FAKTOR LINGKUNGAN DAN KEJADIAN DEMAM BERDARAH DENGUE (DBD) DAERAH ENDEMIS KECAMATAN GADING CEMPAKA KOTA BENGKULU TAHUN 2012

HELFI NOLIA R.TAMBUNAN, Dra. Susi Irawati, Apt., Ph.D.

2013 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Incidence Rate (IR) Demam Berdarah Dengue (DBD) di Kota Bengkulu Provinsi Bengkulu Tahun 2011 adalah 129,76 per 100.000 penduduk dan Case Fatality Rate (CFR) sebesar 1,73 %. Data yang diperoleh dari Dinas Kesehatan Kota Bengkulu menunjukkan jumlah kasus pada tahun 2011 sebanyak 403 kasus. Kejadian DBD di Kecamatan Gading Cempaka 139 kasus pada tahun 2011. Penelitian epidemiologi analitik perlu dilakukan untuk mengetahui faktorfaktor risiko yang berhubungan dengan kejadian DBD, resistensi nyamuk Aedes aegypti terhadap malation dan temefos dan pemetaan distribusi kasus di Kecamatan Gading Cempaka Kota Bengkulu. Selanjutnya dapat membuat kebijakan pemberantasan dan pengendalian DBD dan mengetahui distance index kasus. Tujuan Penelitian: Untuk mengetahui faktor risiko berupa kepadatan penghuni, pencahayaan dalam rumah, angka bebas jentik (ABJ), kebiasaan pemberantasan sarang nyamuk (PSN), dan kebiasaan menggantung pakaian terhadap kejadian DBD, resistensi nyamuk Ae. aegypti terhadap insektisida (malation dan temefos) dan mengetahui distance index kasus DBD. Metode: Rancangan penelitian adalah kasus kontrol dilaksanakan di Kecamatan Gading Cempaka Kota Bengkulu. Besar sampel berjumlah 129 orang kasus dan 129 orang kontrol. Analisis data menggunakan analisis univariat, bivariat, multivariat dan spasial. Hasil : Analisis multivariat menunjukkan bahwa kepadatan hunian dalam rumah ( p value > 0,05 ), pencahayaan dalam rumah ( p value > 0,05 ) dan kebiasaan menggantung pakaian ( p value > 0,05 ) bukan merupakan faktor risiko kejadian DBD ( p value > 0,05 ). Kebiasaan PSN ( p value = 0,001; OR = 2,592 : 95% CI = 1,467 – 4,581) merupakan faktor risiko kejadian DBD ( p value 0,05 ). Angka bebas jentik merupakan faktor risiko kejadian DBD (86,8%) di Kecamatan Gading Cempaka Kota Bengkulu (standar nasional Ae.aegypti telah resisten (53%) terhadap malation dan jentik nyamuk Ae.aegypti toleran (93%) terhadap temefos. Kasus DBD banyak terjadi distance index (flight range nyamuk Ae.aegypti)) sebanyak 35 kasus (85,37%) Kesimpulan : Kebiasaan PSN dan ABJ merupakan faktor risiko terjadinya kasus DBD. Nyamuk Ae.aegypti dari Kecamatan Gading Cempaka Kota Bengkulu resisten terhadap malation dan jentik nyamuk Ae.aegypti toleran terhadap temefos. Kejadian DBD disebabkan oleh perilaku manusia.

Background: Incidence Rate (IR) of Dengue Hemorrhagic Fever (DHF) in Bengkulu Province in 2011 was reported 129.76 per 100,000 population and Case Fatality Rate (CFR) was reported 1.73%. Data obtained from Bengkulu City Health Services, was showed that DHF cases was increased since 2008, and in 2011 was reported of 403 cases. The incidence of DHF cases in Gading Cempaka Sub District was 139 in 2011. Epidemiological studies was conducted to determine the risk factors associated with DHF incidence, Ae.aegypti mosquito resistance to malathion and temephos and distance index of the distribution was conducted in Sub District Gading Cempaka, Bengkulu city in 2011. The study was conducted in an effort to decide an appropriate vector control method to be applied in the study area. Objective: To determine risk factors of DHF transmission such as dwelling density, indoor illumination , larvae free index (LFI), regular household sanitation or clean-up campaigns (to dry of, cover and bury/the vector habitats cleaning), and cloth hanging habit the incidence of DHF, the Ae. aegypti mosquito resistance to malathion and temefos and distance index of DHF cases . Methods: The study design was a case-control implemented in Sub District Gading Cempaka, in the city of Bengkulu. The sample size was 129 cases and 129 controls. Analyzed using univariate, bivariate, multivariate and spatial. Results: Multivariate analysis showed that dwelling density ( p value > 0.05 ), indoor illumination ( p value > 0.05) and cloth hanging habit ( p value > 0.05 ) were not a risk factor for DHF transmission (p value > 0.05) . Regular household sanitation or clean-up campaigns (to dry off, cover and burry/the vector habitats) ( p value = 0.001 ; OR = 2.592 95% CI = 1.467 to 4.581) was risk factors for the incidence of DHF ( p value 0,05 ). Larvae free index was risk factors for the incidence of DHF (86,8 %) in Sub District Gading Cempaka, in the city of Bengkulu ( standard Departement of Health Aedes aegypti mosquitoes the DHF vectors was resistant (53%) to malation and tolerant to temefos larvacide (93%). Many cases of DHF occurred Ae. aegypti mosquito flight range) of 35 cases (85,37%). Conclusion: Regular household sanitation or clean-up campaigns (to dry of, cover and bury/the vector habitats cleaning) and LFI were risk factors for the occurrence of cases of DHF. Ae.aegypti mosquitoes which originated from Sub District Gading Cempaka were resistant to malathion and tolerant to temefos. The incidence of DHF was caused by human behaviour.

Kata Kunci : DBD, Faktor risiko, resistensi insektisida,analisis spasial; DHF, Risk factors, insecticide resistance, spatial analysis