands and the absence from one person to another either by direct of complete information regarding how and contact or indirect contact(4). Increasing the when to wash hands properly and correctly. degree of public health must be supported by Based on these reasons, the researchers are human health resources(5). One of the efforts interested in researching with the title of the to improve behaviour to do that is through effect of video counselling and simulations health education(6). on children's knowledge about washing Most elementary school children hands with soap at Elementary Schools, already know how to wash their hands but Lambandia District, East Kolaka Regency. still have diarrhoea (7). This is influenced by bad attitudes and actions(8). Respondents METHOD who already have good knowledge about The design of this research is a quasi- how to wash their hands have not applied it experiment (15). The implementation time is in their daily lives(9). from July to August 2020 in three SDN Providing health promotion using Lambandia District. The study population the media can provide a difference in action was school children with a sample of 70 between before and after treatment (10). children who were divided into two School-age children are an age that is prone experimental groups and one control group. to various diseases, such as diarrhoea and The questionnaire was used as a data worms(11). Washing hands using soap under collection method (16). running water is more effective at removing dirt and dust on the surface of the skin, is an RESULT effort to reduce the number of disease- Table 1.It shows that most of the causing microorganisms such as viruses, respondents (58%) are 10 years old, as much bacteria, and parasites that stick to the hands as (34%) of the respondents are 11 years old (12). and (8%) of the respondents are 9 years old. Based on the results of the Basic Table 2.It shows that before the Health Research in 2013, the prevalence intervention (pre-test), respondents in the period of diarrhoea in Southeast Sulawesi video group were mostly knowledgeable was 7.3%, with the incidence of diarrhoea enough (78.1%) and respondents in the among children under five around 5%. The simulation group had more knowledge number of cases of diarrhoea handled in (66.7%). After the intervention (post-test) 2016 was 35,864 cases or 46.77% of the there was a change, most respondents in the estimated cases, a decrease compared to video group had good knowledge (53.1%) 2015 as many as 41,071 cases or 77.74% of and the respondents in the simulation group the estimated cases. Meanwhile, the data on had more good knowledge (83.3). the incidence of diarrhoea in the East Kolaka Respondents in the control group at the time Regency were 593 cases in 2018(13). of the pre-test were more knowledgeable Based on a preliminary study in (62.1%) and at the time of the post-test there 2018, the number of cases of diarrhoea in were no changes, namely (62.1%) of East Kolaka was 593. The largest cases of respondents who had sufficient knowledge. Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 40

Ahmad, N., Tasnim,T., & Wahab, H. DOI: 10.36566/ijhsrd/Vol2.Iss1/26 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 Table 3.Based on the results of Table 4.Based on the results of statistical tests using the Wilcoxon test, it statistical tests using the Wilcoxon test, the was obtained a p-value of 0,000 <α = 0.05, p-value was obtained of 0.000 <α = 0.05, meaning that there was an effect of meaning that there was an effect of counselling with the video method on the counselling with a simulation method on the actions of elementary school children about knowledge of elementary school children washing hands with soap in the Lambandia about washing hands with soap in the District, East Kolaka Regency. Lambandia District, East Kolaka Regency.

Table 1 Characteristics of Respondents based on Age in Each Group Age n % 9 6 8 10 46 58 11 27 34 Total 79 100

Table 2 Descriptive Knowledge Change in the Intervention and ControlGroups Changes in the Intervention and Control Group Knowle Video Group Simulation Group Control Group dge Pre-test Post-test Pre-test Post-test Pre-test Post-test N % n % N % n % n % n % Well 0 0 17 53.1 0 0 15 83.3 1 3.4 3 10.3 Enough 25 7.1 15 46.9 12 66.7 3 16.7 18 62.1 18 62.1 Less 7 21.9 0 0 6 33.3 0 0 10 34.5 8 27.6 Total 32 100 32 100 18 100 18 100 29 100 29 100

Table 3 The Effect of Video Screening About Hand washing with Soap on the Knowledge Level of Elementary School Children Measurement Time Knowledge Statistic test Before After Well 0 17 Enough 25 15 P-Value= Less 7 0 0.000 total 32 32

Table 4 Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 41

Ahmad, N., Tasnim,T., & Wahab, H. DOI: 10.36566/ijhsrd/Vol2.Iss1/26 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 The Effect of Simulation of Hand washing with Soap on the Knowledge Level of Elementary School Children Measurement Time Knowledge Statistic test Before After Well 0 15 Enough 12 3 P-Value= Less 6 0 0.000 Total 18 18

DISCUSSION intervention of video viewing was carried The effect of video screenings about out on students. washing hands with soap on the The results showed that there was an knowledge of elementary school children effect of counselling with the video method in Lambandia district on the knowledge of elementary school The results showed that there were 25 children about washing hands with soap in respondents with sufficient knowledge but the Lambandia District, East Kolaka after being given treatment in the form of Regency. These results are in line with the video playback, 15 respondents still had research(18) about the effect of hand sufficient knowledge and 10 respondents washing with video media on hand washing increased their knowledge to be good. practices. Show that there is an effect of Respondents with unknown knowledge counselling about washing hands with video amounted to 7 respondents and after being media on the practice of washing hands given treatment, all respondents increased among students of SDN Nogotirto. their knowledge to be good. While Extension with video media is a medium respondents with good knowledge before following the characteristics of elementary being given treatment did not exist after school children who are very interested in being given the treatment, their knowledge new things. Children are given counseling increased to 17 respondents. This means that using these media to maintain children's the video playback method can increase the health through washing hands. So that, knowledge of elementary school children in respondents can receive information through the Lambandia district. the ear in hearing and the eye insight so that At the final measurement, all the information presented can be received respondents experienced an increase in their well. knowledge score compared to the initial Extension using video media about measurement (pre-test). This shows that washing hands with soap for elementary there is a difference in knowledge at the school children in the District of Lambandia, beginning of the measurement compared to East Kolaka Regency, generally increases the final measurement (post-test). In line children's knowledge to be better, although at with research (17) regarding the effect of first many still imagine about washing hands video viewing interventions on knowledge, with soap before counselling. However, after attitudes, and actions about washing hands being given the intervention, the child with soap for students of SDN 10 Kobawo. became more understanding and easier to Show that The difference in students' understand what was explained because the knowledge about washing hands with soap video was accompanied by moving pictures obtained the results of the McNemar p-value and sounds, attracting children's attention so was 0.002, so statistically, there was a that the material received was stored in their difference in knowledge about washing memory longer. Meanwhile, children who hands with soap before and after the still have sufficient knowledge about hand

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Ahmad, N., Tasnim,T., & Wahab, H. DOI: 10.36566/ijhsrd/Vol2.Iss1/26 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 washing are caused because they do not pay soap in the Lambandia District, East Kolaka attention to and understand the health Regency. These results are in line with the messages conveyed via video during the research(20) regarding the effect of health intervention process. The effect of giving promotion interventions on knowledge, simulations about washing hands with soap attitudes, and practices of washing hands on the knowledge of elementary school with soap in grade 5 at SDN Pengasinan IV, children in Lambandia district. Bekasi City. Show that it is proven that the The results showed that there were 12 health promotion interventions that have respondents with sufficient knowledge, but been given in the research can affect changes after being given treatment in the form of for the better. This study shows that simulation, 3 respondents still had sufficient knowledge is significant between the initial knowledge and 9 respondents increased their measurement and the final measurement. knowledge to be good. Respondents with Counselling by providing simulations less known knowledge amounted to 6 about washing hands with soap to respondents and after being given treatment, elementary school children in the Lambandia all respondents increased their knowledge to District, East Kolaka Regency, generally be good. While respondents with good increases children's knowledge for the better. knowledge before being given treatment did Through the provision of simulations in the not exist after being given the treatment, learning process, their knowledge increases, their knowledge increased to 17 respondents. which previously did not become known. A This means that the simulation method can school is a place for the formation of increase the knowledge of elementary school children's knowledge in addition to the children in the Lambandia district. family environment. This can provide At the final measurement, all children's knowledge to learn to apply respondents experienced an increase in their washing hands with soap in everyday life. knowledge score compared to the initial Meanwhile, children who still have sufficient measurement (pre-test). This shows that knowledge about hand washing are due to there is a difference in knowledge at the their lack of attention and understanding of beginning of the measurement compared to the messages conveyed during the the final measurement (post-test). In line simulation. with (19) regarding the effect of health promotion interventions on knowledge, CONCLUSION attitudes, and behaviour of hand washing in There was an effect of video screening fifth-grade students of Inpres Borong Jambu and simulation on children's knowledge I Elementary School, Makassar City. State about washing hands with soap at the that the pre-test results on knowledge Lambandia District Elementary School, East showed that the average respondent Kolaka Regency. This study suggested the increased to be good knowledge after being school should provide adequate facilities to given health promotion interventions. And apply proper and proper hand washing to the results of research and statistical tests children. The hand washing must be show that the knowledge variable has a provided a bar of soap and the participation significant difference in the knowledge of the teacher in setting an example in variable about washing hands of students getting children to wash their hands. between before and after the health Activating School Health Enterprises in an promotion intervention is carried out. integrated cross-programmatic and cross The results showed that there was an institutions should give the effort to improve effect of counselling with a simulation the ability to live healthily and establish method on the knowledge of elementary PHBS for students, school members, and the school children about washing hands with community. Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 43

Ahmad, N., Tasnim,T., & Wahab, H. DOI: 10.36566/ijhsrd/Vol2.Iss1/26 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 . tangan pakai sabun (CTPS) pada siswa REFERENCES di Sekolah Dasar Negeri Kalasan1, 1. Devis Y, Fahruzi Z. Lectures and Kalasan Sleman Yogyakarta. Jurnal group discussion methods effective Formil (Forum Ilmiah) KesMas increased the students knowledge Respati; 2017. about hand washing using soap. Jurnal 9. Tampara JM, Kairupan B, Boky H. Kesehatan Komunitas/Journal of Hubungan pengetahuan, sikap dan Community Health. 2017;3(4):159-63. tindakan mencuci tangan dengan 2. Sitorus N, Fransisca L. Pengaruh kejadian diare pada siswa SDN Peta Pendidikan Kesehatan Terhadap Kabupaten Kepulauan Sangihe. Pengetahuan dan Sikap Cuci Tangan KESMAS. 2017;6(3). pakai Sabun pada Siswa SD Negeri 10. Andayani R. Metode drill bermedia 157 Kota Palembang Tahun 2014. JPP Flash Card dalam peningkatan (Jurnal Kesehatan Poltekkes pengetahuan cuci tangan pakai sabun Palembang). 2014;2(14). Tunagrahita. Journal of Health 3. Khoiruddin K, Kirnantoro K, Sutanta Education. 2016;1(1). S. Tingkat Pengetahuan Berhubungan 11. Kartika M, Widagdo L, Sugihantono dengan Sikap Cuci Tangan Bersih A. Faktor-faktor yang berhubungan Pakai Sabun Sebelum dan Setelah dengan perilaku cuci tangan pakai Makan pada Siswa SDN Ngebel sabun pada siswa Sekolah Dasar Tamantirta, Kasihan, Bantul, Negeri Sambiroto 01 Kota Semarang. Yogyakarta. Jurnal Ners dan Jurnal Kesehatan Masyarakat (e- Kebidanan Indonesia. 2015;3(3):176- Journal). 2016;4(5):339-46. 80. 12. Desiyanto FA, Djannah SN. Efektivitas 4. Kemenkes R. Pusat data dan informasi mencuci tangan menggunakan cairan kementerian kesehatan RI. Jakarta: pembersih tangan antiseptik (hand infodatin. 2014. sanitizer) terhadap jumlah angka 5. Akbar MI. Analusis of the needs of kuman. Jurnal Kesehatan Masyarakat general praktitioners in Public Health (Journal of Public Health). 2013;7(2). Centres using Health Workload 13. Saputri AI, Hasanuddin M, Mery Y. Method. Public Health of Indonesia. Tren Penyakit Diare Di Kabupaten 2020;6(2):63-9. Buton. Jurnal Kesehatan Masyarakat 6. Saraswati PS, Tasnim T, Sunarsih S. Celebes. 2019;1(1):33-7. Pengaruh Media Whatsapp Dan Leaflet 14. Dinas Kesehatan Kolaka Timur. Profil Terhadap Perilaku Pemeriksaan Kesehatan2018. Payudara Sendiri Pada Siswi Sekolah 15. Mackey A, Gass SM. Second language Menengah Atas Di Kota Kendari. Al- research: Methodology and design: sihah: The Public Health Science Routledge; 2015. Journal. 2019;11(2). 16. Sugiyono. Statistik Nonparametris 7. Igiany PD, Sudargo T, Widyatama R. Untuk Penelitian. 2015. Efektivitas penggunaan video dan buku 17. Wati N, Yuniar N. Pengaruh Intervensi bergambar dalam meningkatkan Penayangan Video terhadap pengetahuan, sikap, dan keterampilan Pengetahuan, Sikap dan Tindakan ibu mencuci tangan memakai sabun. Tentang Cuci Tangan Pakai Sabun Berita Kedokteran Masyarakat. pada Siswa Sdn 10 Kabawo Tahun 2016;32(3):89-94. 2016. (Jurnal Ilmiah Mahasiswa 8. Sekarwati N, editor Pengaruh Kesehatan Masyarakat). 2017;2(5). Pendidingan Kesehatan terhadap 18. Rachmawati F, Putri HA. Pengaruh Perilaku anak Sekolah tentang cuci Penyuluhan Tentang Cuci Tangan Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 44

Ahmad, N., Tasnim,T., & Wahab, H. DOI: 10.36566/ijhsrd/Vol2.Iss1/26 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 dengan Media Video terhadap Penerapan Praktik Cuci Tangan di SD Negeri Nogotirto Yogyakarta: Universitas' Aisyiyah Yogyakarta; 2016. 19. Zafwan M. Pengaruh Intervensi Promosi Kesehatan Terhadap Pengetahuan Sikap Dan Perilaku Cuci Tangan Pada Anak Kelas V Sekolah Dasar Inpres Borong Jambu I Kota Makassar. Skripsi, Universitas Hasanuddin; 2018. 20. Listyowati D. Pengaruh Intervensi Promosi Kesehatan Terhadap Pengetahuan, Sikap, dan Praktek Cuci Tangan Pakai Sabun pada Siswa Kelas 5 di SDN Pengasinan IV Kota Bekasi Tahun 2012. Depok: Fakultas Kesehatan Masyarakat UI. 2012.

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Buton, L. D.,& Fadmi, F. R. DOI: 10.36566/ijhsrd/Vol2.Iss1/13 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718

Research Article Open Access

THE RISK OF KNOWLEDGE, SMOKING AND PATIENT’S CONTACT ON TUBERCULOSIS DISEASE IN PUUWATU HEALTH CENTRE IN KENDARI CITY

La Djabo Buton1,Fitri Rachmillah Fadmi2 1,2Departement Of Publich Health Stikes Mandala Waluya Kendari, Southeast Sulawesi Province, Indonesia

Corresponding Author: La Djabo Buton Email : [email protected]

Abstract

Background: Tuberculosis is a contagious disease that is still a problem in the world today, not only in developing countries but also in developed countries. Likewise in Kendari City in 2012 - 2017. Efforts that can be made to prevent the increasing number of tuberculosis cases in the future is to make predictions. This study aims to determine the time series analysis in predicting the incidence of tuberculosis by sex and working area of health centre in the city of Kendari in 2018-2022. Methods: This type of research is quantitative descriptive with times series analysis design. The source of the research data was obtained from the Kendari City Health Institution, Southeast Sulawesi Province, namely the data on the case of pulmonary TB which included the gender and working area of the Health Centre in 2012 - 2017 in the city of Kendari to be processed and analyzed in time series using the trend method approach into 3 models. linear trend, quadratic trend, and an exponential trend. Results: The results showed that the best model for the prediction of pulmonary TB cases in Kendari City was the quadratic model. Cases of tuberculosis by sex are predicted to decrease in the period 2018 to 2022, with an average decline with an average decrease of 79 cases in men and 286 cases in women. Pulmonary TB cases based on the health centre area are predicted to experience an increase in cases from 2018 until 2022 with the highest average increase being in the Kemaraya Health Centre area. While the highest average decrease in ca ses in the area of the Eye Health Center. It is expected to become information for policymakers so that prevention and promotion efforts can be made early to the community. Conclusion: Based on the results of the study, the conclusion of this study is the Science, knowledge about risk and Patient Contact History is a risk factor for tuberculosis in the work area of Puuwatu Health Centre, Kendari City.

Keywords : Risk, Tuberculosis, Knowledge, Smoking, Contact, Income

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Buton, L. D.,& Fadmi, F. R. DOI: 10.36566/ijhsrd/Vol2.Iss1/13 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 INTRODUCTION women(4). Furthermore, basic health Tuberculosis is a disease caused by research data on the incidence of tuberculosis germs (Mycobacterium Tuberculosis), which ranks Southeast Sulawesi as 17th which has is an aerobic germ that can live mainly in the the prevalence of tuberculosis(5). lungs or various other body organs. These Based on data from the Health germs also have high-fat content in the cell Service Profile of Southeast Sulawesi membrane, causing these bacteria to become Province, Tuberculosis cases from 17 resistant to acids and the growth of germs districts in 2016 totaled 3,033 cases, in 2017 lasts a long time, these bacteria are not there were 3,116 cases and in 2018 there resistant to ultraviolet, therefore their were 4,686 cases(6). Based on data from the transmission is mainly at night(1). Health Service Profile of Kendari City, there Patients with tuberculosis in the were 571 cases of tuberculosis in 2016, in world globally in 2016 there were 10.4 2017 there were 705 cases and in 2018 there million cases of TB incidence (CI 8.8 were 693 cases. Then based on comparative million-12, million) which is equivalent to data on the BTA + 2018 Case Detection Rate 120 cases per 100,000 population. Five from 15 Puskesmas in Kendari City, the countries with the highest incidence of cases highest tuberculosis incidence was are India, Indonesia, China, the Philippines, KemarayaPuskesmas's Work Area of 53 and Pakistan. where also most of the cases (55%), PuuwatuPuskesmas's Work estimated TB incidents in 2016 occurred in Area of 60 Cases (43%), Region Poasia the Southeast Asia Region (45%) where Community Health Center Worked 45 cases Indonesia was one of them and 25% (35%), 39 cases (32%) in the Benu-Benua occurred in Africa(2).Based on WHO in the Community Health Center, 44 Perumnas 2018 Global Tuberculosis Report, it is Health Center Work Areas (22%). and estimated that the incidence of Tuberculosis followed by other lower Puskesmas(7). The in Indonesia reached 842 thousand cases problem of tuberculosis in the working area with a mortality rate of 107 thousand cases. of Puuwatu Health Center in 2017 showed This number makes Indonesia ranked third that there were 28 cases of tuberculosis highest for Tuberculosis cases after India and (BTA-) patients and 104 cases of China. This condition is certainly quite tuberculosis (BTA +) in total, 132 cases alarming because it has a major impact on increased in 2018 with tuberculosis (BTA-) the social and financial of patients, families, of 39 cases and tuberculosis (AFB +) as and communities(3). many as 123 cases in total there are 162 In Indonesia, there were 420,994 cases and in 2019 (January-April) patients cases in 2017. By sex, the number of new TB with tuberculosis (AFB +) as many as 32 cases in 2017 in males is 1.4 times greater cases and tuberculosis (AFB) as many as 15 than in females. Even based on tuberculosis cases in total there are 47 cases(8). prevalence surveys the prevalence in men is Knowledge is the basis for taking 3 times higher than in women. Likewise, tuberculosis prevention and treatment. what happened in other countries. This is Ignorance of the community will hinder possible because men are more exposed to attitudes and actions towards the prevention TB risk factors such as smoking and lack of and eradication of tuberculosis as a sick compliance with taking medication. This person until it can eventually become a survey found that of all the male participants source of transmission and spread of who smoked as much as 68.5% and only tuberculosis to those around him(9, 10). 3.7% of the female participants smoked. Smoking behavior is a habit that is Patients with Tuberculosis in Southeast commonly found in daily life. Lifestyle or Sulawesi have 11,151 new cases of AFB + lifestyle is interesting as a health problem, TB consisting of 2,339 men and 1,548 minimally considered a risk factor for Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 47

Buton, L. D.,& Fadmi, F. R. DOI: 10.36566/ijhsrd/Vol2.Iss1/13 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 various diseases, one of which is each population has an equal chance of being tuberculosis(11). Housemate is a history of selected as a respondent. someone in contact with active pulmonary Data collection was carried out using TB sufferers/living together continuously. questionnaire sheets to obtain data on Household contact with pulmonary TB tuberculosis events, knowledge, smoking sufferers is indirectly related to the dose- behavior, patient contact history, and family response because the longer a person income. Data processing obtained from contacts smear-positive pulmonary TB questionnaires and observations in the field patients the more the risk of developing were processed using a computer program pulmonary TB disease. A patient with with the steps of editing, coding, entry, and positive phlegm often infects his family tabulating. Analysis of research data members. Thus it is clear that family is close consisted of univariate and bivariate analysis. contact. The incubation period for TB germs The univariate analysis aims to explain or starts from the entry of germs until the describe the characteristics of each research infection is estimated to be 6 months to 2 variable that results in the frequency years(12). distribution and percentage of each variable or proportion. While bivariate analysis aims METHOD to measure the risk of independent variables This type of research is an on the dependent variable using Odds Ratio observational analytic study using a case- (OR). The processed data is then presented in control study design that is a study used to the form of a distribution table accompanied determine risk factors or health problems that by a narrative that explains the contents of are suspected to have a close relationship the table. with a disease that occurs in the community(13). This type of research is a RESULT way to compare cases and control groups The results of the univariate analysis based on their papillary status showed that of the 84 respondents (retrospectives) to analyze the risk between categorized the most respondents for gender knowledge, smoking behavior, patient were male, namely 73 people (86.9%), for contact history, family income with the the age group was 20-35 years (40.55), for incidence of tuberculosis. The case employment were entrepreneurs, 44 people population in this study were respondents (52.4%) and for education is the high school who suffered from tuberculosis in the level of 65 people (77.1%). Puuwatu Community Health Center in Table 1 shows that out of 42 January-April 2019, as many as 47 people respondents in the case group 21 respondents and the control population in this study were (50.0%) with less knowledge and 21 people healthy residents who did not have clinical (50.0%) with good knowledge, 22 people symptoms of tuberculosis. The sample is part (52.4%) smoked and 20 people (47, 6%) did of the number and characteristics possessed not smoke, 31 people (73.8%) had a contact by the population which is calculated using history and 11 people (26.2%) had no the sample formula and obtained as many as contact history. While in 42 respondents in 42 people. Thus the number of samples in the group obtained 81 respondents (42.9%) this study 42 people suffering from with less knowledge and 24 people (57.1%) tuberculosis (case group) and 42 people not with good knowledge, 7 people (16.7%) suffering from tuberculosis (control group), a smoked and 35 people (83.3%) not smoking, total of 84 respondents. The sampling 17 people (40.5%) have a contact history and technique used is simple random sampling, 25 people (59.5%) have no contact history. which is simple random sampling, where

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Buton, L. D.,& Fadmi, F. R. DOI: 10.36566/ijhsrd/Vol2.Iss1/13 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718

Tuberculosis Table 1. Results of Case Control OR LL - UP univariate analysisvariable n % n % Knowledge Less 21 50,0 18 42,9 1,333 LL = 0,564 Good 21 50,0 24 57,1 UL = 3.150 Smoking Behavior Smoke 22 52,4 7 16,7 5,500 LL = 1,998 Not Smoke 20 47,6 35 83,3 UL = 15,139 Patient's Contact History Risk 31 73,8 17 40,5 4,144 LL = 1,646 No Risk 11 26,2 25 59,5 UL = 10,435 Statistical test results OR (odds ratio) and eradication of tuberculosis as a sick on the knowledge variable obtained an OR person so that it can eventually become a value of 1,333 with a range of lower limit source of transmission and spread of values of 0.564 and upper limit of 3,150 at a tuberculosis for people around them. confidence interval (Cl) of 95% with a value The bivariate analysis shows that of more than the value 1 so knowledge is a respondents who have less knowledge and risk factor for tuberculosis in the Puuwatu suffer from tuberculosis are caused because Community Health Center in Kendari City. respondents do not know how to prevent or In the smoking behavior variable obtained an avoid the disease. After all, it is caused by a OR value of 5,500 with a range of lower lack of knowledge, another factor is that the limit values of 1.998 and upper limit of ventilation of the house owned by the 15.139 at a confidence interval (Cl) of 95% respondent not eligible which causes bacteria with a value of more than the value 1 so to easily enter the house. Furthermore, smoking behavior is a risk factor for respondents who have less knowledge but do tuberculosis in the Puuwatu Public Health not suffer from tuberculosis show that even Center in Kendari City. In the patient though knowledge is lacking, when the contact, history variable obtained an OR respondent is well ventilated, good lighting value of 4.144 with a range of lower limit and shelter are not dense occupations and are values of 1.646 and upper limit of 10.435 at good when talking to tuberculosis sufferers, a confidence interval (Cl) of 95% with a they will be avoided. Transmission of value of more than the value 1 so that the tuberculosis. Respondents who have good patient's contact history is a risk factor for knowledge but suffer from tuberculosis are tuberculosis in the Puuwatu Health Center caused because although the respondents Work Area Kendari City. have good knowledge because they are caused by the immune system of the DISCUSSION respondent is less, the respondent will be Knowledge is the basis for taking easy to be affected by the disease, one of tuberculosis prevention and treatment. them is tuberculosis. Another factor is that Ignorance of the community will hinder because the house owned by the respondent attitudes and actions towards the prevention does not have good ventilation, it will be Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 49

Buton, L. D.,& Fadmi, F. R. DOI: 10.36566/ijhsrd/Vol2.Iss1/13 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 easy for the bacteria to live and cause women smokers less than 5%(17). disease. while respondents who have good The bivariate analysis shows that knowledge but do not suffer from respondents who were smoking and suffer tuberculosis. It is known that despite having from tuberculosis were one of the risk factors good knowledge but when influenced by that can be a cause of someone affected by other factors such as inadequate ventilation tuberculosis, people who smoke their lungs so that bacteria will easily enter the house in are easily infected by microbes. Therefore, addition to lack of lighting, lack of lighting when the person is exposed to into the room, especially sunlight in addition microorganisms that cause tuberculosis, the to being less comfortable, is also a medium microorganisms will easily multiply in the or a place that is good for living and person's lungs. Besides, more often sleep developing germs, one of which is until late at night will reduce a person's tuberculosis. Another factor is also the type immune system because of the lack of time of work, when working in a dusty to rest it will be susceptible to disease. While environment that will be affected and affect respondents who have smoking behavior but the occurrence of disorders of the respiratory do not suffer from tuberculosis, this happens tract that can increase morbidity, especially because although a person has a history of the onset of symptoms of respiratory disease smoking because they have very good and generally tuberculosis. The same knowledge about tuberculosis, a person will research results show that knowledge about not be easily affected by tuberculosis, other the transmission of pulmonary TB disease (p than that if the living environment conditions = 0,000), the results of the study revealed are not dense the population will avoid that poor knowledge about the causes of TB, tuberculosis transmission. Then the study transmission, symptoms, and prevention are also found respondents who have the often associated with poor treatment-seeking behavior of not smoking but suffering from behavior. A person's tendency to seek tuberculosis. It is known that although the treatment depends on knowledge about and behavior of not smoking, due to other factors the perceived risk of TB(14). Knowledge such as exposure to contact history in includes the ability to recognize symptoms, patients with tuberculosis through cigarette identify causes, and routes of transmission, smoke, for example, a person will also be and understand the availability of drugs(15). susceptible to tuberculosis. While Besides, better knowledge can improve respondents do not have smoking behavior medication adherence for patients with and do not suffer from tuberculosis. This is pulmonary tuberculosis(16). because of the factors of knowledge, the A person's behavior related to environment, good ventilation, and even tuberculosis is a behavior that affects or bacteria, one of which is tuberculosis will makes someone easily infected or infected not easily enter and attack one's immune with tuberculosis germs such as the habit of system. opening a window every day, closing the The research results are in line with mouth when coughing or sneezing, spitting revealing that smoking is a common habit carelessly, smoking, and habit of drying a among men living in both rural and urban mattress or pillow. Smoking can be known to parts of India, being generally more common have an association with an increased risk of in urban than in rural areas. In rural areas, getting lung cancer, coronary heart disease, "beedi" smoking is more common mainly chronic bronchitis, bladder cancer. Smoking because it is cheaper than cigarettes. The also increases the risk of contracting results of the analysis obtained an odds ratio tuberculosis 2.2 times. The prevalence of of 2.48 which concluded that smoking is a smoking in almost all developing countries risk factor for tuberculosis(18). It is more than 50% occurs in adult men, while estimated that, worldwide, 1.3 billion people Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 50

Buton, L. D.,& Fadmi, F. R. DOI: 10.36566/ijhsrd/Vol2.Iss1/13 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 consume tobacco and that most of them live unhealthy environment. Furthermore, in underdeveloped or developing countries, respondents who have a history of contact where the tuberculosis rates are also with patients who are at risk but do not suffer higher(19). Therefore, the greatest impact of from tuberculosis, are caused by factors of smoking in terms of public health issues the immune system that they have are very related to infection is probably the increase good although the respondent talks directly in the risk of tuberculosis. Some systematic to the patient due to the immune system that reviews and meta-analyses of observational is very well owned by the respondent will studies have shown an unfavorable not be easily affected by transmission, other association between the global epidemics of factors also because the knowledge of tuberculosis and smoking, exposure to respondents about how to prevent tobacco smoke having been associated with tuberculosis is very good, the respondents tuberculosis infection, active tuberculosis, will not be easy to get the disease, one of and tuberculosis-related mortality(20). them is tuberculosis. Then respondents with The most dominant variable or a contact history of patients who are not at indicator for predicting tuberculosis is the risk but suffering from tuberculosis. This contact history of patients with tuberculosis happens because the immune system of the patients. This is indeed often encountered respondent is very lacking which facilitates because the main factor a person can become the disease will easily enter the body, another infected is breathing air containing droplets factor is that the respondent lives in a containing germs transmitted by people with densely populated area. Furthermore tuberculosis. History of contact in question, respondents with a contact history of patients among others, once lived at home with who are not at risk and do not suffer it is tuberculosis patients, so that the possibility known that from the control group found of tuberculosis germ droplets that come out some respondents who have a history of through sneezing or coughing patients can be contact at risk or have household contact but inhaled together with oxygen in the air in the do not suffer from tuberculosis, this is due to house by other family members so it is very the awareness of the respondents in easy for the transmission process. But not all preventing disease by implementing early get a history of contact will contract prevention because there are family members tuberculosis, depending on how strong a who were previously affected by the disease person's immune system is not easy to cause so that they are alerts such as the use of glass symptoms of tuberculosis. and cutlery, do not expose phlegm carelessly Bivariate analysis results obtained and keep your mouth shut when coughing or respondents who have a contact history of sneezing, besides, some respondents also patients who are at risk and suffering from have a residential density and home lighting tuberculosis. It is known that some case that meets the requirements to avoid the risk respondents have no household contact or of causing tuberculosis. have a history of low-risk contacts but suffer Consistent research results revealed from tuberculosis, this shows that some of that contact with patients had a 2.96 risk of the tuberculosis transmission occurs due to contracting tuberculosis. Contact with a contacts from outside the home. The most patient is common in the closest person or potential environment for transmission the person treating the patient(21). Other outside the home is the environment/place of studies also reveal that contacts exposed to work. There are several reasons, namely, the patients with TB, in a variety of settings, are workplace is a specific environment with a at substantial risk of LTBI and active TB. population that is concentrated at the same The incidence of new cases is highest in the time and place, workers generally live first year and remains above background around companies in dense housing and an incidence for at least 5 yrs after exposure to Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 51

Buton, L. D.,& Fadmi, F. R. DOI: 10.36566/ijhsrd/Vol2.Iss1/13 https://ijhsrd.com/index.php/ijhsrd e- ISSN: 2715-4718 a patient with TB. The prevalence of TB 7. Tenggara DKPS. Profil Kesehatan among contacts may overestimate the true Provinsi Sulawesi Tenggara Tahun prevalence of the disease among 2018. Kendari: Dinas Kesehatan contacts(22). Provinsi Sulawesi Tenggara. 2019. 8. Puuwatu P. Profil Puskesmas Puuwatu CONCLUSION Tahun 2018. 2019. Based on the results of the study, the 9. Astuti S. Hubungan tingkat conclusion of this study is the Science, pengetahuan dan sikap masyarakat knowledge about risk and Patient Contact terhadap upaya pencegahan penyakit History is a risk factor for tuberculosis in the Tuberkulosis di rw 04 Kelurahan work area of Puuwatu Health Center, Lagoa Jakarta Utara Tahun 2013. Kendari City. In general, respondents' 2013. knowledge about TB is low, it is known from 10. Putera I, Pakasi TA, Karyadi E. many respondents who do not know how to Knowledge and perception of avoid or avoid diseases as well as other tuberculosis and the risk to become factors such as houses that do not meet treatment default among newly health requirements to facilitate the diagnosed pulmonary tuberculosis transmission of pulmonary TB. Besides, the patients treated in primary health care, smoking habits of respondents who are East Nusa Tenggara: a retrospective supported by the habit of sleeping late at study. BMC research notes. night while smoking will reduce the immune 2015;8(1):238. system due to lack of rest time so they will 11. Ferrara G, Murray M, Winthrop K, be easily attacked by TB disease. Centis R, Sotgiu G, Migliori GB, et al. Furthermore, some respondents do not have Risk factors associated with pulmonary household contacts or who have low-risk tuberculosis: smoking, diabetes and contacts but who suffer from tuberculosis, anti-TNFα drugs. Current opinion in this shows that some TB transmission occurs pulmonary medicine. 2012;18(3):233- due to contacts from outside the home. The 40. most potential environment for transmission 12. George EL, Iype T, Cherian A, Chandy outside the home is the Workplace. S, Kumar A, Balakrishnan A, et al. Predictors of mortality in patients with REFERENCES meningeal tuberculosis. Neurology 1. Mertaniasih NM. Buku Ajar India. 2012;60(1):18. Tuberkulosis Diagnostik 13. Bowling A. Research methods in Mikrobiologis: Airlangga University health: investigating health and health Press; 2019. services: McGraw-hill education (UK); 2. Organization WH. Global tuberculosis 2014. report 2017: World Health 14. Uchenna OU, Chukwu J, Oshi D, Organization; 2017. Report No: Nwafor C, Meka A. Assessment of 9241565055. 2018. tuberculosis-related knowledge, 3. WHO TFSN. 104. WHO; 2018. attitudes and practices in Enugu, South 4. Kemenkes R. Tuberkulosis. Jakarta: East Nigeria. Journal of infectious Pusat Data dan Informasi Kementrian Diseases and Immunity. 2014;6(1):1-9. Kesehatan RI. 2018. 15. Buton LD, Fadmi FR, Mulyani S. The 5. Indonesia K. Hasil utama riskesdas Relation between Knowledge, Stress 2018. Jakarta: Badan Penelitian dan and Salt Consumption with Incidence Pengembangan Kesehatan. 2018. of Hypertension in Elderly Woman 6. Kendari DKK. Profil Dinas Kesehatan Out Patients in General Hospital of Kota Kendari. 2018. Bahteramas Southeast Sulwesi Indonesian Journal Of Health Sciences Research and Development Vol. 2, No. 1, August 2020 52

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