Evaluasi Program Pengendalian Pertusis di Kabupaten Bantul Tahun 2023-2024

Muhammad Reza Firdaus, Bayu Satria Wiratama, S.Ked, MPH, Ph.D, FRSPH ; Dr. dr. Citra Indriani, MPH

2025 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar belakang: Kabupaten Bantul memiliki jumlah kasus Pertusis tertinggi di Provinsi DIY pada tahun 2023-2024. Capaian imunisasi >95?lum mampu mencegah kasus Pertusis di Kabupaten Bantul.

Tujuan: Penelitian ini bertujuan untuk mengevaluasi program investigasi kasus dan pelacakan kontak dalam pengendalian Pertusis dan kualitas data sistem surveilans Pertusis serta menganalisis faktor risiko kejadian Pertusis di Kabupaten Bantul tahun 2023-2024.

Metode: Studi convergent mix methods dengan jenis questionnaire variant digunakan untuk evaluasi program dan evaluasi surveilans. Evaluasi program menggunakan pendekatan logic model dengan komponen evaluasi input, proses dan output. Evaluasi surveilans dikaji dengan kerangka dari WHO dengan komponen yang dievaluasi meliputi struktur surveilans, fungsi pokok, fungsi pendukung dan kualitas data. Hasil evaluasi program dan surveilans dianalisis univariat (frekuensi dan persentase) untuk data kuantitatif dan deskriptif naratif untuk data kualitatif. Pada substudi analitik faktor risiko kejadian Pertusis, desain studi unmatched case-control digunakan dengan rasio 1:4. Faktor risiko yang dianalisis meliputi variabel pada tingkat individu dan wilayah. Pada individu dilakukan analisis univariat, analisis bivariat (chi-square dan regresi logistik sederhana), dan analisis multivariabel (regresi logistik berganda). Pada kewilayahan dilakukan poisson regression. Uji multilevel dilakukan dengan multilevel regresi logistik. Data dikumpulkan menggunakan kuesioner dan observasi data sekunder yang dimiliki pasien, fasilitas kesehatan dan Dinas Kesehatan pada tahun 2023-2024.

Hasil: Hasil evaluasi program investigasi kasus dan pelacakan kontak ditemukan kelemahan pada variabel pelaksanaan investigasi suspek Pertusis, kelengkapan investigasi dan ketepatan investigasi. Pada evaluasi kualitas data surveilans ditemukan kelemahan pada variabel kelengkapan kasus, kelengkapan data, dan akseptabilitas, selain itu pada komponen lain ditemukan kelemahan pada jejaring dan kerjasama, analisis dan interpretasi data, kesiapsiagaan KLB, umpan balik, serta supervisi. Pada substudi analitik, menunjukkan faktor risiko yang signifikan dengan kejadian Pertusis diantaranya epidemic rate (aOR = 30,12; 95% CI: 2,41–377,02) pada tingkat kewilayahan dan klaster penularan (aOR = 5,47; 95% CI: 1,36–21,94) pada tingkat individu.

Kesimpulan: Masih terdapat kekurangan dalam implementasi program investigasi kasus dan pelacakan kontak serta kualitas data surveilans Pertusis. Klaster dan epidemic rate menjadi faktor risiko utama kejadian Pertusis di Kabupaten Bantul tahun 2023-2024. Peningkatan koordinasi antar Fasyankes serta kolaborasi dengan jejaring diperlukan guna peningkatan kualitas data dan program investigasi. Kewaspadaan dan investigasi sesuai prosedur diperlukan guna mengantisipasi penyebaran dan peningkatan klaster penularan. Peningkatan pengetahuan orang tua dan guru diharapkan dapat menurunkan penularan di keluarga dan sekolah.

Background: Bantul District had the highest number of pertussis cases in Yogyakarta during 2023–2024. Despite immunization coverage exceeding 95%, pertussis cases could not be prevented in Bantul District.

Objective: This study aimed to evaluate the case investigation and contact tracing program for pertussis control, assess the quality of the pertussis surveillance system, and analyze risk factors for pertussis incidence in Bantul District, 2023–2024.

Methods: A convergent mixed-methods study using the questionnaire variant was employed for program and surveillance evaluation. Program evaluation applied a logic model approach, assessing input, process, and output components. Surveillance evaluation used the WHO framework, which included surveillance structure, core functions, support functions, and data quality. Quantitative data were analyzed using univariate analysis (frequency and percentage), while qualitative data were analyzed using narrative description. For the risk factor substudy, an unmatched case-control design with a 1:4 ratio was used. Risk factors analyzed included individual- and area-level variables. At the individual level, univariate analysis, bivariate analysis (chi-square and simple logistic regression), and multivariable analysis (multiple logistic regression) were conducted. Area-level analysis used Poisson regression, and multilevel testing was performed using multilevel logistic regression. Data were collected through questionnaires and secondary data observation from patients, healthcare facilities, and the District Health Office during 2023–2024.

Results: The evaluation of the case investigation and contact tracing program revealed weaknesses in the implementation of suspected case investigations, completeness, and timeliness. The surveillance data quality assessment found gaps in case completeness, data completeness, and acceptability. Other weaknesses were identified in networking and collaboration, data analysis and interpretation, outbreak preparedness, feedback, and supervision. In the analytical substudy, significant risk factors associated with pertussis incidence included epidemic rate (aOR = 30.12; 95% CI: 2.41–377.02) at the area level and transmission clusters (aOR = 5.47; 95% CI: 1.36–21.94) at the individual level.

Conclusion: Gaps remained in the implementation of the case investigation and contact tracing program as well as in the quality of pertussis surveillance data. Transmission clusters and epidemic rate were the main risk factors for pertussis incidence in Bantul District during 2023–2024. Strengthening coordination among healthcare facilities and collaboration with surveillance networks is needed to improve data quality and investigation programs. Adherence to investigation procedures is essential to anticipate the spread and increase of transmission clusters. Enhancing the knowledge of parents and teachers is expected to reduce transmission within households and schools.

Kata Kunci : Surveilans, program investigasi, Pertusis, faktor risiko, Bantul