The Fidelity of Wolbachia Technology Implementation for Controlling Dengue Case in Bantul, Special Region of Yogyakarta (A Qualitative Case Study of WoW Mantul Program Implementation at Jetis, Sewon, and Kasihan Sub-Districts)

Mandira Ajeng Rachmayanthy, Prof. dr. Adi Utarini, M.Sc, MPH, Ph.D/dr. Riris Andono Ahmad, MD, MPH, Ph.D.

2023 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Memastikan pengendalian penularan infeksi demam berdarah telah mendorong pertimbangan untuk adanya upaya tambahan. Intervensi Applying Wolbachia to Eliminate Dengue (AWED), sebagai strategi tambahan untuk mengendalikan jumlah kasus demam berdarah, dianggap sebagai strategi paling efektif. Karena perbedaan karakteristik antara kecamatan di Bantul, itu memengaruhi pendekatan dan metode implementasinya. Evaluasi awal diperlukan untuk memberikan masukan untuk merencanakan implementasi teknologi Wolbachia di masa depan.

Tujuan Penelitian: Studi ini mengevaluasi ketepatan implementasi teknologi Wolbachia untuk mengendalikan kasus demam berdarah di kecamatan Jetis, Sewon, dan Kasihan, Bantul, Daerah Istimewa Yogyakarta, Indonesia.

Metode: Studi ini dimulai dengan fase observasi terbuka kemudian dilanjutkan dengan wawancara mendalam dan diskusi kelompok fokus untuk pengumpulan data. Metode ini akan digunakan untuk menilai rincian kepatuhan dan moderator potensial dalam wilayah Bantul, termasuk kecamatan Jetis, Sewon, dan Kasihan. Subjek yang terlibat melibatkan staf perawatan kesehatan primer, koordinator program dari kantor kesehatan, perwakilan pelatih program dan koordinator tim Yogyakarta World Mosquitoes Program, koordinator program dari Mulismat Nahdlatul Ulama (NU) Bantul, Kader, dan kelompok yang dipercayakan dengan ember telur nyamuk Wolbachia (Orang Tua Asuh). Penelitian ini menggunakan metode kualitatif deskriptif yang berakar pada desain formatif, menggunakan sampling purposif dan stratified. Triangulasi melibatkan sumber data dan perspektif ganda. Analisis tematik menggunakan perangkat lunak NVivo 12 untuk ekstraksi wawasan.

Hasil: Program menggunakan teknologi Wolbachia berhasil diimplementasikan dengan beberapa penyesuaian, termasuk durasi pelepasan selama 7 bulan, wadah air ditempatkan pada jarak 50 hingga 75 meter, dan perluasan kualifikasi OTA yang mencakup bayi, anak di bawah 2 tahun, balita, dan anak-anak kecil. Program mencapai tingkat cakupan keseluruhan sebesar 75%, dengan cakupan tertinggi di kecamatan Kasihan. Sesi diseminasi tambahan, kegiatan peningkatan kapasitas, dan pemantauan dan evaluasi reguler dilakukan selama implementasi. Namun, program menghadapi tantangan, seperti menemukan ember yang hilang, dipindahkan, atau rusak, keterlambatan dalam penggantian dan pengumpulan ember, variasi karakteristik kader, kondisi wadah, dan ketidaksesuaian antara peta dan lapangan aktual. Meskipun menghadapi tantangan ini, keberadaan fasilitator, termasuk dukungan pemangku kepentingan dan pemantauan dan evaluasi yang konsisten, membantu menjaga kemajuan dan efektivitas program.

Kesimpulan: Secara keseluruhan, program berhasil mengimplementasikan teknologi Wolbachia dengan penyesuaian, mencapai tingkat cakupan 75%. Tantangan dihadapi, tetapi fasilitator seperti dukungan pemangku kepentingan dan pemantauan yang konsisten memastikan efektivitas program.

Kata kunci: Demam Berdarah, Wolbachia, Teknologi Wolbachia, Rencana Pengembangan Pengendalian Kasus Demam Berdarah, Nyamuk Wolbachia, Indonesia.

Background: Ensuring the eradication in the transmission of dengue infection has led to consideration for extra efforts. Applying Wolbachia to Eliminate Dengue (AWED) intervention, as an additional strategy for controlling number of dengue cases is considered to be the most effective strategy. Due to the differences in characteristics among Bantul sub-districts, it influenced on how the approach and method of implementation. An initial assessment is needed to provide input for planning the implementation of Wolbachia technology in the future.

Objective: The study evaluated the fidelity of Wolbachia technology implementation for controlling dengue cases in Jetis, Sewon, and Kasihan sub-districts, Bantul, Special Region of Yogyakarta, Indonesia.

Method: The study commenced with an open observation phase then continued with in-depth interview and focus group discussion for data collection. This method will be used for assessing details of adherence and potential moderators within Bantul region, including Jetis, Sewon, and Kasihan sub-districts. The subjects involved the primary health care staff, program coordinators from health office, representative of program trainers and coordinators World Mosquitoes Program Yogyakarta team, program coordinator from Mulismat Nahdlatul Ulama (NU) Bantul, Cadres (Kader), and the group entrusted with the Wolbachia mosquito egg bucket (Orang Tua Asuh). The research employed qualitative, descriptive methods rooted in formative design, using purposive and stratified sampling. Triangulation involved multiple data sources and perspectives. Thematic analysis utilized NVivo 12 Software for insights extraction.

Result: The program using Wolbachia technology was successfully implemented with several adjustments, including a 7-month release duration, water containers placed at distances of 50 to 75 meters, and expanded OTA qualifications covering infants, children under 2, toddlers, and young children. The program achieved an overall coverage rate of 75%, with the highest coverage in the Kasihan sub-district. Additional dissemination sessions, capacity building activities, and regular monitoring and evaluation were conducted during the implementation. However, the program faced challenges, such as finding missing, relocated, or damaged buckets, delays in bucket replacement and collection, variations in cadre characteristics, conditions of the containers, and discrepancies between the map and the actual field. Despite these challenges, the presence of facilitators, including stakeholder support and consistent monitoring and evaluation, helped maintain the program's progress and effectiveness.

Conclusion:  In conclusion, the program successfully implemented Wolbachia technology with adjustments, achieving a 75% overall coverage rate. Challenges were faced, but facilitators like stakeholder support and consistent monitoring ensured program effectiveness.

Keywords: Dengue, Wolbachia, Wolbachia technology, dengue case control development plan, Wolbachia mosquito, Indonesia.

Kata Kunci : Dengue, Wolbachia, Wolbachia technology, dengue case control development plan, Wolbachia mosquito, Indonesia