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KESEPAKATAN MASYARAKAT UNTUK MENGENDALIKAN VEKTOR DEMAM BERDARAH DENGUE (DBD)DENGAN PENDEKATAN EKOSISTEM

LILIK ZUHRIYAH, Prof. dr. Hari Kusnanto, SU., Dr.PH.; dr. Tri Baskoro T.S. MSc., PhD.; Prof. Dr.P.M. Laksono, M.A.

2016 | Disertasi | S3 Ilmu Kedokteran

Latar Belakang Demam Berdarah Dengue (DBD) masih menjadi masalah kesehatan di Indonesia. Pengendalian vektor perlu melibatkan masyarakat karena DBD adalah penyakit bio-antropososial. Selama ini pengendalian vektor DBD belum dilakukan secara terintegrasi. Karena itu upaya yang terintegrasi melalui pendekatan ekosistem yang dilandasi kesepakatan masyarakat diperlukan untuk meningkatkan komitmen masyarakat. Penelitian ini bertujuan mengkaji bagaimana proses membangun kesepakatan masyarakat untuk menggunakan pendekatan ekosistem memberi dampak positif dalam mengendalikan vektor DBD di perkotaan. Metode Mix Method dengan Experimental Model dilakukan dengan metode kualitatif Multiple Case Study dan metode kuantitatif Community Based Controlled Trial. Enam Rukun Warga (RW)dan empat Sekolah Dasar (SD)di Kota Malang dipilih secara Purposive Sampling dan dialokasikan dalam kelompok kontrol, perlakuan 1 (pendekatan ekosistem), dan perlakuan 2 (pendekatan ekosistem dan kesepakatan masyarakat). Penelitian dilakukan mulai Juni 2013 hingga Desember 2015, namun intervensi dilakukan selama 4 bulan. Variabel indipenden meliputi proses membangun kesepakatan masyarakat, karakteristik intervensi, partisipasi stakeholder, dan 5 intervensi pendekatan ekosistem yaitu surveilans, aplikasi ovitrap, pengelolaan sampah anorganik, pelatihan pemetaan faktor risiko DBD, dan buku penghubung DBD. Variabel dependen meliputi angka kepadatan vektor dan keberlanjutan intervensi. Grafik moving average 3 mingguan, Uji Kruskal Wallis, dan Uji Mann Whitney digunakan untuk analisis data kuantitatif. Data Kualitatif dianalisis dengan content analysis. Validasi data dilakukan dengan triangulasi metode dan sumber. Hasil Angka kepadatan vektor (larva dan telur)nyamuk kelompok perlakuan 2 (pendekatan ekosistem dan kesepakatan masyarakat) cenderung menurun dibandingkan kelompok perlakuan 1 (pendekatan ekosistem)dan kontrol, meskipun dalam uji statistik kelompok perlakuan 1 tidak berbeda dengan kelompok perlakuan 2. Kesepakatan masyarakat berkontribusi positif terhadap partisipasi stakeholder dan keberlanjutan intervensi. Simpulan Pencegahan vektor DBD dengan pendekatan ekosistem yang dilandasi kesepakatan masyarakat berpotensi menurunkan angka kepadatan vektor DBD (larva dan telur nyamuk Aedes aegypti)dan meningkatkan peluang keberlanjutan pencegahan oleh masyarakat.

Background Dengue Hemorrhagic Fever (DHF) is a health problem in Indonesia. Vector control need to involve the community because dengue is a bio-anthropo-social disease. Nowadays the dengue vector control has not been carried out in an integrated manner. Therefore, an integrated effort through the ecosystem approach based on a community consensus is needed to increase the commitment of the community. This study aimed to examine how the process of building community consensus to use the ecosystem approach have a positive impact on dengue vector control in urban areas. Methods Mix Method with Experimental Model was conducted by using the Multiple Case Study as qualitative methods and Community-Based Controlled Trial as quantitative methods. Six neighborhood (RW) and the four elementary schools (SD) in Malang were selected by purposive sampling and allocated in the control group, treatment 1 (the ecosystem approach)group, and treatment 2 (the ecosystem approach and community agreement)group. The study was conducted from June 2013 to December 2015, but the intervention was carried out for 4 months. Independent variables include the process of community consensus building, intervention characteristics, stakeholder participation, and 5 interventions of ecosystem approach, namely surveillance, application ovitrap, inorganic waste management, training of dengue risk factors mapping and DHF connector book. Dependent variables include the number of vector density and intervention sustainability. Three weekly moving average Graph, Kruskal Wallis and Mann Whitney test was used for analysis of quantitative data. Qualitative data were analyzed using content analysis. Data validation is done by triangulation of methods and sources. Results The number of mosquito vector density (larvae and eggs)of treatment 2 group (the ecosystem approach and community consensus) tends to decrease compared to the treatment 1group and control group, although in a statistical test treatment group 1 did not differ by treatment group 2. Community consensus contribute positively to society and stakeholder participation sustainability. Conclusion Prevention of dengue vectors with the ecosystem approach which is based on a community consensus could potentially reduce the number of dengue vector density (larvae and eggs of Aedes aegypti) and increase the chances of sustainability of prevention by the public.

Kata Kunci : Community Consensus, ecosystem approach, dengue vector density

  1. S3-2016-306365-abstract.pdf  
  2. S3-2016-306365-bibliography.pdf  
  3. S3-2016-306365-tableofcontent.pdf  
  4. S3-2016-306365-title.pdf