UPAYA PENCEGAHAN DAN PENGENDALIAN LEPTOSPIROSIS DENGAN PENDEKATAN ONE HEALTH DI KABUPATEN KULON PROGO TAHUN 2024

Samsul Askhori, Prof. dr. Tri Wibawa, Ph.D., Sp.MK(K); Dr. dr. Citra Indriani, MPH

2025 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Leptospirosis merupakan salah satu penyakit zoonosis yang masih menjadi masalah kesehatan masyarakat di Indonesia, termasuk di Kabupaten Kulon Progo. Kompleksitas siklus penularan yang melibatkan manusia, hewan, dan lingkungan menuntut penerapan pendekatan One Health. Namun, efektivitas program pencegahan dan surveilans terpadu belum banyak dievaluasi secara komprehensif.

Tujuan: Mengevaluasi pelaksanaan program pengendalian leptospirosis dan sistem surveilans terpadu lintas sektor serta menganalisis determinan pelaporan oleh kader di Kabupaten Kulon Progo tahun 2024.

Metode: Penelitian ini menggunakan desain bundling dengan tiga komponen. Pertama, evaluasi program pengendalian leptospirosis dengan pendekatan deskriptif menggunakan kerangka logic model untuk menilai input, proses, dan output. Kedua, evaluasi sistem surveilans lintas sektor menggunakan empat fungsi utama menurut pedoman WHO. Ketiga, studi analitik cross sectional pada 370 kader kesehatan dengan pendekatan Precede–Proceed Model. Data diperoleh melalui wawancara mendalam, telaah dokumen, dan kuesioner, kemudian dianalisis secara deskriptif serta menggunakan regresi logistik berganda.

Hasil: Hasil penelitian menunjukkan bahwa koordinasi lintas sektor telah terbentuk, namun belum berjalan optimal akibat keterbatasan pedoman teknis dan dukungan pendanaan. Fungsi surveilans sudah dilaksanakan, tetapi pengelolaan data masih didominasi sektor kesehatan manusia, sementara sektor hewan dan lingkungan relatif terbatas kontribusinya. Analisis faktor determinan menemukan bahwa pengetahuan (aOR 4,33; 95% CI 2,20-8,50), dan wilayah kader (aOR 0,42; 95% CI 0,22-0,80) berpengaruh signifikan terhadap perilaku pelaporan kasus leptospirosis.

Kesimpulan: Penerapan One Health dalam pengendalian leptospirosis di Kulon Progo sudah dimulai namun belum efektif. Integrasi lintas sektor dan pemberdayaan kader perlu diperkuat melalui panduan teknis terpadu dan dukungan sumber daya bersama.

Background: Leptospirosis is a zoonotic disease that remains a public health problem in Indonesia, including in Kulon Progo District. The complexity of its transmission cycle involving humans, animals, and the environment requires the implementation of a One Health approach. However, the effectiveness of integrated prevention programs and surveillance has not been comprehensively evaluated.

Objective: To evaluate the implementation of leptospirosis control programs and integrated multisectoral surveillance systems, as well as to analyze determinants of case reporting by community health cadres in Kulon Progo District in 2024.

Methods: This study employed a bundling design with three components. First, a descriptive evaluation of leptospirosis control programs using the logic model framework to assess inputs, processes, and outputs. Second, an evaluation of multisectoral surveillance systems using the four core functions defined by WHO. Third, an analytic cross-sectional study of 370 health cadres applying the Precede–Proceed Model. Data were collected through in-depth interviews, document reviews, and questionnaires, then analyzed descriptively and with multivariate logistic regression.

Results: The findings showed that multisectoral coordination has been established but has not functioned optimally due to limited technical guidelines and funding support. Surveillance activities have been implemented, yet data management remains dominated by the human health sector, while the animal and environmental sectors contributed relatively little. Determinant analysis revealed that knowledge (aOR 4.33; 95% CI 2.20–8.50) and cadre location (aOR 0.42; 95% CI 0.22–0.80) were significantly associated with case reporting behavior.

Conclusion: The implementation of the One Health approach in leptospirosis control in Kulon Progo has been initiated but remains ineffective. Strengthening cross-sectoral integration and cadre empowerment through comprehensive technical guidelines and shared resource allocation is essential.

Kata Kunci : Leptospirosis; one health; surveilans; kader