Evaluasi Terpadu Pengendalian DBD di Kabupaten Bantul: Efektivitas Intervensi Wolbachia, Performa Program, dan Kinerja Sistem Surveilans

Yusli Harini, Bayu Satria Wiratama, SKed, MPH, PhD, FRSPH; Dr. dr. Citra Indriani, MPH

2026 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Demam Berdarah Dengue (DBD) masih menjadi masalah kesehatan masyarakat di Kabupaten Bantul meskipun intervensi nyamuk Aedes aegypti ber-Wolbachia telah diimplementasikan sejak tahun 2022. Penurunan kasus pada tahun 2023 yang diikuti peningkatan kembali pada tahun 2024 menunjukkan perlunya evaluasi terpadu terhadap efektivitas intervensi Wolbachia, implementasi program pengendalian DBD, dan kinerja sistem surveilans. Oleh karena itu, penelitian ini bertujuan mengevaluasi implementasi program pengendalian DBD, kinerja sistem surveilans, dan efektivitas intervensi Wolbachia secara terpadu di Kabupaten Bantul.

Metode: Penelitian ini merupakan studi bundling yang terdiri atas tiga sub-studi. Evaluasi program pengendalian DBD dan evaluasi sistem surveilans menggunakan desain mixed methods dengan pendekatan konvergen melalui kuesioner, wawancara mendalam, dan telaah dokumen. Data kuantitatif dianalisis secara deskriptif, sedangkan data kualitatif dianalisis menggunakan pendekatan analisis konten (content analysis). Sub-studi efektivitas Wolbachia menggunakan desain longitudinal ekologis dengan analisis difference-in-differences terhadap data bulanan dari 75 desa periode Januari 2016-Desember 2025, yang dianalisis menggunakan regresi binomial negatif campuran dengan penyesuaian terhadap tren waktu, variasi bulanan, ABJ, dan riwayat fogging satu bulan sebelumnya.

Hasil: Program pengendalian DBD di Kabupaten Bantul didukung oleh koordinasi lintas sektor yang rutin, jejaring kader kesehatan yang luas, dan pelaksanaan PSN lintas sektor setiap bulan. Namun demikian, implementasi program masih menghadapi keterbatasan sumber daya manusia akibat rangkap tugas, belum tersedianya alokasi khusus untuk penyuluhan rutin DBD, pelaksanaan fogging yang belum sepenuhnya sesuai pedoman, serta belum optimalnya pemantauan PSN mandiri. Sistem surveilans menunjukkan sensitivitas sebesar 85,1?ngan kelengkapan informasi dasar kasus yang mencapai hampir 100% pada sebagian besar variabel, meskipun sinkronisasi data antar sistem informasi masih perlu ditingkatkan. Analisis efektivitas menunjukkan bahwa perubahan insiden DBD pada wilayah intervensi setelah implementasi Wolbachia sebesar 60% lebih rendah dibandingkan perubahan pada wilayah nonintervensi setelah penyesuaian terhadap tren waktu, variasi bulanan, ABJ, dan riwayat fogging satu bulan sebelumnya (adjusted IRR 0,40; 95% CI 0,34-0,46; p<0>

Kesimpulan: Pengendalian DBD di Kabupaten Bantul didukung oleh implementasi program pengendalian DBD, sistem surveilans yang mampu menyediakan informasi yang andal bagi pengambilan keputusan, dan implementasi Wolbachia sebagai intervensi pengendalian vektor. Penguatan ketiga komponen tersebut perlu dilakukan secara berkelanjutan untuk mempertahankan efektivitas pengendalian DBD.

Background: Dengue remains a major public health problem in Bantul District despite the implementation of the Wolbachia-infected Aedes aegypti intervention since 2022. The substantial decline in dengue incidence in 2023 followed by an increase in 2024 highlighted the need for an integrated evaluation of Wolbachia effectiveness, dengue control program implementation, and surveillance system performance. Therefore, this study aimed to evaluate dengue control program implementation, surveillance system performance, and the effectiveness of the Wolbachia intervention through an integrated approach in Bantul District.

Methods: This bundling study consisted of three sub-studies. The dengue control program and surveillance system evaluations employed a convergent mixed-methods design using structured questionnaires, in-depth interviews, and document review. Quantitative data were analyzed descriptively, while qualitative data were analysed using content analysis. The Wolbachia effectiveness sub-study employed a longitudinal ecological design using a difference-in-differences approach based on monthly data from 75 villages between January 2016 and December 2025. Data were analyzed using a mixed-effects negative binomial regression model adjusted for temporal trends, monthly variation, larval-free index, and fogging activities in the previous month.

Results: The dengue control program in Bantul District was supported by routine cross-sectoral coordination, an extensive community health volunteer network, and monthly cross-sector mosquito source reduction activities. However, program implementation continued to face challenges, including workforce constraints due to multiple responsibilities, the absence of dedicated funding for routine dengue education, fogging practices that did not fully comply with national guidelines, and suboptimal monitoring of community-based mosquito source reduction activities. The surveillance system demonstrated a sensitivity of 85.1%, with nearly complete reporting of essential case information across most variables, although information system integration still requires improvement. The effectiveness analysis showed that the change in dengue incidence following Wolbachia implementation was 60% lower in intervention areas than in non-intervention areas after adjustment for temporal trends, monthly variation, larval-free index, and fogging activities in the previous month (adjusted IRR 0.40; 95% CI 0.34-0.46; p<0>

Conclusions: Dengue control in Bantul District was supported by dengue control program implementation, a surveillance system capable of providing reliable information for decision-making, and Wolbachia implementation as a vector control intervention. Strengthening these three components is essential to sustain the effectiveness of dengue control.

Kata Kunci : dengue, Wolbachia, programme evaluation, surveillance, difference-in-differences