EVALUASI PROGRAM PENANGGULANGAN KEJADIAN LUAR BIASA (KLB) PERTUSIS DI DAERAH ISTIMEWA YOGYAKARTA TAHUN 2024

Sri Purwanti, DR.dr.Citra Indriani, MPH;dr.Ahmad Watsiq Maula, MPH

2025 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang : Insidensi pertusis di Yogyakarta melebihi rata-rata nasional maupun global. Cakupan imunisasi dasar lengkap diatas 95% kenyataannya belum mampu mencegah munculnya KLB, tren kasus justru meningkat dari 2022-2024, kinerja sistem surveilans yang maksimal dan outbreak respon yang adekuat diharapkan dapat memunculkan sinyal kewaspadaan, namun pelaporan pada SKDR masih rendah, terdapat kesenjangan penemuan kasus, serta upaya penanggulangan yang belum optimal. Evaluasi terhadap sistem surveilans, komponen program serta analisis faktor yang mempengaruhi performa petugas dalam penemuan kasus perlu dilakukan.
Metode: Studi potong lintang dengan pendekatan kuantitatif dan kualitatif deskriptif dilakukan di Maret-Juni 2025. Data sekunder berasal dari SKDR, SISPD3I, Form Pert 02 dan dokumen pendukung lain, pada sub studi evaluasi program dan evaluasi surveilans wawancara mendalam dilakukan pada 10 petugas Dinas Kesehatan dan pada sub studi analitik survei dilakukan pada 105 petugas surveilans. Analisis kuantitatif menggunakan Zero-Inflated Negative Binomial (ZINB) menggunakan stata 17 sedangkan analisis kualitatif secara deskriptif menggunakan software Nvivo.
Hasil: Belum ada laporan terkait jumlah kasus yang diberikan profilaksis, pelaksanaan RCA, dan juga imunisasi kejar sebagai upaya respon pertusis. Promosi kesehatan serta advokasi kepada stakeholder dilakukan pada saat KLB sudah terjadi, belum ada upaya mitigasi faktor risiko terhadap kejadian pertusis. Hal ini menunjukkan masih lemahnya upaya penanggulangan. Belum optimalnya monitoring dan evaluasi untuk penanganan KLB serta tidak adanya SOP upaya respon dan pencatatan pelaporan mengakibatkan penanganan kasus tidak di dilaksanakan dengan tuntas dan dilaporkan dengan sistematis di SKDR, SISPD3I, maupun formulir manual. Pentingnya pelaksanaan monitoring evaluasi pada program pertusis ini ditegaskan melalui sub studi analitik dimana pada level puskesmas monitoring evaluasi secara signifikan menurunkan peluang petugas untuk tidak menemukan kasus sebesar 2,47 kali (aIRR =-2,47; 95% CI: -4,31–(-0,64) selain pelatihan PD3I yang berpengaruh signifikan terhadap peningkatan penemuan kasus pertusis (aIRR = 5,21; 95% CI: 1,37–19,7).
Kesimpulan: Upaya respon KLB pertusis masih belum dilakukan secara komprehensif dan terlaporkan secara sistematis. Tidak optimalnya komponen input, khususnya ketiadaan SOP serta lemahnya monitoring dan evaluasi, berdampak pada tidak terkendalinya upaya respon dan sistem surveilans yang dikembangkan. Oleh karena itu, diperlukan penyusunan dan implementasi SOP surveilans serta penguatan upaya monitoring dan kontrol program.

Background: The incidence of pertussis in Yogyakarta exceeds both the national and global averages. Despite a complete basic immunization coverage rate above 95%, this has not been sufficient to prevent the emergence of an outbreak. The trend of cases has increased from 2022 to 2024. Optimal surveillance system performance and adequate outbreak response are expected to trigger early warning signals; however, reporting in the EWARS remains low, there are gaps in case detection, and mitigation efforts have not been optimal. An evaluation of the surveillance system, program components, and analysis of factors influencing the performance of field officers in case detection is necessary.
Method: A cross-sectional study with a quantitative and descriptive qualitative approach was conducted from March to June 2025. Secondary data were obtained from EWARS, SISPD3I, Form Pert 02, and other supporting documents. In the program evaluation sub-study and surveillance evaluation sub-study, in-depth interviews were conducted with 10 health department staff members, while in the analytical sub-study, 105 surveillance staff members were interviewed. Quantitative analysis used Zero-Inflated Negative Binomial (ZINB) using Stata 17, while qualitative analysis was conducted descriptively using qualitative analysis software.
Results: There are no reports on the number of cases receiving prophylaxis, the implementation of Raapid Convenience Assesment, or catch-up immunization as part of the pertussis response efforts. Health promotion and advocacy to stakeholders were conducted after the outbreak had already occurred, with no efforts to mitigate risk factors for pertussis incidents. This indicates the weakness of response efforts. The suboptimal monitoring and evaluation of outbreak management, along with the absence of standard operating procedures (SOPs) for response efforts and reporting documentation, resulted in cases not being managed thoroughly and reported systematically in the EWARS, SISPD3I, or manual forms. The importance of implementing monitoring and evaluation in this pertussis program is emphasized through an analytical sub-study, where at the community health center level, monitoring and evaluation significantly reduce the likelihood of staff failing to identify cases by 2.47 times (aIRR = -2.47; 95% CI: -4.31–(-0.64) in addition to PD3I training, which significantly influenced the increase in pertussis case detection (aIRR = 5.21; 95% CI: 1.37–19.7).
Conclusion: Response efforts for pertussis outbreaks are still not being carried out comprehensively and reported systematically. The suboptimal components of input, particularly the absence of SOPs and weak monitoring and evaluation, have impacted the uncontrolled response efforts and the surveillance system developed. Therefore, the development and implementation of surveillance SOPs, as well as strengthening monitoring and program control efforts, are necessary

Kata Kunci : Pertusis, Kejadian Luar Biasa, surveilans, monitoring dan evaluasi.