TESIS INDEKS RISIKO SUMBER PENULARAN AKTIF KEJADIAN KUSTA PADA ANAK DI KABUPATEN BANGKALAN TAHUN 2015
TESIS
INDEKS RISIKO SUMBER PENULARAN AKTIF KEJADIAN KUSTA
PADA ANAK DI KABUPATEN BANGKALAN TAHUN 2015
RAMDANI RAMLI
UNIVERSITAS AIRLANGGA
FAKULTAS KESEHATAN MASYARAKAT
PROGRAM MAGISTER
PROGRAM STUDI EPIDEMIOLOGI
SURABAYA
2016
TESIS
INDEKS RISIKO SUMBER PENULARAN AKTIF KEJADIAN KUSTA
PADA ANAK DI KABUPATEN BANGKALAN TAHUN 2015
RAMDANI RAMLI
NIM. 101414553026
UNIVERSITAS AIRLANGGA
FAKULTAS KESEHATAN MASYARAKAT
PROGRAM MAGISTER
PROGRAM STUDI EPIDEMIOLOGI
SURABAYA
2016
INDEKS RISIKO SUMBER PENULARAN AKTIF KEJADIAN KUSTA
PADA ANAK DI KABUPATEN BANGKALAN TAHUN 2015
TESIS
Untuk memperoleh gelar Magister Epidemiologi
Minat Studi Epidemiologi
Program Studi Epidemiologi
Fakultas Kesehatan Masyarakat
Universitas Airlangga
Oleh:
RAMDANI RAMLI
NIM. 101414553026
UNIVERSITAS AIRLANGGA
FAKULTAS KESEHATAN MASYARAKAT
PROGRAM MAGISTER
PROGRAM STUDI EPIDEMIOLOGI
SURABAYA
2016
PENGESAHAN
Dipertahankan di depan Tim Penguji Tesis
Minat Studi Epidemiologi
Program Studi Epidemiologi
Fakultas Kesehatan Masyarakat Universitas Airlangga
dan diterima untuk memenuhi persyaratan guna memperoleh gelar
Magister Epidemiologi (M.Epid.)
pada tanggal 20 Juli 2016
Mengesahkan
Universitas Airlangga
Fakultas Kesehatan Masyarakat
Dekan,
Prof. Dr. Tri Martiana, dr., M.S
NIP. 19560303 198701 2 001
Tim Penguji:
Ketua : Dr. RR. Soenarnatalina M, Ir., M.KesAnggota : 1. Dr. Windhu Purnomo, dr., M.S 2. Prof. Dr. Chatarina U.W, dr., M.S., M.PH 3. Prof. Dr. Rika Subarniati T, dr., S.KM 4. Dr. Cita Rosita, dr., Sp. KK
ii
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PERSETUJUAN
TESIS
Diajukan sebagai salah satu syarat untuk memperoleh gelar
Magister Epidemiologi (M.Epid.)
Minat Studi Epidemiologi
Program Studi Epidemiologi
Fakultas Kesehatan Masyarakat
Universitas Airlangga
Oleh:
RAMDANI RAMLI
NIM. 101414553026
Menyetujui,
Surabaya, 20 Juli 2016
Pembimbing Ketua,Dr. Windhu Purnomo, dr., M.S NIP. 19540625 198303 1 002 Pembimbing, Prof. Dr. Chatarina U.W, dr., M.S., M.PH NIP. 19540916 198303 2 001
Mengetahui,
Koordinator Program Studi Epidemiologi
Prof. Dr. Chatarina U.W, dr., M.S., M.PH
NIP. 19540916 198303 2 001 Yang bertanda tangan di bawah ini, saya: Nama : Ramdani Ramli NIM : 101414553026 Program Studi : Epidemiologi Minat Studi : Epidemiologi Angkatan : 2014 Jenjang : Magister menyatakan bahwa saya tidak melakukan kegiatan plagiat dalam penulisan tesis saya yang berjudul:
INDEKS RISIKO SUMBER PENULARAN AKTIF KEJADIAN KUSTA
PADA ANAK DI KABUPATEN BANGKALAN TAHUN 2015Apabila suatu saat nanti terbukti saya melakukan tindakan plagiat, maka saya akan menerima sanksi yang telah ditetapkan. Demikian surat pernyataan ini saya buat dengan sebenar-benarnya.
Surabaya, 20 Juli 2016 Ramdani Ramli
NIM. 101414553026
iv Puji Syukur kehadirat Allah SWT atas segala limpahan rahmat dan karuniaNya kepada kita semua, dan tidak lupa pula shalawat serta salam kita haturkan kepada junjungan Nabi Muhammad SAW sehingga penulis dapat menyelesaikan tesi yang berjudul “Indeks Risiko Sumber Penularan Aktif
Kejadian Kusta Pada Anak Di Kabupaten Bangkalan
” guna melengkapi tugas akhir dan memenuhi salah satu syarat untuk menyelesaikan Program Pendidikan S-2 Epidemiologi dan mencapai gelar Magister Epidemiologi (M.Epid). Penulis mengucapkan banyak terimakasih kepada kedua orangtua penulis ayahanda Drs. H. Ramli dan ibunda Hj. Jumasia dan Saudara/i penulis yang telah menjadi motivator terbaik bagi penulis.
Tesis ini berisikan mengenai faktor risiko dan indeks risiko sumber penularan aktif kejadian kejadian kusta pada anak di Kabupaten Bangkalan. Penulis menyadari dalam penyusunan tesis ini tidak lepas dari bantuan serta bimbingan dari berbagai pihak. Sehingga dalam kesempatan kali ini, penulis ingin menyampaikan ucapan rasa terima kasih dan penghargaan kepada Dr. Windhu Purnomo, dr.,M.S selaku pembimbing I dan Prof. Dr.Chatarina U. W,dr.,M.S.,M.PH pembimbing II, yang telah memberikan bimbingan, pengarahan, koreksi dan saran hingga terselesaikannya tesis ini.
Dalam penyusunan tesis ini, penulis juga ingin mengucapkan terima kasih kepada:
1. Prof. Dr. Moh. Nasih, SE., M.T., AK.,CMA., CA selaku rektor Universitas Airlangga Surabaya yang telah berkenan menerima penulis untuk belajar di Program Magister Program Studi Epidemiologi
2. Prof. Dr. Tri Martiana, dr., M.S selaku Dekan Fakultas Kesehatan Masyarakat Universitas Airlangga yang telah memberikan kebijakan dalam penyusunan usulan penelitian tesis.
3. Prof. Dr. Chatarina U. W, dr., M.S., M.PH selaku Koordinator Program Magister Epidemiologi beserta seluruh dosen dan karyawan yang telah memberikan ilmunya serta memberikan pelayanan selama saya menuntut ilmu di Universitas Airlangga Surabaya.
4. Prof. Dr. Rika Subarniati T, dr,. S.KM, Dr.Soenarnatalina, ir., M.Kes dan Priyo Santoso, S.KM, M.Kes selaku anggota penguji tesis atas kesediannya menguji dan membimbing dalam perbaikan tesis.
5. Kepala Dinas Kesehatan Kabupaten Bangkalan, Kabid P2PM, Kasie P2M dan Wasor Kusta Dinas Kesehatan Kabupaten Bangkalan beserta Staf, yang telah mengizinkan untuk melakukan penelitian dan membantu dalam kelancaran penelitian di Kabupaten Bangkalan.
6. Puskesmas sewilayah Kabubaten Bangkalan dan petugas kusta di Puskesmas Wilayah Kabupaten Bangkalan, yang telah membantu dalam penelitian ini.
7. Seluruh masyarakat dan khususnya para responden di Kabupaten Bangkalan yang banyak membantu pada proses penelitian,.
8. Teman-teman angkatan 2014 dan 2015 S2 Epidemiologi FKM UNAIR dan semua pihak yang tidak dapat peneliti sebutkan satu persatu.
9. Sahabat dara daeng di Sulawesi Selatan yang selalu memberi semangat dan motivasi bagi penulis.
Penulis juga menerima segala kritik dan saran dari semua pihak demi kesempurnaan tesis ini. Tesis ini telah penulis susun dengan optimal, namun tidak menutup kemungkinan adanya kesalahan, kekurangan dan jauh dari kesempurnaan. Oleh karena itu, penulis berharap adanya kritik dan saran yang membangun dari semua pihak yang membaca demi kesempurnaan tesis ini.
Surabaya, 2016 Penulis
ii
SUMMARY
The occurence of the disease is an interaction between the various factors,those are host (host), germ (the agent) and the environment (environment),
through a process known as transmission chain. It consists of six components,
cause, source of infection, way out of the transmission source, modes of
transmission, how to infect the host, and the host.Leprosy is a very complex issue and an issue of humanity completely.
Problems encountered in patients not only from the medical aspect but also their
psychosocial aspect as a result of the disaese. The incidence of leprosy in children
is a problem, although the disease is not fatal but can inflict disability and threaten
their future. Leprosy is widespread in tropical and subtropical regions which is
sultry and humid with unsanitary and unhealthy living environment. This disease
may only be transmitted through close contact, such as between a mother and
child.Leprosy is a chronic infectious disease caused by M. leprae and affects
mainly the skin and peripheral nerves. In 2011-2013 reported by WHO the most
number of new leprosy patients was in India with 134 759 new cases in 2013, then
Brazil 33 303 new cases, and the third place was Indonesia with 18 994 cases.Ministry of Health RI 2015 report that leprosy in children during 2008-
2014 the new case detection rate in 2014 was still high at 11.12 per 100,000
population. The proportion of MB on 2008-2014leprosy is relatively static ie 80%
-83%. High leprosy burden in children found in 11 provinces in 2011, 14
provinces in 2012, and 13 provinces in 2013.
By 2015, the proportion of children in Bangkalan leprosy is still above the
national target of 5%. Based on these data where in recent years the proportion of
leprosy children of 12% is still far from national indicators of achievement in
terms of eradication of leprosy which is 5%. It can be concluded that child leprosy
is a problem in Bangkalan especially for leprosy.The purpose of this study was to develop a risk index of active
transmission resources of leprosy occurence in children in bangkalan district. This
research was an analytic observational study using case control study design. The
sample in this study consisted of sample of cases 31 people, and control sample
31 people. So the total sample were 82 people. The sampling technique used in
this study was simple random sampling while the technique of collecting data by
conducting interviews, observations, and measurements directly in the field. Data
were analyzed using descriptive and inferential analysis, in which the inferential
analysis using simple logistic regression and multiple logistic regression.The results of this study indicate that there are 6 variables are candidates to
continued multiple logistic regression analysis, those are: the child's age (p value
= 0.032), history of vaccine (p value = 0.115), history of contact (p value =
0.000), parental knowledge (p value = 0.006), parenting parents (p value = 0.001)
and ventilation (p value = 0.144) ,. While the gender variable (p value = 0.443),
nutritional status (p value = 1.000), residence duration (p value = 0.561),
population density (p value = 0.602), socioeconomic (p value = 0.799),
temperature (p value = 1.000), humidity (p value = 0.643), and lighting (p value =
0.643) did not match to be candidate because it was under the candidate variable
value (p value <0.25). The final result of multiple regression analysis, there were
four indicators of the incidence of children leprosy. Those were the child's age,
intensity of contacts, knowledge of parenting and parenting parents. The final
results obtained were risk index of active transmission resources of leprosy
- occurrence in children in bangkalan district (-6,078 3,558 * Age (6-14) + 2,170 *
Parenting Parents (less) + 1,802 2,549 * history of
- Parent’s Knowledge (less) + contact (intense)).
This index is expected to be considered and utilized as a measuring tool in
helping health workers, especially health centers for early screening in society
especially for children at the age of 0 until 14 years old, so potentially children
affected by leprosy can be seen and detected by applying the indexes that have
been obtained.ii
ABSTRACT
Leprosy is a chronic infectious disease caused by M. leprae and affectsmainly the skin and peripheral nerves. Leprosy has been spread throughout the
world with concentration, especially in developing countries that hygiene and
sanitation is poor. Leprosy can strike all ages no exception in children, or infants.
The purpose of this study was to develop a risk index of active transmission
resources of leprosy occurence in children in bangkalan district. The study was
observational epidemiological studies analytic case control method. The sample
size in this study 62 people, 31 cases and 31 controls with sampling methods
Simple Random Sampling. The results of this study indicate that there were 6
variables of candidates to be continued to multiple logistic regression analysis,
those were the child's age (p value = 0.032), history of vaccine (p value = 0.115),
history of contact (p value = 0.000), parental knowledge (p value = 0.006),
parenting parents (p value = 0.001) and ventilation (p value = 0.144) ,. While the
gender variable (p value = 0.443), nutritional status (p value = 1.000), long lived
(p value = 0.561), population density (p value = 0.602), socioeconomic (p value =
0.799), temperature (p value = 1.000), humidity (p value = 0.643), and lighting (p
value = 0.643) did not match the condition because the candidate variable value
was (p value <0.25). The final result of multiple regression analysis, there were
four indicators of the incidence of children leprosy, those are child's age, intensity
of contacts, knowledge of parenting and parenting parents. The final results
obtained were risk index of active transmission resources of leprosy occurrence in
children in Bangkalan district + (-6,078 3,558 * Age (6-14) + 2,170 * Parenting
Parents (less) + 1,802 2,549 * history of contact
- Parent’s Knowledge (less) +
(intense)). Risk index leprosy incidence in children is expected to be utilized as a
measuring tool in helping health workers, especially health centers for early
screening in society especially for children at the age of 0 until 14 years old, so
potentially children affected by leprosy can be seen and detected by applying the
indexes that have been obtained. Keywords: Index, Leprosy children, Infection, Bangkalan
INDEKS RISIKO SUMBER ...
12 2.1 Pengertian Penyakit Kusta ...........................................................
25 2.11 Stigma .........................................................................................
24 2.10 Pengobatan Penyakit Kusta .........................................................
23 2.9 Pencegahan Kusta ........................................................................
21 2.8 Diagnosis Penyakit Kusta ............................................................
21 2.7 Gejala dan Tanda Penyakit Kusta ................................................
17 2.6 Klasifikasi Kusta ..........................................................................
15 2.5 Patogenesis Penyakit Kusta .........................................................
13 2.4 Epidemiologi Penyakit Kusta ......................................................
13 2.3 Etiologi Penyakit Kusta ...............................................................
12 2.2 Sejarah Penyakit Kusta ...............................................................
11 BAB 2 TINJAUAN PUSTAKA ...................................................................
xii
DAFTAR ISI
SAMPUL DEPAN .......................................................................................... i11 1.5.3 Manfaat Bagi Masyarakat ..................................................
11 1.5.2 Manfaat Praktisi ..................................................................
11 1.5.1 Manfaat Teoritis ..................................................................
10 1.5 Manfaat Penelitian ......................................................................
10 1.4.2 Tujuan Khusus ....................................................................
10 1.4.1 Tujuan Umum .....................................................................
10 1.4 Tujuan Penelitian .........................................................................
8 1.3 Rumusan Masalah ........................................................................
1 1.2 Kajian Masalah ............................................................................
1 1.1 Latar Belakang dan Identifikasi Masalah ....................................
SAMPUL DALAM ......................................................................................... ii HALAMAN PRASYARAT GELAR ............................................................ iii HALAMAN PENGESAHAN ........................................................................ iv HALAMAN PERSETUJUAN ....................................................................... v PERNYATAAN TENTANG ORISINALITAS ........................................... vi KATA PENGANTAR .................................................................................... vii SUMMARY ...................................................................................................... ix ABSTRACT ..................................................................................................... xi DAFTAR ISI ................................................................................................... xii DAFTAR TABEL ........................................................................................... xiv DAFTAR GAMBAR ...................................................................................... xvi DAFTAR LAMPIRAN .................................................................................. xvii DAFTAR ARTI LAMBANG DAN ISTILAH ............................................. xviii BAB 1 PENDAHULUAN ............................................................................
26 TESIS RAMDANI RAMLI
2.12 Kusta Pada Anak Berdasarkan Konsep Segitiga Epidemiologi ..
27 2.13 Indeks ..........................................................................................
46 BAB 3 KERANGKA KONSEPTUAL DAN HIPOTESIS ......................
52 3.1 Kerangka Konseptual ...................................................................
52 3.2 Hipotesis Penelitian ....................................................................
54 BAB 4 METODE PENELITIAN ................................................................
55 4.1 Jenis Penelitian.............................................................................
55 4.2 Rancang Bangun Penelitian ........................................................
55 4.3 Lokasi dan Waktu Penelitian ......................................................
56 4.4 Populasi dan Sampel ....................................................................
56 4.4.1 Populasi ...............................................................................
56 4.4.2 Sampel.................................................................................
56 4.4.3 Besar Sampel .....................................................................
57 4.4.4 Teknik Pengambilan Sampel ..............................................
58 4.5 Kerangka Operasional ..................................................................
58 4.6 Variabel Penelitian dan Devinisi Operasional .............................
59 4.7 Teknik dan Prosedur Pengambilan Data .....................................
67 4.8 Pengolahan dan Analisa Data ......................................................
67 BAB 5 HASIL DAN ANALISIS DATA ....................................................
70 5.1 Gambaran Umum Lokasi Penelitian ............................................
70 5.2 Karakteristik Sampel ...................................................................
71 5.2 Analisis Deskriptif ......................................................................
72 5.3 Analisis Inferensial .......................................................................
77 BAB 6 PEMBAHASAN ..............................................................................
92 6.1 Karakteristik Responden ..............................................................
92
6.2 Lingkungan Sosial ....................................................................... 94
6.3 Lingkungan Fisik ......................................................................... 101
6.4 Indikator Kejadian Kusta Pada Anak ........................................... 104
6.5 Indeks Risiko Kejadian Kusta Pada Anak ................................... 111
BAB 7 PENUTUP ......................................................................................... 113
7.1 Kesimpulan .................................................................................. 113
7.2 Saran ............................................................................................. 114 .................................................................................... 116
DAFTAR PUSTAKA LAMPIRAN .................................................................................................... 120
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TESIS
INDEKS RISIKO SUMBER ... RAMDANI RAMLI
INDEKS RISIKO SUMBER ...
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DAFTAR TABEL
25
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Distribusi Kejadian Kusta Pada Anak Berdasarkan Status Gizi Di Kabupaten Bangkalan Tahun 2016......................................................
Distribusi Kejadian Kusta Pada Anak Berdasarkan Riwayat Vaksinasi Di kabupaten Bangkalan .....................................................
Distribusi Lama Kontak Kejadian Kusta Pada Anak di Kabupaten Bangkalan............................................................................................ Distribusi Intensitas Kontak Kejadian Kusta Pada Anak di Kabupaten Bangkalan............................................................................................ Distribusi Klasifikasi Kontak Kejadian Kusta Pada Anak di Kabupaten Bangkalan.......................................................................... Distribusi Kejadian Kusta Pada Anak Berdasarkan Umur Di Kabupaten Bangkalan ......................................................................... Distribusi Kejadian Kusta Pada Anak Berdasarkan Jenis Kelamin Di Kabupaten Bangkalan..........................................................................
Distribusi Pekerjaan Orangtua Anak di Kabupaten Bangkalan........... Distribusi Status Hubungan Kejadian Kusta Pada Anak di Kabupaten Bangkalan............................................................................................
Distribusi Jenis Kelamin Sampel Anak di Kabupaten Bangkalan....... Distribusi Pendidikan Orangtua Anak di Kabupaten Bangkalan..........
Kriteria penentuan tipe pengobatan kusta dengan cara MDT WHO... Kategori dan ambang batas status gizi anak berdasarkan indeks........ Definisi Operasional............................................................................ Distribusi Umur Sampel Anak di Kabupaten Bangkalan.....................
Tabel 5.14 Klasifikasi tipe PB dan MB menurut Widoyono 2011 .......................16 Tabel 2.2 Tabel 2.3 Tabel 2.4 Tabel 4.1 Tabel 5.1 Tabel 5.2 Tabel 5.3 Tabel 5.4 Tabel 5.5 Tabel 5.6 Tabel 5.7 Tabel 5.8 Tabel 5.9 Tabel 5.10 Tabel 5.11 Tabel 5.12 Tabel 5.13
6
5
Pencapaian Program Pemberantasan Penyakit Kusta Kabupaten Bangkalan Tahun 2011- 2015.............................................................. Proporsi Kusta Anak Berdasarkan Jumlah Penduduk Anak Tahun 2014-2015 .......................................................................................... Situasi Kusta Menurut Regional WHO pada Tahun 2012 Diluar Regional Eropa....................................................................................
Nomor Judul Tabel Halaman Tabel 1.1 Tabel 1.2 Tabel 2.1
80 TESIS RAMDANI RAMLI
Tabel 5.15 Distribusi Kejadian Kusta Pada Anak Berdasarkan Lama Bermukim81 Di Kabupaten Bangkalan..................................................................... Tabel 5.16
Distribusi Kejadian Kusta Pada Anak Berdasarkan Riwayat Kontak
81 Di Kabupaten Bangkalan..................................................................... Tabel 5.17
Distribusi Kejadian Kusta Pada Anak Berdasarkan Pengaruh
82 Kepadatan Hunian Di Kabupaten Bangkalan...................................... Tabel 5.18
Distribusi Kejadian Kusta Pada Anak Berdasarkan Sosial Ekonomi
82 Di Kabupaten Bangkalan..................................................................... Tabel 5.19
Distribusi Kejadian Kusta Pada Anak Berdasarkan Pengetahuan
83 Orangtua Di Kabupaten Bangkalan..................................................... Tabel 5.20
Distribusi Kejadian Kusta Pada Anak Berdasarkan Pengaruh Pola
84 Asuh Orangtua Di Kabupaten Bangkalan............................................ Tabel 5.21
Distribusi Kejadian Kusta Pada Anak Berdasarkan Pengaruh
84 Ventilasi Di Kabupaten Bangkalan..................................................... Tabel 5.22
Distribusi Kejadian Kusta Pada Anak Berdasarkan Pengaruh Suhu
85 Di Kabupaten Bangkalan..................................................................... Tabel 5.23
Distribusi Kejadian Kusta Pada Anak Berasarkan Kelembaban Di
86 Kabupaten Bangkalan.......................................................................... Tabel 5.24
Distribusi Kejadian Kusta Pada Anak Berdasarkan Pencahayaan Di
87 Kabupaten Bangkalan.......................................................................... Tabel 5.25
Rangkuman Hasil Uji Regresi Logistik Sederhana Kejadian Kusta
88 Pada Anak di Kabupaten Bangkalan................................................... Tabel 5.26
90 Hasil Analisis Regresi Berganda Kejadian Kusta Pada Anak Di Tabel 5.27
91 Kabupaten Bangkalan.......................................................................... Nilai Spesivisitas dan Sensitifitas Indeks Risiko Kejadian Kusta anak
….................................................................................................. Skor Kategori Variabel Kejadian Kusta Pada Anak.............................
Penerapan Formula Indeks Dalam Contoh Kasus................................
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TESIS
INDEKS RISIKO SUMBER ... RAMDANI RAMLI
DAFTAR GAMBAR
Nomor Judul Tabel Halaman
Gambar 1.1 Jumlah penderita kasus baru kusta per provinsi tahun2 2013..........
Gambar 1.2 Proporsi Kusta MB Dan Proporsi Kusta Pada Anak Tahun 2008-2014..........................................................................4 Gambar 1.3 Kusta Pada Anak Tahun
8 2014.......................................................
Gambar 2.1 Mycobacterium leprae. ...................................................14 Gambar 2.2 Tren Proporsi dan Kasus Baru Kusta pada Anak 0-14 Tahun 2011-2013.....................................................................................
17 Gambar 2.3 Perjalanan Penyakit Kusta............................................................
19 Gambar 2.4 Segitiga Epidemiologi............
27 ..................................................
Gambar 3.1 Kerangka Konsep Penelitian ............55 ...........................................
Gambar 4.1 Skema dasar Studi Kasus Kontrol............55 ....................................
Gambar 4.2 Kerangka Operasional Penelitian............58 Gambar 5.1 .....................................
70 Gambar 5.2 Peta Kabupaten Bangkalan............
89 ............................................... Kurva ROC...................................................................................
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TESIS
INDEKS RISIKO SUMBER ... RAMDANI RAMLI