STUDI LINGKUNGAN PENULARAN KOLERA DI KECAMATAN SEPATAN DAN KECAMATAN PAKUHAJI KABUPATEN TANGERANG, PROVINSI BANTEN

Aprilia Rubiana, Prof.dr.M.Juffrie,SpA(K).PhD

2012 | Tesis | S2 Kesehatan Masyarakat/EL

Latar Belakang: Dalam sepuluh tahun terakhir ini secara epidemiologi perhatian dunia terhadap kolera mengalami peningkatan dan kejadian kolera dapat menjadi ancaman kesehatan global. Hubungan antara Vibrio cholerae, host, di lingkungan menyebabkan dinamika kolera menjadi lebih komplek. Studi ekologi menjelaskan bahwa lingkungan perairan sebagai habitat asli Vibrio cholerae , kemampuan hidup bakteri di luar maupun di dalam lingkungan perairan menyebabkan pengendalian kolera menjadi lebih komplek. Kejadian luar biasa kolera di bagian utara Kabupaten Tangerang tahun 2005, 2007, dan 2009/2010, menjadi dasar penelitian untuk mengetahui tentang faktor lingkungan yang berperanan dalam pertumbuhan bakteri dan distribusi Vibrio cholerae di wilayah tersebut. Tujuan: Mengetahui kejadian kolera ditinjau dari kondisi lingkungan, untuk mengetahui hubungan antara lingkungan perairan sebagai faktor risiko kolera dengan penularan kolera termasuk didalamnya juga mengetahui distribusi geografi (spasial) kejadian kolera. Metode:Studi observational case control , yang terdiri atas 88 kasus dan 88 kontrol yang dipilih berdasarkan catatan medik di puskesmas. Sampel air dikumpulkan dari setiap sumber air yang dimiliki responden, sungai, dan rawa untuk pemeriksaan sifat abiotik dan biotik lingkungan perairan. Geographic information system (GIS) membantu proses pemetaan dan deteksi terbentuknya kluster. Kuesioner memandu dalam proses evaluasi faktor risiko antara lain jenis air minum, kondisi bangunan fisik sumber air, dan perilaku cuci tangan. Hasil: 7 dari 176 sampel air sumur positif Vibrio cholerae. Analisis spasial memperlihatkan kejadian kolera tahun 2009/2010 membentuk kluster primer dengan radius 2558m dari pusat kasus. Analisis multivariat menunjukkan air minumyang tidak diolah (OR: 2,85, CI95% 1,4-5,81) dan kondisi fisik bangunan dengan tingkat cemaran tinggi (OR:6.43, CI95% 3,14-13,17) merupakan faktor risiko penularan kolera di wilayah tersebut. Kesimpulan: Jenis air minum dan kondisi fisik bangunan sumur menjadi faktor risiko penularan kolera, dengan meningkatkan kondisi sanitasi lingkungan dan memotivasi pemakaian air olahan dapat mencegah kejadian kolera di wilayah tersebut.

Background: In the last decade, attention to cholera epidemiology increased, cholera epidemics became a worldwide health problem. Vibrio cholerae interactions with its host and with other organisms in the environment suggest that cholera dynamics is much more complex. Ecological studies suggest that the aquatic environment is the natural habitat of Vibrio cholerae. Its ability to survive within and outside the aquatic environment makes cholerae a complex health problem to manage. The occurence of epidemics of cholera in Tangerang in 2005, 2007, and 2009/2010, mainly in north of Tangerang communities have stimulated efforts to understand environmental factors influencing the growth and geographic distribution of epidemic Vibrio cholerae. Objective: To identify the epidemic of cholera, through environmental approach. The study was to identify association of aquatic environment with transmission of cholera, comprising risk factors and spatial analysis of cholerae. Method: Case control study was undertaken with 88 cases and 88 controls. Participants were enrolled based medical records in primary health care. Cases were confirmed laboratory of Vibrio cholera in epidemic of cholera in 2009/2010. Controls were individuals without cholera and diarrhea in epidemic and this study. Water samples collected from fresh water of all of participants, river, and swamp were tested abiotic and biotic aquatic environment. Geographic information system (GIS) technology have helped disease mapping and cluster detection. A questionnare was administered to people to evaluate drinking water, sanitation of fresh water, and handwashing practice as risk factor. Result: Seven of 176 water samples from fresh water were positive for Vibrio cholerae. A spatial scan statistics also identified significant spatial cluster of cholera that is primary cluster also showed that the radius within case centre is 2558 meter. Multivariate analyses showed that untreatment drinking water (OR: 2.85, 95% CI 1.4-5.81) and dirty level of fresh water (OR: 6.43, 95% CI 3.14-13.17) were risk factors. Conclusion: The study findings suggest that risk factors for cholera in the district are known factors. Study findings will be used to improve the promotion of sanitation and treating drinking water to prevent of cholera in this setting.

Kata Kunci : lingkungan perairan, sanitasi, air minum , kolera, Vibrio cholerae