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Menurut laporan MDG's tahun 2007, 30,7% masyarakat Indonesia tanpa akses sanitasi yang layak. Provinsi Banten memiliki masalah yang cukup besar terkait dengan masalah air, higiene dan sanitasi. Beberapa cakupan sanitasi dasar di Provinsi Banten merupakan cakupan terendah di Pulau jawa, seperti cakupan jamban keluarga pada tahun 2007 yang hanya 67,69 %. Kondisi sanitasi lingkungan yang buruk ini akhirnya menyebabkan masih seringnya terjadi KLB diare dan demam berdarah di Provinsi Banten. Selain itu kejadian demam tifoid dan malaria juga mengalami peningkatan dari tahun ke tahun.
Tujuan penelitian ini adalah untuk mengetahui risiko dan dampak sanitasi lingkungan terhadap status kesehatan balita di Provinsi Banten dengan menggunakan data sekunder hasil RISKESDAS 2007. Penelitian ini merupakan penelitian kuantitatif dengan desain cross sectional. Populasi dan sampel dari penelitian ini adalah balita (12 - 59 bulan).
Hasil penelitian menunjukkan bahwa balita yang pernah menderita sakit sebanyak 17,2%. Sedangkan faktor sanitasi lingkungan yang memiliki risiko terhadap status kesehatan balita adalah ketersediaan air bersih (OR = 1,6; 95%CI 1,2 - 2,3), sarana pembuangan air limbah (OR = 1,7; 95% CI 1,0 - 3,1) dan tempat penampungan air (OR = 1,9; 95%CI 1,2 - 2,9). Sarana pembuangan air limbah memberikan dampak yang paling besar diantara ketiga variabel yang berisiko, dimana jika di populasi, sarana pembuangan air limbah yang tidak memenuhi syarat diperbaiki, maka akan menurunkan kejadian sakit pada balita sebanyak 36,9%. Hasil penelitian ini menyarankan bahwa untuk mengurangi risiko dan dampak sanitasi lingkungan diperlukan upaya pengelolaan terhadap air, mulai dari air bersih sampai dengan air buangan.
According to the MDG's in 2007, 30.7% of Indonesian people without access to improved sanitation. Banten province has a considerable problem associated with the problem of water, hygiene and sanitation. Some basic sanitation coverage in Banten Province is the lowest coverage in Java, such as family latrine coverage in 2007 is only 67.69%. Conditions of poor environmental sanitation is still ultimately lead to frequent outbreaks of diarrhea and dengue fever in the province of Banten. In addition to the incidence of typhoid fever and malaria also increased from year to year.
The purpose of this study was to determine the risk and impact of environmental sanitation on the health status of children under five in Banten province by using secondary data from RISKESDAS 2007. This research is quantitative cross-sectional design. Population and sample of the study was a toddler (12-59 months).
The results showed that infants who have suffered from as much as 17.2%. While environmental sanitation factors that have exposure to the health status of children under five are the availability of clean water (OR = 1.6, 95% CI 1.2 to 2.3), wastewater disposal (OR = 1.7, 95% CI 1, 0 to 3.1) and a reservoir of water (OR = 1.9, 95% CI 1.2 to 2.9). Wastewater disposal provide the greatest impact among the three variables is at risk, which if in the population, wastewater disposal are not eligible eliminated, it will reduce the incidence of illness in infants as much as 36.9%. Results of this study suggest that to reduce the risk and impact of environmental sanitation to water management efforts are needed, ranging from clean water to waste water.
Abstrak
Latar Belakang. Penetapan Rumah Sakit vertikal sebagai Unit Pelaksana Teknis Kementerian Kesehatan dengan Pola Pengelolaan Keuangan Badan Layanan Umum diatur dalam Undang-Undang Nomor 1 Tahun 2004 tentang Perbendaharaan Negara, Peraturan Pemerintah Nomor 23 Tahun 2005 tentang Pengelolaan Keuangan Badan Layanan Umum, dan dipertegas dalam Undang-Undang Nomor 44 Tahun 2009 tentang Rumah Sakit. Lembaga negara dengan Pola Pengelolaan Keuangan Badan Layanan Umum harus memiliki tata kelola pemerintahan yang baik. salah satu wujud tata kelola pemerintahan yang baik adalah akuntabilitas yang dapat dinilai dari keberadaan arsip sebagai bukti otentik terselenggaranya tata kelola. Pengelolaan arsip di Rumah Sakit Unit Pelaksana Teknis Kementerian Kesehatan diatur dengan Pedoman Tata Kearsipan Dinamis yang ditetapkan sebagai Peraturan Menteri Kesehatan Nomor 684/MENKES/PER/VIII/2006. Rumah Sakit Unit Pelaksana Teknis Kementerian Kesehatan melaksanakan Pedoman Tata Kearsipan Dinamis di bawah pembinaan Sekretariat Direktorat Jenderal Bina Upaya Kesehatan melalui kegiatan monitoring dan evaluasi ketatausahaan dan gaji yang dilakukan Sub Bagian Tata Usaha. Pelaksanaan kegiatan monitoring dan evaluasi ini merupakan upaya supervisi yang diberikan sesuai fungsi manajemen Direktorat Jenderal Bina Upaya Kesehatan. Hingga saat penelitian dilakukan, kegiatan supervisi yang sudah dilakukan tidak dapat diukur pelaksanaannya karena tidak memiliki panduan tertulis baik yang berisi daftar pekerjaan yang harus dilakukan ataupun panduan teknis tahapan supervisi yang harus dilakukan oleh pelaksana supervisi.
Metode. Penelitian ini merupakan penelitian deskriptif analitik yang dirancang dengan pendekatan kualitatif. Data primer diperoleh melalui wawancara mendalam. Untuk melengkapi informasi yang diperoleh melalui wawancara dan memperkuat hasil observasi pada subjek penelitian dilakukan pengambilan gambar. Wawancara dilakukan kepada informan yang memegang kewenangan supervisi dan informan-informan dari pihak Rumah Sakit Unit Pelaksana Teknis Kementerian Kesehatan yang menjadi tujuan kegiatan supervisi. Peneliti melakukan evaluasi terhadap proses kegiatan supervisi yang dilakukan Sub Bagian Tata Usaha dan Gaji Direktorat Jenderal Bina Upaya Kesehatan sehingga diketahui faktor-faktor perilaku yang mencerminkan kinerja pelaksana supervisi.
Hasil. Berdasarkan hasil wawancara dan observasi yang dilakukan, diketahui bahwa kegiatan supervisi yang dilakukan belum sesuai dengan tahapan supervisi dalam Siklus Deming yang terdiri dari Plan-Do-Check-Action. Akibatnya, kinerja pelaksana supervisi tidak dapat diukur dan hasil kegiatan supervisi tidak dapat menjadi rekomendasi untuk digunakan sebagai bahan pertimbangan pembuatan kebijakan selanjutnya. Pedoman Tata Kearsipan Dinamis yang ada juga belum dilengkapi dengan panduan praktis yang berisi daftar pekerjaan yang harus dilakukan dalam pelaksanaan Tata Kearsipan Dinamis. Sebagai upaya evaluasi pelaksanaan kegiatan supervisi, peneliti membuat rancangan panduan daftar pekerjaan yang dibuat berdasarkan Pedoman Tata Kearsipan Dinamis Kementerian Kesehatan dan rancangan panduan pekerjaan pada tahapan supervisi sesuai Siklus Deming. Peneliti juga menterjemahkan daftar tersebut dalam bentuk formulir supervisi yang diisi secara online.
Background. Determination of government hospitals as the Ministry of Health Technical Unit Hospitals with public service board financial management system stated in Law No. 1 Year 2004 on State Treasury, Government Regulation No. 23 Year 2005 on the financial management system of public service board. It is also affirmed in Law No. 44 Year 2009 on Hospital. As the Ministry of Health Technical Unit Hospitals with public service board financial management system, government hospitals must meet the public service board requirement of good governance by institution?s accountability. Accountability can be assessed by way of hospitals archives as authentic evidence of implementation of governance. Archives management in government hospitals implemented based on Minister of Health Regulation No. 684/MENKES / PER/VIII/2006 for Guidelines to Dynamic Filing System. Implementation of Guidelines to Dynamic Filing System in Ministry of Health Technical Unit Hospitals supervised by Head of Sub Division Of Administration and Payroll under the Secretariat Directorat General of Health Care Efforts. Supervision in government hopitals are done through Monitoring and Evaluation Program as the managerial functions of Directorat General of Health Care Efforts. However, the list of work to be done in the implementation of Dynamic Filing System in Ministry of Health Technical Unit Hospitals and technical manual steps for supervisor?s performance in doing supervision could not be measured and mostly done uncompleted because there are no written guidelines.
Method. This research is a descriptive analytic study designed with qualitative approach. Primary data obtained through interviews. In order to help visualize the information from primary data and observations, researcher also took pictures. Interviews were conducted to the informant who holds the authority of doing supervision and informants from Ministry of Health Technical Unit Hospitals that were involved in the supervision activities. Researcher conducted an evaluation of the supervision activitiy performed by Sub Division of Administration and Payroll in Directorate General of Health Efforts to study how behavioral factors reflects supervisor?s performance in doing steps of supervision.
Results. Based on interviews and observations, gathered information shows that the supervision activities are done uncompletely by not doing the ?Check? as the stages of supervision in the Deming Cycle (Plan-Do-Check-Action) shows. As a result, the supervisor?s performance in doing problem solving can not be measured and the results of the supervision activities can not be used as a recommendation for consideration of future policy-making. The Guideline to Dynamic Filing System does not have a practical guide that contains a list of work to be done in the implementation of Dynamic Filing Procedures. As an effort to evaluate the supervision activities, researchers developing guidelines of job listings based on Ministry of Health?s Guideline to Dynamic Filing System. Archives Ministry of Health and the draft guide work on Deming Cycle stages appropriate supervision. Researchers also translate the list in the web-based supervision form that could be filled online.
Background: Stunting is a condition of failure to thrive in children under five due to chronic malnutrition, especially in the first 1,000 days of life (HPK). Health financing including stunting, commitment by regional policy makers. Objective: To find an overview of the realization of health spending from the government for stunting at the Serang District Health Office in 2018-2019. Methods: This study used a non-experimental research design with a Distric Health Account (DHA) approach. Results: The analysis shows that the 2018 health budget states IDR 3,296,445,655,287 (10.73%) and an increase in 2019 may be IDR 3,429,111,553,700 (11.48%). Allocated costs for this type of stunting activity are mostly used for direct activities, in 2018 the portion reached 58.29% and in 2019 the portion was up to 100%. Viewed from the line item budget, the realization is mostly used for operational costs. In 2018 it was 91.63% and in 2019 it reached 100%. The type of stunting intervention shows that the Serang District Health Office has implemented but has not implemented stunting reduction instructions in 2018 and 2019. Conclusion: This study provides information that the adequacy of stunting financing in the Serang District Health Office in 2018 and 2019 is performance-based, but not all activities have been carried out according to new and commitment of policy makers in 2019
PROGRAM PASCA SARJANA
PROGRAM STUDI ILMU KESEHATAN MASYARAKAT
BIOSTATISTIK
Tesis, 28 Juni 2013
Sasmin Itadi Suhanto
Peran dan Dampak Perilaku Pencegahan Gigitan Nyamuk Terhadap Kejadian Malaria di Kabupaten Kaur, Provinsi Bengkulu, tahun 2012
ABSTRAK
Malaria masih merupakan masalah kesehatan masyarakat walaupun berbagai usaha telah dilakukan untuk mencegahnya tetapi malaria masih ditemukan. Kabupaten Kaur termasuk daerah dengan endemisitas rendah dengan angka API< 1‰. Tujuan penelitian ini adalah untuk mengetahui gambaran, peran dan dampak perilaku pencegahan gigitan nyamuk serta faktor risiko lainnya terhadap kejadian malaria di Kabupaten Kaur tahun 2012. Penelitian ini menggunakan rancangan observasional dengan pendekatan case control study. Lokasi penelitian ini adalah seluruh wilayah kerja puskesmas yang ada dalam Kabupaten Kaur yaitu sebanyak 16 puskesmas. Dengan jumlah sampel sebanyak 264 orang dengan rincian 132 orang kasus dan 132 orang kontrol. Kasus adalah pengunjung yang datang ke rumah sakit, puskesmas dan jaringannya dengan gejala demam dengan hasil pemeriksaan sediaan darah di laboratorium atau RDT (Rapid Diagnostik Test) positif malaria. Kontrol adalah pengunjung yang datang ke rumah sakit, puskesmas dan jaringannya dalam tahun 2012 dengan gejala demam dan hasil pemeriksaan sediaan darah di laboratorium atau RDT (Rapid Diagnostik Test) menunjukan negatif malaria.
Hasil : Analisis multivariate menunjukan bahwa kebiasaan sering dan kadang-kadang begadang malam di luar rumah dengan nilai OR masing-masing sebesar 6,37 (95% CI 1,65–24,60) dan 1,84 (95% CI 0,72–4,71), kebiasaan sering dan kadang-kadang menggunakan kelambu dengan nilai OR masing-masing sebesar 0,1 (95% CI 0,004-0,05) dan 0.08 (95% CI 0.01-0,68), kebiasaan sering dan kadang-kadang menggunakan obat anti nyamuk bakar dengan nilai OR masing-masing sebesar 0,01 (95% CI 0,004-0,05) dan 0,75 (95% CI 0,12-4,79) dan kebiasaan sering dan kadang menggunakan obat anti nyamuk cair dengan nilai OR masing-masing sebesar 0,02 (95% CI 0,005-0,06) dan 0,06 (95% CI 0,004-0,997) berhubungan signifikan dengan kejadian malaria setelah dikontrol dengan langit-langit rumah. Sedangkan penggunaan kasa ventilasi tidak berhubungan signifikan dengan kejadian malaria. Hasil perhitungan dampak: kebiasaan sering begadang malam di luar rumah dapat menurunkan kasus kejadian malaria sebesar 19,1% jika dihentikan/ditiadakan, penggunaan kelambu 15,5%, penggunaan obat anti nyamuk (bakar dan cair ) masing-masing sebesar 32,7% dan 24% pada populasi.
Kesimpulan :
Perilaku pencegahan gigitan nyamuk seperti kebiasaan begadang malam di luar rumah, penggunaan kelambu, obat anti nyamuk (bakar dan cair/semprot) mempunyai perananan penting dalam kejadian malaria.
Kata kunci : Kejadian malaria, perilaku pencegahan gigitan nyamuk, case control.
PROGRAM MAGISTER
PUBLIC HEALTH SCIENCE PROGRAM
Biostatistics Thesis, June 28, 2013
Sasmin Itadi Suhanto
Role and Impact Behavior Mosquito Bite Prevention Against Malaria incidence in Kaur regency, Bengkulu province, in 2012
ABSTRACT
Malaria remains a public health problem despite efforts have been done to prevent it, but malaria is found. Kaur district includes areas with low endemicity with API numbers <1 ‰. The purpose of this study is to describe the role and impact of mosquito bite prevention behaviors and other risk factors on the incidence of malaria in the district Kaur in 2012. This study uses observational design of case control study. The study site is the working area of the existing health center in the district as many as 16 health centers Kaur. With a total sample of 264 people with the details of 132 cases and 132 controls. Case was the visitors who come to the hospital, health center and network with symptoms of fever with the results of blood clots in the laboratory or RDT (Rapid Diagnostic Test) positive malaria. Control was the visitors who come to the hospital, health centers and networks in the year 2012 with symptoms of fever and blood clots in the results of the laboratory examination or RDT (Rapid Diagnostic Test) showed a negative malaria.
Results: Multivariate analysis showed that the habit of frequent and sometimes stay up all night outside the house with a value amounting OR 6.37 (95% CI 1.65 to 24.60) and 1.84 (95% CI 0.72 - 4.71), and a frequent habit of sometimes using nets with OR values respectively of 0.1 (95% CI 0.004 to 0.05) and 0:08 (95% CI 0.01-0,68), and a frequent habit sometimes use anti mosquito OR at each value of 0.01 (95% CI from 0.004 to 0.05) and 0.75 (95% CI 0.12 to 4.79) and the habit of frequent and sometimes use anti mosquito liquid with each value OR of 0.02 (95% CI 0.005-0.06) and 0.06 (95% CI 0.004 to 0.997) significantly associated with the incidence of malaria after controlled ceiling. While the use of gauze vents are not significantly associated with the incidence of malaria. Results of impact assessment: the habit to stay up late at night outside the home can reduce the incidence of malaria cases by 19.1% if terminated / removed, 15.5% use of mosquito nets, mosquito drug use (fuel and liquid), respectively by 32.7% and 24% of the population.
Conclusion: Mosquito bite prevention behaviors such as staying up all night habits outside the home, the use of bed nets, anti mosquito (fuel and liquid / spray) have an important role in the incidence of malaria.
Keywords: incidence of malaria, a mosquito bite prevention behaviors, case control.