Different of Asthma Control Level in Suburban and Urban Areas

Julvainda Eka P.U 1, Muhammad Amin 2, Laily Hidayati 2 1 Master of Nursing Student, Faculty of Nursing Universitas Airlangga 2Faculty of Medicine Universitas Airlangga

Keyword: Asthma control level, Suburban and urban area

Abstract: Background: Asthma is a reversible and temporary respiratory disorder. The level of asthma control can be influenced by many factors, such as the environmental factor. This research aims to depict the differences asthma control level in suurban and urban communities. This research conducted in Kendalsari and Kedungkandang, Malang, East Java. Method: This research use observational analytic with crossectional approach.. Sample were taken by simple random technique as many as 50 respondents. Patient asthma 18-60 years with 20 women and 5 men in each areas The Asthma control levels were measured using Asthma Control Test (ACT), Data were analyzed using the Mann Whitney Test. Result: Asthma control level data, In suburban areas uncontrolled patients 60% and 40% partially controlled. In urban areas there are 28% of patients uncontrolled and 72% partially controlled. Distribution age of asthma patients predominantly 26-45 years (66%). Distribution education level predominantly in senior high school 18 patients (36%). The result of analysis showed a difference of asthma control level in suburban and urban areas (p 0,024). Conclusion: There are different asthma control level in suburban and urban areas in Malang, East Java (α0,05).

1 INTRODUCTION asthma patient (18.3%) present at 15-44 years of productive age (RISKESDAS, 2013). Asthma is health problem in the world, that is not Kendalsari area’s is the middle of the city with a only infected in progress countries but also in population of 99,359 people (BPS, 2014). developing countries. According from the Global Kendalsari located in the middle of town. The area is Initiative for Asthma (GINA) it stated estimated border to various office areas, health facilities, and number of asthma in the world until 300 million educational facilities (BPS, 2014). Puskesmas people and number of deaths continuing to increased Kendalsari (Community Health Center) is one of for 180,000 people/year (GINA, 2017). Asthma is Puskesmas at located in sub district lowokwaru with can’t be cured but it can be controlled. Asthma can high asthma prevalence. The number patient of attack a children, adults, oldster, men and women asthma get treatment at Kendalsari community (Prasetya, 2011). Asthma management focused in health care in June - September was 92 patients. how to reduce symptoms, restrain recurrence and Kedungkandang located at suburban area in decrease used corticosteroids or can be controlled district of malang with a population of 94,663 asthma (GINA, 2017). people (BPS, 2014). Kedungkandang located in the Asthma symtoms can be monitored by suburban of city. The area is border to industrial, measuring instrument, it’s Asthma Control Test tradisional market and trading area. Puskesmas (ACT). Asthma Control Test is a evaluation method Kedungkandang (Community Health Center) is one by assessing the final score obtained from answers of Puskesmas at located in sub district with high questions in asthma patients. The results of these asthma prevalence. The number patient of asthma scores, are classified into 3 categories: fully get treatment at Kendalsari community health care controlled, partially controlled and uncontrolled in June - September was 106 patients. This research (PDPI, 2007) was to explain the difference of asthma control level East Java is one of province with a high in urban and suburban areas of Malang East java. prevalence of asthma, this prevalence is 5.7%. Malang is one of district in East Java with a high prevalence of asthma, this prevalence is 4%, highest

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2 METHOD Distribution of Age This research use observational analytic with Suburban Area crossectional approach. A population in this study is asthma patients with treatment in Kendalsari and Kedungkandang community health care at April- 18-24 September 2017. 25-44 This research was conducted in patients asthma 14% with 18-60 years. This sample was a 20 women and 29% 45-60 5 men in each area. Technique sampling use simple random sampling with a total 50 respondents. The research was started in January-February 2018. The 57% collection data use analysis quesioner ACT (Asthma Control Test) questionnaire to measure the level of asthma control. Analysis data use Mann Whitney test (α0,05). Figure 2. Represent in suburban area the majority of 3 RESULTS respondents at the age of 45-60 (57%) Education Level Urban Area Based on data with the number of samples of 50 respondents, in the Urban and Suburban areas Elementary Table 1: Distribution of age in Urban Area represent in school 20% 16% urban areas average asthma patient at 39 years. The Junior high youngest is 24 years old and the oldest at the age of 12% school 57 years. Senior high Mean Mode Min-Max school Age 39 37 24-57 52% Bachelor degree Distribution of Age Urban Area

Figure 3 represent majority of respondents' education in urban areas is SMA (52%)

8% Education Level Suburban Area 24% 18-24 25-44 Elementary 45-60 school 12% 68% 20% Junior high 20% school Senior high 48% school

Figure 1: Represent in urban area the majority of Bachelor respondents at the age of 45-60 (68%) degree Table 2: Distribution of age in Urban Area represent in suburban areas average asthma patient at 40 years. The Figure 4 represent majority of respondents' education in youngest is 24 years old and the oldest at the age of 57 urban areas is SMP (48%) years.

Mean Modus Min-Maks Age 40 35 24-57

18 The 9th International Nursing Conference 2018 “Nurses at The Forefront in Transforming Care, Science, and research”

Chi Square obtained p 0.015 (α 0.05), it means there Asthma Control Level is a correlated between age with level of control Urban Area asthma

Table 4. Correlated education level with asthma control Uncontrolled level 28% Education p Total Partially Asthma ES-JHS SHS-BD Value controlled Control n n n % 72% Partially 8 20 28 56% 0.002 Uncontrolled 16 6 22 44% Total 24 26 50 100%

Table 4 represent about majority patients are Figure 5 represent asthma control level in urban areas is majority partially controlled level (72%) partially controlled. Most Education level respondent at senior high school – Bachelor degree. The result of straticistic test with Chi Square Asthma Control Level obtained p 0.002 (α 0.05), it means there is a Suburban Area correlated between education level with level of control asthma

Table 5. Different asthma control level in urban and suburban area Uncontrolled Mean Group n p Rank 40% partially Urban 25 21,5 60% controlled Asthma Control 0.024 Level Suburban 25 29,5

Table 5 represent about results of statistical tests with Mann Whitney, obtained results p 0.024 (α Figure 6 represent asthma control level in Suburban areas is majority uncontrolled level of asthma (60%) 0.05), it’s means there are differences asthma control level in urban and suburban areas.

Table 3: Correllated age with asthma control level 4 DISCUSSION

Age p Total Asthma 18-44 45-60 Value This research indicate in urban area and suburban Control n n areas, average of age represent is 39-40 years. These n % results be accordance to Mergani (2017), Majority 24 4 of asthma suffered in elderly patients. Age of Partially 28 56% majority respondents are in the productive period, so 0.015 12 that possible increased pollution exposure, high Uncontrolled 10 22 44% activity and increased of strees. This point may 36 14 trigger effect of asthma symptoms or asthma Total 50 100% recurrent (Merghani & Alawad, 2017). Based on age category, there is was an increase Table 3 represent about majority asthma control incidence of asthma in line with increasing of age. level is partially controlled. Partially control asthma incidence of asthma aged 18-24 years in urban areas are at 18-44 years. The result of straticistic test with 8% and 14% in suburban areas. It is related to the

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pattern of adolescent life that can be effect asthma respondents, there are different are elementary high symptoms (Talreja, 2011). school – junior high school education with 8 Based on age category in urban area, the majority respondent with partially asthma control level. of asthma sufferers are 25-44 years with a Result of statistical test with Chi square (α 0,05), percentage of 68%. In the suburban area, majority of Educational level with level of control asthma, p respondents are 25-44 years with a percentage of value 0,002. There is a relationship between 57%. These results are consistent with statistical education level and asthma control levels. This data of asthma patients from the Center for Disease research in line with Atmoko ( 2011) this research Control and Prevention (CDC) and the National represented of the higher level education can Center for Health Statistics (NCHS), it say in improve control of asthma. Education affects to productive patients have the greatest asthma people for the attitudes, actions, thoughts of a prevalence (Talreja, 2011). person. There are different affect for normally has The difference precentage age category between primary, middle or upper education, each has urban and suburban, represent in urban areas have a different characteristics for controling asthma (Lara, higher percentage of age at 25-44, it’s related to 2012). productivity level, this trigger a potential Education can be affect the mindset, higher respondents are often pollution exposure, high education should be the better the consideration and activity, and increased stress levels. A person in health behaviour. Behaviour can be influence from productive age will be more frequently exposed to science and education, it will impact in actions, pollution that can cause asthma symptoms (Atmoko, attitudes, and making decision. Education will be 2011). These people are often confronted with work influence to this, influencing factors such as the problems, which can trigger stress, stress factors can environment (Adam, 2008). Higher education also trigger asthma symptoms (Dorevitc 2008). indicate that people with to be more concerned Asthma in adolescents can still survive to adulthood about health, so efforts to improve health status are and there is also asthma can disappear for years but pursued by treatment to health facilities (Adam, can reappear in related a getting older. These older 2008). people had a decrease a lung function and more risk People with higher education level correlated for inflammation airway (Barnes, 2015). more asthma controlled level. It’s possible the level Analysis with Chi square (α 0,05), age of education consistent with the ability to receive correlation with level of control of asthma, p value health information from mass media or health 0,015. This result represent there is a correlated workers. Someone had a higher level of education, it between age and asthma control level. This research mostly has a good perception. Higher education as to in line with Talreja's (2011), Age may be affect more easily receive information, and can participate asthma control rates. Levels of asthma control are actively in solve health problems (Skloot et al., decrease with older age (Talreja, 2011). Age may be 2016) affect to control asthma because in older people, Asthma control level in urban area indicate system decreases to T lymphocyte dysfunction partially controlled (72%) and Uncontrolled (28%). (Barnes, 2015). Suburban area had the partially controlled Limphocyte T are increases susceptibility of respondents (60%) and Uncontrolled (40%). This virus or bacterial infection and causes damage to result be accordance to Atmoko (2011) the majority remodeling airways. Decreased lung function in of respondents have partially controlled asthma elderly people affect to decreased respiratory muscle control levels. The level of asthma control is strength and decreased elastic pulmonary recoil with influenced by various factors including age, sex, increased stiffness a chest expansion (Barnes, 2015). genetics, smoking, etc (Atmoko, 2011). Based on education level, in urban area represented Analsis statistic data test with Mann Whitney (α the majority of respondents have senior high school 0,05), difference of asthma control level urban area of level education (52%) and in suburban area and suburban area got p value 0,024. There is a majority have junior high school of level education difference in asthma control level in urban areas and (48%). The distribution of asthma control level suburban areas. This study differs from othe based on educational level confident to most research [9] that in urban areas, asthma control uncontrolled asthma is affect by respondents with levels to decrease trend. Differences in asthma junior high school as many as 16 respondents. A control level in urban and suburban areas are due to partially asthma control level more higher on Senior many factors, such as regional characteristics, High School-Bachelor Degree as many as 20

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education level, pollution, socioeconomic and health Malang: Badan Pusat Stastistik Kabupaten Malang. services (Lara, 2012) Talreja N and Baptist AP. (2011). Effect of age on asthma The characteristics of the suburban areas an control: results from the National Asthma Survey. industrial area, near traditional market and trading Ann Allergy Asthma Immunol. 106(1):24-9. doi: 10.1016/j.anai.2010.10.017 areas. Environmental factors are very influential Merghani, T. H., & Alawad, A. O. (2017). Indicators of with the occurrence of asthma symptoms. industrial Asthma Control in Asthmatic Patients: Are they area could be a trigger an increase in pollution. related to Depression? Open Access Macedonian Pollution is instrumental in triggering asthma Journal of Medical Sciences, 5(5), 673– symptoms. In the Urban area, areas tend to be in the 676.https://doi.org/10.3889/oamjms.2017.091 office area and health facilities and educational Atmoko W, Faisal HKP, Bobian ET dkk (2011). facilities (Dorevitc, 2008). Prevalensi asma tidak terkontrol dan faktor-faktor In Urban area, majority of respondent's education yang berhubungan dengan tingkat kontrol asma di level is senior high school and Suburban area rumah sakit Persahabatan, Jakarta. J Respir Indo. 2011;31:53-60. majority of respondents have junior high school. It’s Dorevitc S, Karandikar A, Washington GF, Walton GP. indicates a different level of education, that is related (2008) Efficacy of an outdoor air pollution to consideration and behavior. The mindset education program in a community at risk for generated from science gained from education will asthma morbidity. J Asthma. 2008;45: 839-44 have an impact on actions, attitudes, actions in solving health problems (Skloot et al., 2016) Barnes, P. et al. (2015). Asthma and COPD - Basic Mechanism and Clinical Management. (Academic 5 CONCLUSION press, Ed.) (2nd Editio). Elsevier Ltd. There is a different of asthma control level in Siroux, V., Boudier, A., Anto, J. M., Cazzoletti, L., Accordini, S., Alonso, J., Pin, I. , (2008). Original urban areas and suburban areas. The level of article Quality-of-life and asthma-severity in education affects the level of asthma control, general population asthmatics : results of the futhermore Age is related with asthma control ECRHS II study, 547–554. levels, older people has high risk to decrease asthma https://doi.org/10.1111/j.1398-9995.2008.01638.x control level. . Lara JA, Jeanne EM, Cathy B, et al. (2012). Trends in Asthma Prevalence, Health Care Use, and Mortality in the United State, 2001- 2010. National Care REFERENCES Health Society 2012; 94: p.2-5. Adam D Amanda SB, Joan E. (2008). Identificationand GINA. (2017). Pocket Guide for Asthma Management and Education of adolescents with asthma in anurban Prevention. In Based Global Strategy for Asthma school district: results from a large scale asthma Management And Prevention (Ed.). intervention. Journal of Urban Health 2008; 85: Prasetya, & Widya, A. (2011). Pengaruh Latihan Nafas p.361 Buteyko terhadap PEFR dan Derajat Kontrol Asma Skloot, G. S., Busse, P. J., Braman, S. S., Kovacs, E. J., di Puskesmas Pakis. Universitas Airlangga. Dixon, A. E., Vaz Fragoso, C. A., … Ragless, B. B. PDPI. (2007). Pedoman Diagnosis Asma dan (2016). An official American thoracic society Penatalaksanaan di Indonesia. Jakarta. workshop report: Evaluation and management of Departemen Kesehatan RI. (2009). Pedoman Pengendalian asthma in the elderly. Annals of the American Penyakit Asma. Direktorat Jenderal Pengendalian Thoracic Society, 13(11), 2064–2077. penyakit dan penyehatan Lingkungan. Direktorat https://doi.org/10.1513/AnnalsATS.201608-658ST pengendalian penyakit tidak menular : Jakarta Balitbang Kemenkes RI. (2015). Riset Kesehatan Dasar - RISKESDAS. Jakarta: Balitbang Kemenkes RI. Badan Pusat Statistik (2014). Kota Malang dalam Angka.

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