Penyelidikan epidemiologi demam berdarah dengue di Kabupaten Gianyar Provinsi Bali

SUWITA, I Made, Prof.dr. Hari Kusnanto J., DrPH

2005 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Penyakit demam berdarah dengue (DBD) masih merupakan masalah kesehatan yang pemberantasannya didasarkan pada kontrol terhadap nyamuk penyebar dengue yaitu Aedes aegypti dan Aedes albopictus. Kecepatan diagnosis menjadi salah satu faktor utama keberhasilan penyembuhan dan pemberantasan penyakit DBD. Kasus DBD segera ditindaklanjuti dengan penyelidikan epidemiologi (PE) dan dilakukan penanggulangan seperlunya untuk mencegah penyebar luasan penyakit. PE ditindaklanjuti dengan tindakan pemberantasan nyamuk dan jentik, seperti fogging dan PSN. Tujuan: Mengetahui penyelidikan epidemiologi DBD di Kabupaten Gianyar dan faktor-faktor lain yang mempengaruhi PE. Mengetahui pelaporan RSU ke Dinas Kesehatan dan tindak lanjut PE. Metode penelitian adalah studi kasus PE DBD di Kabupaten Gianyar. Bukti atau data berasal dari dokumen laporan, rekaman arsip, wawancara, dan pengamatan langsung. Subyek penelitian adalah Direktur RSU, Kepala Dinas Kesehatan Kabupaten, Kepala Subdinas P2M, Petugas pelaporan SP2TP RSU, Kepala seksi P2M DBD, Kepala Puskesmas dan petugas surveilan di desa endemis DBD. Hasil : Jumlah desa endemis bertambah dari 5 desa menjadi 18 desa endemis. Kasus DBD bulan Maret didapatkan 37 kasus yang melebihi kasus puncak maksimal 5 tahun terakhir. Insiden penyakit DBD didapatkan 32 per 100.000 penduduk. Keterlambatan penemuan kasus pertama bersumber pada keputusan keluarga dalam mencari pengobatan ke RSU. Pada hari pertama dan kedua tidak ada yang berobat langsung ke RSU, ha nya 2,97% yang mencari pengobatan ke RSU pada hari 3. Keterlambatan kedua adalah diagnosis dan pelaporan kasus DBD oleh RSU ke dinas kesehatan. Keterlambatan pelaporan RSU Sanjiwani Gianyar ke dinas kesehatan didapatkan 65,5% dan RSU non Gianyar 95,8%. PE yang tepat waktu didapatkan 11,3%. Peran pemda, pokjanal/pokja, lintas sektor dan partisipasi masyarakat aktif masih sangat kurang untuk menanggulangi kasus DBD. Keterlambatan/kecepatan PE oleh puskesmas tidak mempengaruhi perluasan endemisitas kasus DBD di Kabupaten Gianyar Kesimpulan: Keterlambatan PE mempengaruhi penyebarluasan penyakit DBD dan tindakan penanggulangan oleh dinas kesehatan. Faktor diagnosis dan pelaporan kasus DBD oleh RSU, peran pemda, lintas sektoral dan peran serta masyarakat melakukan PSN masih kurang.

Background: Dengue hemorrhagic fever disease (DHF) is a health problem of which its eradication is based on control of dengue disseminator mosquitos, i.e. Aedes aegepty and Aedes albopictus. Speedy diagnosis is one of main factors for the success of cure and eradication of the disease. DHF case is soon followed by epidemiologic surveillance and action as necessary to cope with the spreading disease. Epidemiologic surveillance is further followed by action of mosquito larvae eradication such as fogging and mosquito breeding place eradication. Objectives: The study was aimed at identifying DHF epidemiologic surveillance at Gianyar District and other factors affecting epidemiologic surveillance and to know hospital reporting to the health office and further action of epidemiologic surveillance. Methods: This was a case study of DHF epidemiologic surveillance at Gianyar District. Evidence or data derived from report documents, record files, interview, and direct observation. The subject were hospital directors, head of district health office, Heads of contangious disease eradication sub health office, staff of hospital integrated report eradication system, DHF contangious disease eradication section, head of community health center and surveillance staff at DHF villages. Results: The number of endemic villages increased from 5 villages to 18 villages. There were 37 DHF cases in March. This exceeded maximum peak case in the past five years. There were 32 DHF occurences per 100,000 people. Late discovery of the case was caused by family decision in seeking for cure to hospital. In the first and second day, none came directly to hospital for cure, there was only 2,97% who sought for cure to hospital in the third day. Another delay was caused by diagnosis and DHF case reported by hospital to the health office. Report to the health office was 65.5% delayed at Sanjiwani Hospital of Gianyar and 95.8% delayed at non Gianyar hospital. As much as 11.3% of epidemiologic surveillance was on time. Local government, regional working committee, cross sector and the community did not take much role in preventing dengue fever case. Delayed/speedy epidemiologic surveillance by the community health center did not affect the spread of DHF case endemy at Gianyar District. Conclusion: Delayed epidemiologic surveillance affected the spread of DHF and action by the health office. Diagnosis and DHF case reported by the hospital, role of local government, cross sector and community in the eradication of mosquito breeding place were still low.

Kata Kunci : Layanan Kesehatan, Epidemiologi DB Dengue, dengue hemorrhagic fever, epidemiologic surveillance.