Analisis Determinan Keterlambatan Penemuan Kasus Leptospirosis Di Kabupaten Magelang Tahun 2025

Kartini, Dr. dr. Citra Indriani, MPH

2026 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar belakang : Kabupaten Magelang merupakan daerah endemis leptospirosis di Jawa Tengah dengan kasus dan kematian yang masih tinggi. Sekitar 40% pasien terlambat datang ke fasilitas pelayanan kesehatan, dan 40% di antaranya meninggal dalam 7-14 hari setelah timbul gejala. Penelitian ini bertujuan menganalisis faktor yang berkontribusi terhadap keterlambatan penemuan kasus leptospirosis.

Metode : Studi convergent mixed methods jenis questionnaire variant digunakan untuk evaluasi pelaksanaan promosi kesehatan dan sistem surveilans. Evaluasi promosi kesehatan menggunakan pendekatan logic model (input, proses, dan output) pada 27 responden, sedangkan evaluasi surveilans menggunakan kerangka WHO (struktur, fungsi pokok, fungsi pendukung, dan kualitas data) pada 88 responden. Data kuantitatif dianalisis secara univariat dan data kualitatif secara deskriptif naratif. Substudi analitik cross-sectional pada 395 petani menganalisis faktor yang memengaruhi perilaku pencarian pengobatan menggunakan GLM dengan modified Poisson regression untuk memperoleh PR dan aPR.

Hasil : Evaluasi sistem surveilans menunjukkan bahwa jejaring surveilans telah terbentuk, namun pelaksanaan deteksi dini, penyelidikan epidemiologi, analisis data, umpan balik, dan pemanfaatan data surveilans untuk komunikasi risiko masih belum optimal. Evaluasi promosi kesehatan menunjukkan bahwa seluruh puskesmas memiliki petugas promosi kesehatan, tetapi belum tersedia anggaran khusus, hanya 43,5% petugas yang pernah mengikuti pelatihan, dan pelaksanaan promosi kesehatan masih bersifat reaktif setelah ditemukan kasus. Analisis multivariat menunjukkan bahwa sikap (aPR = 1.63; CI: 1.31-2.04) , persepsi (aPR = 1.36; 95% CI: 1.10-1.66) dan aksesibilitas informasi (aPR = 6.05; 95% CI: 1.57-23.29) berhubungan secara signifikan dengan perilaku pencarian pengobatan, dengan aksesibilitas informasi sebagai faktor yang paling dominan.

Kesimpulan : Keterlambatan penemuan kasus leptospirosis di Kabupaten Magelang dipengaruhi oleh belum optimalnya surveilans, promosi kesehatan yang masih berorientasi pada respons kasus, dan rendahnya akses informasi kesehatan. Penguatan surveilans dan promosi kesehatan melalui peningkatan kapasitas tenaga kesehatan, pemanfaatan data untuk komunikasi risiko, serta perluasan edukasi pada masyarakat berisiko diperlukan untuk meningkatkan deteksi dini dan menurunkan kesakitan dan kematian akibat leptospirosis

Background : Magelang District is an endemic area for leptospirosis in Central Java, with case rates and mortality that remain high. Approximately 40% of patients seek care at health care facilities too late, and 40% of them die within 7-14 days after the onset of symptoms. This study aims to analyze the factors contributing to delays in the detection of leptospirosis cases.

Methods : A convergent mixed-methods study using a questionnaire variant was employed to evaluate health promotion and the surveillance system. Health promotion evaluation utilized a logic model approach (inputs, processes, and outputs) among 27 respondents, while surveillance evaluation employed the WHO framework (structure, core functions, supporting functions, and data quality) among 88 respondents. Quantitative data were analyzed using univariate methods, and qualitative data were analyzed using descriptive narrative methods. A cross-sectional analytical substudy involving 395 farmers analyzed factors influencing treatment-seeking behavior using GLM with modified Poisson regression to obtain PR and aPR.

Results: The surveillance system evaluation showed that a surveillance network had been established. however, the implementation of early detection, epidemiological investigation, data analysis, feedback, and the use of surveillance data for risk communication was still suboptimal. The health promotion evaluation showed that all community health centers have health promotion officers, but no specific budget is available; only 43.5% of officers have ever attended training; and health promotion efforts remain reactive, occurring only after cases are identified. Multivariate analysis showed that attitudes (aPR = 1.63; CI: 1.312.04), perceptions (aPR = 1.36; 95% CI: 1.10-1.66), and access to information (aPR = 6.05; 95% CI: 1.57-23.29) were significantly associated with the behavior of seeking medical treatment, with access to information being the most dominant factor.

Conclusion : Delays in the detection of leptospirosis cases in Magelang Regency are influenced by suboptimal surveillance, health promotion efforts that remain case-response oriented, and limited access to health information. Strengthening surveillance and health promotion through capacity building for health workers, the use of data for risk communication, and expanded education for at-risk communities are necessary to improve early detection and reduce morbidity and mortality from leptospirosis.

Kata Kunci : Evaluasi Program, Surveilans Leptospirosis, Perilaku Pencarian Pengobatan, Kabupaten Magelang