ANALISIS SPASIAL PEMANFAATAN SUMBER AIR MINUM, SANITASI DASAR DAN AKSESIBILITAS FISIK KEJADIAN DIARE PADA BALITA DI KECAMATAN GANDUS KOTA PALEMBANG
Robiatul Adawiyah, Prof. Dr. dr. Adi Heru Sutomo, M.Sc
2012 | Tesis | S2 Ilmu Kesehatan MasyarakatLatar belakang: Diare merupakan salah satu penyebab utama kesakitan dan kematian pada balita dan sebagai penyebab kematian tertinggi ketiga di seluruh dunia, di Indonesia setidaknya terdapat kasus 162 ribu balita meninggal pertahun atau sekitar 460 balita setiap harinya akibat diare. Selama tahun 2011 di kecamatan Gandus terdapat 1.488 kasus diare dari total sebanyak 22.537 kasus diare yang tercatat di Dinas Kesehatan Kota Palembang. Faktor penting yang dapat mempengaruhi munculnya diare yaitu faktor lingkungan (sumber air minum, pembuangan sampah, SPAL, pembuangan kotoran/tinja), faktor perilaku individu, faktor agent, dan faktor pelayanan kesehatan. Tujuan: mengetahui persebaran kejadian diare pada balita secara spasial, mengetahui hubungan antara faktor risiko sumber air minum, jamban keluarga, sarana pembuangan air limbah, cara pembuangan sampah, jarak sanitasi ke sumber air minum, dan aksesibilitas fisik ke pelayanan kesehatan dengan kejadian diare pada balita di Kecamatan Gandus Kota Palembang. Metode Penelitian: Jenis penelitian adalah observasional analitik dengan rancangan kasus kontrol. Sampel diambil random berjumlah 70 kasus dan 70 kontrol. Analisis data dilakukan dengan sistem informasi geografis untuk melihat distribusi spasial dan analisis univariabel, bivariabel, dan multivariabel. H0 asil Penelitian : Hasil analisis Permutation model didapatkan 2 cluster berdasarkan waktu kejadian diare pada balita di Kecamatan Gandus Kota Palembang. Most likely cluster terjadi pada koordinat 3.016100 S, 104.692861 E dengan radius 0,088 km dengan p-value = 0,81. Hasil analisis Purely Spatial Bernoulli Model didapat 6 cluster kejadian diare pada balita berdasarkan wilayah di Kecamatan Gandus Kota Palembang. Most likely cluster terjadi pada 9 populasi yang berpusat pada koordinat 3.019400 S, 104.740722 E dengan radius 0.24 km dengan p-value = 0,084. Hasil analisis multivariabel menunjukkan faktor risiko kejadian diare pada balita adalah sumber air minum (p=0,026), sedangkan jamban keluarga, sarana pembuangan sampah, sarana pembuangan air limbah, jarak sarana sanitasi dasar ke sumber air minum dan aksesibilitas fisik ke pelayanan kesehatan bukan menjadi faktor risiko kejadian diare pada balita. Sumber air minum merupakan faktor risiko yang paling dominan dengan nilai koefisien Wald paling besar yaitu 4,985. Kesimpulan : Terdapat clustering penderita diare pada balita di Kecamatan Gandus Kota Palembang. Sumber air minum yang tidak terlindungi secara statistik bermakna sebagai faktor risiko terhadap kejadian diare pada balita di Kecamatan Gandus Kota Palembang
Background: Diarrhea is one main cause of morbidity and mortality in under five years children, especially in developing countries, and is the third major cause of death around the world. In Indonesia, there are at least 162 thousand cases of deceased under five years children per year or around 460 under five years children everyday, caused by diarrhea. During the year 2011 in Gandus subdistrict, 1,488 cases of diarrhea occured from a total number of 22,537 cases of diarrhea reported in Health Office of Palembang municipality. Objective: This research aimed at determining the distribution of occurence of diarrhea in under five years children spatially, to understand the correlation between risk factors of drinking water source, family latrine, disposal facilities of liquid waste, disposal of litter, distance of sanitation to drinking water source, and physical accessibility of health care in correlation with the occurence of diarrhea in under five years children in Gandus subdistrict, Palembang municipality. Methods: Research was observational analytic with case control design. Samples were randomly obtained with a number of 70 cases and 70 controls. Data analysis was conducted with geographic information system to assess spatial distribution and univariate, bivariate, and multivariate analysis. Results: SatScan with Permutation model analysis obtained 2 clusters based on time of occurence of diarrhea in under five years children. Cluster served as most likely cluster was found in coordinate (3.016100 S, 104.692861 E) with a radius of 0.088 km with p-value = 0.81 which implied that this clustering was not significant. In Purely Spatial Bernoulli Model analysis, 6 clusters of occurence of diarrhea in under five years children were found in regard to regions. Cluster served as most likely cluster was found in 9 populations centered in coordinate (3.019400 S, 104.740722 E) with radius of 0.24 km with p-value = 0.084, which also implied that this clustering was not significantly meaningful. Result of multivariate analysis showed that risk factors for occurence of diarrhea in under five years children were drinking water source (p=0.026). Conclusion: Clustering was found in under five years children patients, but this clustering was not significantly meaningful. Correlation was found between the occurence of diarrhea and factors of drinking water source.
Kata Kunci : akses fisik – spasial – diare – balita – air.
