Doni Lasut

Objectives: Indonesia has the second-highest number of tuberculosis (TB) cases globally, after India. The estimated TB incidence in Indonesia is 1 090 000 cases (387 cases per 100 000 population), with an associated mortality of 131 000 deaths (47 deaths per 100 000 population). The 2023-2024 TB Inventory Study in Indonesia aimed to quantify the extent of under-reporting by identifying TB cases that were diagnosed and/or treated but not reported to the National TB Surveillance System (Sistem Informasi Tuberkulosis [SITB]). This study specifically assessed the magnitude of under-reporting of TB cases among children younger than 15 years in Indonesia. Methods: This study used a cross-sectional design and analyzed data from the 2023-2024 TB Inventory Study (SIV-TB) in Indonesia. The sample included all TB cases in children younger than 15 years identified from eligible health facilities. Under-reported cases were defined as those that were diagnosed and/or treated but not reported to the SITB. Descriptive statistics were used to characterize under-reporting. A record-linkage process was performed to compare SIV-TB data with SITB data after deduplication. Results: A total of 12 293 TB cases in children younger than 15 years were identified across health facilities in 31 districts and cities. The overall under-reporting rate for childhood TB was 23.5%. The highest under-reporting rate was observed in Eastern Indonesia (28.0%). Conclusions: Under-reporting of childhood TB was significantly associated with both age group and type of health facility.

Driver health checks are crucial to ensure the safety and well-being of individuals operating vehicles, especially those in public transportation professions, such as intercity and interprovincial buses (AKAP) and similar modes of transportation, to prevent the risk of road accidents. This study aims to analyze the relationship between driver health risk factors—namely age, blood sugar levels, and amphetamine in urine—and driving fitness during the Eid al-Fitr season at two intercity bus terminals in East Jakarta Administrative City during the 2024 Eid al-Fitr season. Data collection was conducted through surveillance from April 3, 2024, to April 17, 2024, involving 667 drivers, and analyzed using univariate and bivariate methods with JASP software. The results showed that 76.6% of drivers had mild to severe hypertension, 7.8% had blood sugar levels >200 mg/L, 0.4% tested positive for respiratory alcohol, and 0.3% tested positive for amphetamine. As a recommendation, 11.1% of drivers were deemed unfit to drive. Hypertension, blood glucose levels, and driving fitness were statistically associated with driver age (p < 0.001). Age, as a confounding factor, is closely related to the measured parameters and driving fitness, necessitating attention to reduce the risk of road accidents, particularly during the Eid al-Fitr holiday period. These findings highlight the critical need for regular health monitoring of aging commercial drivers and the implementation of age-specific fitness assessment protocols to enhance road safety during high-traffic holiday periods.

Objective: To analyze the risk factors associated with multidrug- resistant tuberculosis (MDR-TB) as a first national survey in Indonesia. Methods: This national coverage cross-sectional study was conducted from 2017 to 2018. The study subjects were selected using a multi-stage probability random sampling method. MDR- TB is tuberculosis caused by bacteria resistant to at least isoniazid and rifampicin. The dependent variable was MDR-TB. Independent variables included age, sex, education, employment status, place of residence, history of living with TB patients, and the number of household members. Univariate and multivariate logistic regression models were used to analyze the risk factors associated with MDR- TB. All the data were analyzed using STATA V.14.0 (Stata Corp LLC, College Station, TX). Results: This study found the MDR rate was 109/3 234 (3.4%) among positive pulmonary TB patients. More than twice as many patients had MDR re-treatment (74/3 234, 2.3%), compared to 35/3 234 (1.1%) who had new TB diagnoses or were getting initial treatment. After adjusting for employment status, individuals with a prior history of tuberculosis treatment were found to have significantly higher odds of developing MDR-TB, with an odds ratio of 7.22 (95% CI 3.87-13.44). Conclusions: Increasing attention should be paid to these patients to prevent MDR-TB, and MDR-TB transmission is an urgent challenge for controlling TB worldwide. Early detection of MDR-TB is a critical part of TB control programs.

Handwashing with soap is vital for preventing infectious diseases, yet data on household-level facilities in Indonesia remain limited. This study analyzed data from the 2020 Household Drinking Water Quality (HDWQ) survey, covering 15,721 households across 34 provinces, to determine the proportion of limited handwashing facilities among households with existing ones and the sociodemographic, environmental, and geographic factors related to their availability. Based on Joint Monitoring Programme (JMP) criteria, 37.1% of households had limited facilities, while 62.9% had basic facilities among households with existing infrastructure. Java-Bali and Eastern Indonesia had the lowest and the highest proportion of limited facilities (30.9% and 63.5%). Multivariable logistic regression with complex survey weighting showed that households in rural areas (AOR=1.95; 95% CI: 1.71-2.22), using unimproved water sources for hygiene (AOR=1.69; 95% CI: 1.37-2.09), unimproved sanitation (AOR=1.28, 95% CI: 1.05-1.55), or shared sanitation (AOR=2.00; 95% CI: 1.65-2.42) were more likely to have limited facilities. Despite national progress, regional disparities remain significant in access to handwashing facilities. Interventions should prioritize improving water and sanitation infrastructure in rural and Eastern Indonesia, while promoting household-level behavior change. These findings can inform national hygiene strategies in alignment with the Sustainable Development Goals.

Typhoid fever is one of the common enteric fevers in developing countries, especially in emerging metropolitan areas in Indonesia. Yet, studies on spatial and temporal distribution of tyhoid fever are lacking. This study was conducted to analyze retrospective hospital-based data at the village level over the period 2017-2023 to understand the spatial and temporal variation of typhoid fever in Jakarta. Spatial analyses were performed by Moran's I and Local Indicators of Spatial Association (LISA) to examine spatial clustering of typhoid incidence and to identify high-risk villages for typhoid fever, respectively. Seasonal decomposition analysis was performed to investigate the seasonality of this infection. A total of 57,468 typhoid cases, resulting in a cumulative incidence of 533.99 per 100,000 people, were reported during the study period. The incidence was significantly clustered (I=0.548; p=0.001) at the village level across Jakarta. Statistically significant high-risk clusters were detected in the South and East of Jakarta that were heterogeneous over time. We identified seven persistent high-risk clusters in the eastern part of the city and two in the southern part. Moreover, the typhoid incidence showed a strong seasonality trend, significantly associated with monthly total rainfall (p=0.018). The study revealed a significant spatial variation with strong seasonality in typhoid incidence across the city suggesting a variation in transmission intensity and needs for effective public health interventions, especially in the high-risk areas. Improvement in water and sanitation facilities, hygiene awareness and surveillance are essential to help reduce typhoid transmission in Jakarta.

In collaboration with other stakeholders, National Task Force of COVID-19 Control conducted massive detection of the cases, followed by contact tracing. The study aimed to overview COVID-19 cases from 58 districts of 11 provinces in Indonesia and its associated factors. A cross-sectional study design used secondary data from The National Task Force of COVID-19 Control. COVID-19 cases and other variables were collected in 58 districts in 11 provinces of Indonesia year 2021. The study incorporated descriptive, correlation, and multiple linear regression analysis with the district as an analysis unit. The median of COVID-19 cases was 804 per district, traced cases were 70.6% of cases, cases had contact was 2.6% of cases, close contact was 2,188, the ratio of close contact: cases were 2.75, isolation drop out was 8, quarantine drop out was 9, test for close contact was 962, COVID-19 vaccine dose 1 was 147, dose 2 was 205, and no vaccine was 354. Factors significantly correlated with COVID-19 cases were cases traced, cases have epicontact, close contact, and ratio close contact. In multivariate analysis, the percentage of traced cases, cases had epicontact, isolation drop out, COVID-19 vaccine dose-1, and no COVID-19 vaccine associated with COVID-19 cases. Identifying factors related to the incidence of COVID-19 can be used to increase efforts to prevent and control COVID-19 cases in the community as a response to alertness to the emergence of new cases due to new variation mutations.

The WHO Global Malaria Programme (GMP) oversees and directs the global initiatives of the World Health Organization (WHO) aimed at controlling and eradicating malaria.. Its work is guided by the "Global Technical Strategy for Malaria 2016–2030. Mappi district a high endemic area in South Papua Province was still combat to eliminate malaria transmission. However, the spread and transmission of malaria differ across different regions. The study sought to analyze the distribution and extent of malaria over a five-year period within the Mappi District and the operational areas of its Public Health Centers (PHCs). A Retrospective study was Weekly surveillance data was gathered over a five-year period from 2018 to 2022. The data was collected from health facilities and private clinics, archived at zonal Public Health Centers (PHCs), and conducted in the intentionally selected Mappi District in South Papua Province. The data was gathered, entered, cleaned, analyzed, and interpreted using Microsoft Excel 2019. Various tables, figures, and maps were employed to display the results. Age 15-64 (41%) was the highest proportion of cases, with male proportion (54,46%) higher than female(45,54%), Paracites were dominated by Plasmodium falciparum (65,84%), Malaria test are dominated by microscope (56,25%) than RDT (43,75%), Average Annual Paracites Index (API) was 46,9 per 1000. The trend shows us elimination as GMP and National Strategy in Indonesia in 2030 need more effort to decrease the malaria transmission in Mappi District, The most prevalent malaria parasite species were Plasmodium falciparum and Plasmodium vivax. The magnitude of API at Kumaban, Sammad, and Sekko area. Attention is required to expand vector control measures during periods of high malaria transmission.

Background: Increased community involvement has become a topic in global malaria control and eradication plans. This study aimed to examine a method or system of community involvement in developing Bacillus thuringiensis H-14 with coconut media for malaria control in the Central Bangka District. Method: The quasi-experimental research design with qualitative observation method involving 30 participants. Selected participants received training on Bacillus thuringiensis culture in coconut and guidance in assessing the population density of Anopheles larvae in ponds containing mosquito larvae before and after administration of Bacillus thuringiensis. Results: The use of local coconuts as a breeding medium for Bacillus thuringiensis H-14 was able to mobilize the community members to participate voluntarily. Participants were able to easily practice Bacillus thuringiensis H-14 culture using local coconut media and determine the location of ponds with Anopheles larvae and assess the population density of larvae in ponds few days after sowing Bacillus thuringiensis H-14. Conclusion: The intervention proved successful in mobilizing participants in malaria prevention and control in malaria-endemic areas. The intervention consisted of local organizational structure, education, and utilization of local wisdom as well as encompassing problem identification, planning, and evaluation elements. This method can be applied in other archipelagic areas that are still endemic to malaria.

Malaria remains a public health concern in Indonesia, especially in the east.The intervention of the Long Lasting Insecticides Nets (LLINs) distribution program is one of the strategies used to reduce malaria cases in Indonesia.Therefore, treating LLINs according to the guidelines is critical to maintaining the effectiveness of the mosquito net.This research aimed to determine the ownership, usage and maintained LLINs behaviour after they were distributed in 2019-2020.This study was an observational study with a cross-sectional design.In six malaria-endemic districts, structured questionnaires were administered to 2,658 households in randomly selected villages that received bed nets in 2019-2020.Of the 2658 households, 2421 are known to have LLINs.The data collected included mosquito net ownership, utilization, socio-demographic characteristics such as gender, age, education, occupation, household size, and LLINs care behaviour.The collected data were analyzed descriptively.The study found that 91% of households had at least one LLIN, and 84.7% slept under LLINs the previous night.In addition, 82.6% of households followed the washing instructions for the bed net, and most households (64.8%) followed the care instructions for mosquito nets.However, 34.4% of households were still drying the mosquito nets in direct sunlight.The overall maintenance behaviour for LLINs, beginning with the first time they received the bed net and including how to wash and dry it, was inconsistent with the correct usage instructions (88.4%).Better community education and promotion by health workers on the appropriate use and upkeep of LLINs are essential to ensure the effectiveness of LLINs-based malaria interventions.

Abstract
 Background : Hepatitis as an infectious disease and silent infection needs to be taken seriously, therefore the Directorate General of Hepatitis-PISP Sub Directorate of P2P conducts early detection of pregnant women as a risk group so that it does not transmit to the mother’s baby.
 Objective : This study is a review of studies based on surveillance data conducted at the time of early detection of hepatitis B in pregnant women in the Matraman District Health Center during January 2018 to October 2018.Method : This study uses DDHB surveillance data at the Matraman District Health Center. The analysis was carried out with correlation coverage with the average distance and abstracted with the closest distance analysisResults : The results of early detection of HBsAg reactive pregnant women obtained 32 pregnant women (2.71%) reactive from 1180 pregnant women who followed DDHB. Based on the distribution of pregnant women coverage in the region varies if the spatial analysis approach is done by calculating the flat distance as confounding which is assessed and found to be more distant urban areas from the location of the Matraman District Health Center, the fewer pregnant women who check their pregnancy.Conclusion : Distance related to the coverage of DDHB in the Matraman District Health Center. This situation needs a more adequate surveillance system Keywords : Jarak, Hepattitis B, DDHB, HBsAg
 
 
 Abstrak
 Latar Belakang : Hepatitis sebagai penyakit menular dan bersifat silent infection karenanya perlu ditangai secara serius, oleh karena itu Subdit Hepatitis-PISP Dirjen P2P melakukan deteksi dini hepatitis B (DDHB) pada ibu hamil sebagai kelompok beresiko sehingga tidak menularkan ke bayi yang dikandungnya.
 Tujuan : Penelitian mendapatkan hubungan jarak terhadap cakupan DDHB bumil di Puskesmas Kecamatan Matraman selama Bulan Januari 2018 hingga Oktober 2018.
 Metode : Penelitian ini menggunakan data survailans DDHB Puskesmas Kecamatan Matraman. Analisis dilakukan dengan mendapatkan nilai korelasi di antara keduanya..
 Hasil : Hasil deteksi dini ibu hamil reaktif HbsAg didapatkan sebanyak 32 ibu hamil (2,71 %) reaktif dari 1180 ibu hamil yang mengikuti DDHB. Berdasarkan distribusi cakupan ibu hamil di wilayah tersebut bervariasi apabila dilakukan pendekatan analisis spasial dengan penghitungan jarak datar didapatkan semakin jauh wilayah kelurahan dari lokasi Puskesmas Kecamatan Matraman maka akan semakin sedikit ibu hamil yang memeriksakan kehamilannya.
 Kesimpulan : Jarak berhubungan terhadap cakupan DDHB di Puskesmas Kecamatan Matraman. Keadaan ini perlunya sistem survilans yang lebih memadai
 
 Kata Kunci : Jarak, Hepattitis B, DDHB, HBsAg

The COVID-19 pandemic has heterogeneously affected the use of essential health services worldwide, with disruptions in some countries beginning in the early stages of the emergency in March 2020. These disruptions have occurred on both the supply and demand sides of healthcare and have often been related to resource shortages to provide care and lower patient turnout associated with mobility restrictions and fear of contracting COVID-19 at facilities. The goal of this paper, compare the HBsAg test before and after the COVID-19 pandemic to a pregnant woman's early detection with HBsAg to achieve the target of at least 80% in 2020. Method using a simple mathematical calculation modeling approach developed to predict health service use until the pandemic using routinely collected health information systems data (SIHEPI). Results show HBsAg reactive Proportion of total pregnant women in each Province is about 2,1% on 47,91% of pregnant women in Indonesia, highest in eastern Indonesia province (NTT, Papua, and West Papua). With a calculation of 80% targeted a pregnant woman in 2020, reactive Proportion predicted about 4,4% in Indonesia, West Papua becomes the highest Province with 21,38%, Papua about 12,63%, and NTT about 11,31%. In conclusion, refered to comparison of mathematical calculation approach from 80% targeted average become 4,4% reactive HBsAg test. Delaying early detection in pregnant women before and after the covid19 pandemic becomes a double burden in Indonesia. These phenomena become a high-risk factor for maternal-to-child transmission. Indonesia needs serious action to achieve Hepatitis B elimination in 2030.

ABSTRACT
 The distribution of LLINs (Long Lasting Insecticidal Nets) is one of the strategies implemented by health programs to control malaria in Indonesia. This study aims to determine the sociodemographic factors associated with the use of LLINs. The research is an observational with a cross-sectional study design. Interviews using a structured questionnaire were carried out on household members from 4602 sample houses in selected villages with systematic random sampling that had been distributed malaria nets in 2017 - 2018 in 12 malaria endemic districts. The data collected were ownership of bed nets, sociodemographic data including gender, marital status, education, age, occupation, household status, and behavior of using bed nets. Data analysis used multivariate logistic regression. The results showed that 83.9% of respondents had mosquito nets and as much as 82.4% of them were obtained from the LLINs program, and the use of LLINs netting was obtained by 60.5%. Sociodemographic factors associated with the use of bed nets were gender (OR=1,12, 95%CI=1,08 – 1,20), marital status (OR=1,31, 95%CI=1,22-1,44), , educational status (OR=1,26, 95% 1,08-1,45), age (OR=1,58, 95% CI=1,40 – 1,77), occupation (OR=1,23, 95%CI=1,11 – 1,21) and status in the household (OR=1,09, 95%=1,00 – 1,19). The use of LLINs in the community is still low, so there is a need for more intensive socialization and education, so that the use of mosquito nets in the community increases. 
 Keywords: Endemic, bed nets, LLINs, malaria, sociodemographic
 
 ABSTRAK
 Distribusi kelambu anti nyamuk merupakan salah satu strategi yang dilakukan program kesehatan untuk mengendalikan kasus malaria di Indonesia. Penelitian ini bertujuan untuk mengetahui faktor-faktor sosiodemografi yang berhubungan dengan penggunaan kelambu anti nyamuk. Studi ini merupakan observasional dengan desain studi cross-sectional. Wawancara menggunakan kuisioner terstruktur dilakukan pada anggota rumah tangga, dari 4602 sampel rumah di desa terpilih secara systematic random sampling yang telah didistribusikan kelambu malaria tahun 2017 – 2018 pada 12 kab/kota endemis malaria. Data yang dikumpulkan adalah kepemilikan kelambu, karakteristik sosiodemografi meliputi jenis kelamin, status pernikahan, pendidikan, umur, pekerjaan, status di rumah tangga serta perilaku penggunaan kelambu. Analisis data digunakan regresi logistik multi variat. Hasil penelitian menunjukkan bahwa 83,9% responden memiliki kelambu dan sebanyak 82,4% kelambu tersebut diperoleh dari program (LLINs), dan penggunaan kelambu LLINs diperoleh sebesar 60,5%. Faktor sosiodemografi yang berhubungan dengan penggunaan kelambu adalah jenis kelamin (OR=1,12, 95%CI=1,08 – 1,20), status perkawinan (OR=1,31, 95%CI=1,22-1,44), pendidikan (OR=1,26, 95% 1,08-1,45), usia (OR=1,58, 95% CI=1,40 – 1,77), status pekerjaan (OR=1,23, 95%CI=1,11 – 1,21), serta kedudukan responden (OR=1,09, 95%=1,00 – 1,19). Penggunaan kelambu LLINs di masyarakat masih rendah, sehingga perlu dilakukan sosialisasi dan edukasi yang lebih intensif lagi, agar penggunaan kelambu di masyarakat meningkat.
 Kata kunci: Endemis, kelambu anti nyamuk, malaria, sosiodemografi

The Special Capital Region of Jakarta is the epicentre of the transmission of COVID-19 in Indonesia. However, much remains unknown about the spatial and temporal patterns of COVID-19 incidence and related socio-demographic factors explaining the variations of COVID-19 incidence at local level. COVID-19 cases at the village level of Jakarta from March 2020 to June 2021 were analyzed from the local public COVID-19 dashboard. Global and local spatial clustering of COVID-19 incidence was examined using the Moran's I and local Moran analysis. Socio-demographic profiles of identified hotspots were elaborated. The association between village characteristics and COVID-19 incidence was evaluated. The COVID-19 incidence was significantly clustered based on the geographical village level (Moran's I = 0.174; p = .002). Seventeen COVID-19 high-risk clusters were found and dynamically shifted over the study period. The proportion of people aged 20-49 (incidence rate ratio [IRR] = 1.016; 95% confidence interval [CI]: 1.012-1.019), proportion of elderly (≥50 years) (IRR = 1.045; 95% CI = 1.041-1.050), number of households (IRR = 1.196; 95% CI = 1.193-1.200), access to metered water for washing, and the main occupation of the residents were village level socio-demographic factors associated with the risk of COVID-19. Targeted public health responses such as restriction, improved testing and contact tracing, and improved access to health services for those vulnerable populations are essential in areas with high-risk COVID-19.

Bekasi City is one of the dengue-endemic areas in West Java province which has fluctuated the number of cases annually. Dengue transmission was influenced by the interaction between humans, virus, vector, and environmental factors. This study was conducted to analyze environmental factors and source reduction practices related to the status of dengue hemorrhagic fever (DHF) transmission in Bekasi. This study was an observational study with a cross-sectional design that was carried out in Mustikajaya Sub-district, Bekasi City. Total samples were 280 households from two villages. The obtained data were analyzed using chi-square and multivariate logistic regression with a p-value of 0.05. Bivariate analysis results showed that plants were taller than five meters (OR=7,98 95% CI=2,83-22,45), uneven growing vegetation (OR = 2.14 95% CI = 1.21-3, 78), even growing vegetation (OR = 8.84 95% CI-2.84-27.54), frequency of cleaning water containers at least once a week (OR = 2.9 95% CI = 1.77-4.78), and the use of anti-mosquito (OR = 2.2 95% CI = 1.37-3.61) related to DHF transmission in Mustikajaya Sub-district. Dominant variables that contributed to the high dengue transmission in Mustikajaya District were the frequency of cleaning water containers and the use of household anti-mosquitoes. The socialization and evaluation of source reduction at the community level need to be improved so that the DHF control will be more effective Abstrak Kota Bekasi merupakan salah satu wilayah endemis Demam Berdarah Dengue (DBD) di Provinsi Jawa Barat dengan jumlah kasus fluktuatif setiap tahun. Transmisi DBD dipengaruhi oleh interakasi antara manusia, virus, nyamuk vektor, dan faktor lingkungan. Tujuan penelitian adalah menganalisis faktor lingkungan dan perilaku Pemberantasan Sarang Nyamuk (PSN) yang berhubungan dengan status transmisi DBD di Kota Bekasi. Penelitian ini merupakan studi observasional dengan desain cross sectional yang dilaksanakan di Kecamatan Mustikaya, Kota Bekasi. Jumlah sampel sebanyak 280 rumah tangga di dua kelurahan. Data dianalisis menggunakan chi square dan regresi logistik berganda dengan nilai P sebesar 0,05%. Hasil analisis bivariat menunjukkan bahwa tinggi tanaman lebih dari lima meter (OR=7,98 95% CI=2,83–22,45), rimbunan tanaman tidak merata (OR=2,14 95% CI=1,21-3,78) dan vegetasi tersebar merata (OR=8,84 95% CI-2,84-27,54), frekuensi membersihkan Tempat Penampungan Air (TPA) minimal satu minggu sekali (OR=2,9 95% CI=1,77-4,78), serta penggunaan obat anti nyamuk (OR=2,2 95% CI=1,37-3,61) berhubungan dengan transmisi DBD di Kecamatan Mustikajaya. Variabel dominan yang berkontribusi pada tingginya transmisi kasus DBD di Kecamatan Mustikajaya yaitu frekuensi membersihkan TPA dan penggunaan obat anti nyamuk. Sosialisasi dan evaluasi PSN di tingkat masyarakat perlu ditingkatkan agar pelaksanaannya lebih efektif dalam pengendalian DBD di Kota Bekasi.

Mapping Studi inventori TB (tuberculosis) di Kabupaten Karanganyar adalah bagian dari sampel nasional namun demikian dengan penentuan klaster kabupaten sehingga seluruh fasyankes yang melayani TB di wilayah tersebut dilakukan pendataan. Diperkirakan fasyankes-fasyankes bukan DOTS (Direct Observation Therapy Strategy) penyebab under-reporting. Hal ini karena fasyankes bukan DOTS tidak melakukan pelaporan ke SITT (Sistem Informasi TB Terpadu). Metode penelitian dengan desain cross sectional, populasi seluruh fasyankes dan sampel penelitian total populasi. Pengumpulan data dengan inklusi fasyankes eligible adalah fasyankes yang dalam 3 bulan terakhir setidaknya mendiagnosa dan atau melayani TB setidaknya 1 pasien untuk kemudian dianalisis, dan selanjutnya dilakukan pemetaan dengan penentuan koordinat menggunakan smartphone GPS (Global Positioning System) menjadi basisdata geospasial yang divisualkan dengan webmap. Hasil menunjukkan semua jenis fasyankes didapatkan fasyankes eligible, proporsi terbesar adalah puskesmas yakni 100%, diikuti rumahsakit 75%, klinik 9,6% dan DPM (Dokter Praktek Mandiri) 7,4%. Distribusi merata secara keruangan menunjukkan masih ada beberapa fasyankes bukan DOTS sehingga notifikasi kasus TB under-reporting. Gambaran tersebut juga menunjukkan masih tingginya ancaman penyakit TB yang terjadi di Kabupaten Karanganyar. Sebagai kesimpulan masih didapatkan kasus under-reporting, sehingga perlunya jejaring yang melibatkan seluruh fasyankes terutama rumah sakit swasta, klinik dan DPM yang terintegrasi ke dalam sistem informasi survailans kesehatan daerah.

ABSTRACT
 The long-term use of insecticides causes resistance to targeted insects, so that a study of its resistance in Indonesia is needed. A cross-sectional study was conducted to determine the resistance status of Aedes aegypti to organophosphates and pyrethroids in 102 districts in 2015 with reference to WHO standard bioassay test. Sampling and testing of Ae. Aegypti larvae from 100 houses were carried out from three area of each health center. Test results on 0.8% malathion revealed that 84% districts were resistant, 13% districts were tolerant, and 3% districts were vulnerable. The test results for temephos of 0.02% also found that 49% districts were resistant, 29% districts were tolerant and 22% districts were vulnerable. While for 0.05% cypermethrin insecticide test; 98% were resistant, and 1% was tolerant. The test on 0.025% alpha cypermethrin found that 40% were resistant, 51% were tolerant and 9% were vulnerable. Test on 0.025% deltamethrin found that 65% were resistant, 22% districts were tolerant and 14% districts were vulnerable. With the high resistance to organophosphate and pyrethroid groups, it is recommended to rearrange the application of insecticide types in each region cyclically. 
 Keywords: Insecticides, resistance, organophosphates, pyrethroid, Aedes aegypti
 
 ABSTRAK
 Penggunaan insektisida dalam jangka waktu lama menyebabkan resistensi terhadap serangga sasaran, sehingga diperlukan uji status kerentanan Ae.aegypti di Indonesia. Jenis penelitian adalah deskriptif dengan desain potong lintang. Pengambilan sampel uji (jentik Ae. aegypti) dilakukan di 102 Kabupaten/kota di Indonesia pada 100 rumah di setiap tiga wilayah kerja puskesmas. Metode uji kerentanan menggunakan bioassay test standar WHO. Hasil uji terhadap malathion 0,8% mendapatkan 86 (84%) kabupaten telah resisten, 13 kabupaten (13%) toleran dan 3 (3%) kabupaten rentan. Hasil uji terhadap temephos 0,02% menunjukkan 50 (49%) kabupaten resisten, 30 (29%) kabupaten toleran dan 22 (22%) kabupaten rentan. Hasil uji insektisida sipermetrin 0,05%, sebanyak 100 (98%) kabupaten resisten, dan 1 (1%) kabupaten toleran. Hasil uji terhadap alfa sipermetrin 0,025%, sebanyak 18 kabupaten (40%) resisten, 23 (51%) kabupaten toleran dan 4 (9%) kabupaten berstatus rentan. Hasil uji terhadap deltametrin 0,025% sebanyak 66 (65%) kabupaten resisten, 22 (22%) kabupaten toleran dan 14 (14%) kabupaten rentan. Dapat disimpulkan bahwa telah terjadi resistensi terhadap insektisida golongan organofosfat dan piretroid. Disarankan untuk mengganti kedua jenis insektisida tersebut di setiap wilayah yang teridentifikasi resitensi tinggi.
 Kata kunci: Insektisida, resitensi, organofosfat, piretroid, aedes aegypti

ABSTRACT 
 Dengue cases are increasingly widespread in all parts of Indonesia, but currently, the priority of control is prevention through fogging focus on endemic DHF areas. The purpose of this study was to determine the entomology indicator of dengue vector mosquitoes about the susceptibility status of the Ae aegypti mosquito. The study design was a cross-sectional study and data analysis using Pearson Correlation statistical tests. This research was conducted in seven provinces in Sumatra, which consisted of three districts with three regions endemic to dengue fever centers in each province. The larvae collection was carried out in 100 houses in each selected Puskesmas. The susceptibility test of adult mosquitoes to six types of insecticide active ingredients was carried out by the WHO Bioassay method while the larval susceptibility test used the Elliot method. The results showed that index of entomology at 7 provinces in Sumatra were; HI and CI the highest in Kota. Pematang Siantar (58,60 % and 64 % ) and the lowest in Kabupaten Prabumulih and Palembang ( 22,70 and 0 % ), the highest of BI in Kabupaten Bangka Barat ( 87,40 % ) and the lowest in the Kota Metro ( 31,10 % ); the highest of ABJ in Kota Palembang ( 77,30 % ) and the lowest in Kota Pematang Siantar ( 41,40 %). Malathion 0.8 % still effective as an mosquito control by the presence of strong and moderate relationship was for CI and HI. Whether there are mosquitoes control using chemical insecticides in several locations in 7 provinces of Sumatra show resistant condition, thus controlling by PSN, 3M plus is still a major strategy to be done to break the chain of transmission of dengue fever. 
 Keywords: DHF, Aedes, Correlation, Suceptibility
 
 ABSTRAK
 Kasus DBD semakin meluas di seluruh wilayah Indonesia, namun saat ini prioritas pengendaliannya berupa pencegahan melalui fogging focus pada wilayah-wilayah endemis DBD. Tujuan penelitian ini untuk mengetahui indikator entomologi nyamuk vektor DBD hubungannya dengan status kerentanan nyamuk Ae. aegypti. Desain penelitian adalah studi potong lintang dan analisis data menggunakan uji statistik Pearson Correlation. Penelitian ini dilakukan di tujuh Provinsi yang ada di wilayah Sumatera yang terdiri dari tiga kabupaten dengan masing-masing tiga wilayah Puskesmas endemis DBD di setiap Provinsi. Pengumpulan jentik dilakukan pada 100 rumah di setiap Puskesmas terpilih. Uji kerentanan nyamuk dewasa terhadap enam jenis bahan aktif insektida dilakukan dengan metode Bioassay WHO sedangkan uji kerentanan jentik menggunakan metoda Elliot. Hasil penelitian menunjukkan indeks entomologi di 7 Provinsi di wilayah Sumatera yang diperiksa menunjukkan nilai HI dan CI tertinggi di Kota Pematang Siantar (58,60% dan 64%) dan terendah di Kab. Prabumulih dan Kota Palembang (22,70 % dan 0%), BI tertinggi di Kab. Bangka Barat (87,40%) dan terendah di Kota Metro (31,10%), ABJ tertinggi di Kota Palembang (77,30%) dan terendah di Kota Pematang siantar (41,40%). Pestisida Malathion 0,8 % masih efektif sebagai upaya pengendalian nyamuk dengan adanya hubungan yang kuat dan sedang terhadap Container Indeks (CI) dan House Indeks (HI) di 7 Provinsi di Wilayah Sumatera. Pengendalian jentik dengan menggunakan insektisida kimiawi di beberapa lokasi di 7 Provinsi di wilayah Sumatera menunjukkan kondisi resisten nyamuk vektor DBD dengan demikian pengendalian dengan PSN 3M Plus masih merupakan strategi utama yang harus dilakukan untuk memutus rantai penularan DBD.
 Kata kunci: DBD, Aedes, Korelasi, Suseptibilitas

The event of traffic accidents become concerning problems within the community, due to significant number of severe injuries and deaths. This paper will describe traffic accident occurrence in Indonesia during 2010 – 2014. The materials came from traffic accidents data collected by Traffic Corporations Republic of Indonesia (Korlantas) and Hospital Information System (SIRS) on 2013. In-depth Interview dan Roundtable Discussion (RTD) were done to elicit information regarding the management of traffic accident cases. The results show that traffic accident cases slightly decrease compared to previous years, however the death proportion remains the same. Provinces with the proportion of deaths due to traffic injuries increased over 50 percent while the fatalities of traffic accidents in the most populated provinces are increased. Events and deaths due to traffic accidents are dominated by age group between 26-30 years old who were riding a motorcycle. The most direct cause of death is head injuries, while the external causes of the accidents are recorded as a traffic accident without detailed description. The study conludes that traffic accidents and deaths are public health issues which should be handled holistically and comprehensively by the related agencies. It is suggested that the implementation of Decade of Action for Road Safety program should be periodically evaluated especially for closing potholes, repair sharp bend, availability of road marking and pedestrian facilities. Underlying cause of death information according to ICD-10 should be included in National SIRS online. Keywords: Traffic accidents, cedera, Indonesia, year 2010 - 2014 A BSTRAK Kejadian kecelakaan lalu lintas (lalin) menjadi isu yang mengkhawatirkan bagi masyarakat Indonesia, karena banyak terjadi cedera berat dan meninggal. Makalah ini bertujuan mengetahui kejadian karena kecelakaan lalin di Indonesia tahun 2010-2014. Bahan berasal dari data kecelakaan lalin yang dikumpulkan oleh Korps lalu lintas (Korlantas) dan Sistem Informasi Rumah Sakit (SIRS) RS Fatmawati. Indepth Interview dan R oundtable Discussion dilakukan untuk mengetahui upaya pengelolaan kecelakaan lalin. Hasil menunjukan kasus kecelakaan lalin tahun 2014 sedikit menurun, namun proporsi kematiannya masih menetap.Provinsi dengan proporsi kematian karena cedera lalu lintas di atas 50 persen semakin bertambah. Fatalitas kecelakaan lalin di provinsi dengan penduduk padat semakin tinggi. Kejadian dan kematian karena kecelakaan lalin tertinggi pada kelompok usia 26-30 tahun yang mengendarai sepeda motor. Penyebab kematian langsung terbanyak cedera kepala, sedangkan penyebab luar kecelakaan dicatat sebagai kecelakaan lalin tanpa deskripsi rinci. Kesimpulan: kecelakaan lalin dan kematian merupakan masalah kesehatan masyarakat yang harus ditangani secara holistik, komprehensif oleh instansi terkait. Saran: kejadian kecelakaan harus ditangani secara profesional, pelaksanaan Program Dekade Aksi Keselamatan Jalan harus dievaluasi secara berkala terutama penutupan lubang jalan, penanganan tikungan tajam, pemasangan marka jalan, penyediaan fasilitas pejalan kaki. Informasi penyebab dasar kematian menurut International Classification of Diseases (ICD) -10 harus dicatat ke dalam National SIRS daring. Kata kunci : Kecelakaan lalu lintas, cedera, Indonesia, tahun 2010-2014

In 2015, the forest fires are quite severe in Riau Province. This causes the reduction of air quality, which in turn can cause breathing problems. This article aims to determine the relationship of the increase in air pollution index (API) and the cases of respiratory problems in Pekanbaru City in 2015. The study design was cross-sectional. Samples are all people with respiratory problems (Upper Respiratory Tract Infections/URI, asthma, and pneumonia) who visited Puskesmas or health post in Pekanbaru, amounted to 12,939 people. Data collected were daily data of API and Pekanbaru residents visit to Puskesmas and health posts with complaints of respiratory problems. Spearman rho correlation test was used to analyze the data with SPSS software. API from July to October 2015 range was quite wide from 34.7 up to 778.0. Average API in September and October 2015 were more than in the period of July and August 2015. The Spearman rho correlation analysis showed that the API value have significant correlation (p=0.000) with respiratory problems. Correlation between API with URI, asthma, and pneumonia is highest on the lag time 0, respectively 0.779; 0.237; and 0.436. It can be concluded that the increased API will increase URI on the same day . Keywords: Forest fires, API, URI, asthma, pneumonia A BSTRAK Pada tahun 2015 terjadi kebakaran hutan yang cukup parah di Provinsi Riau. Hal ini mengakibatkan menurunnya kualitas udara yang pada akhirnya dapat menimbulkan gangguan kesehatan terutama yang terkait dengan pernapasan. Artikel ini bertujuan untuk mengetahui hubungan peningkatan indeks standar pencemaran udara (ISPU) dengan kejadian gangguan pernapasan di Kota Pekanbaru tahun 2015. Desain penelitian adalah potong lintang. Sampel adalah semua penderita gangguan pernapasan (Infeksi Saluran Pernapasan Atas /ISPA, asma, dan pneumoni) yang berkunjung ke Puskesmas atau posko kesehatan di Kota Pekanbaru, berjumlah 12.939 orang. Data yang dikumpulkan adalah data harian ISPU dan kunjungan penduduk Kota Pekanbaru ke Puskesmas dan pos kesehatan dengan keluhan ISPA, asma dan pneumonia. Digunakan uji korelasi Spearman rho untuk analisis data dengan piranti lunak SPSS. Didapatkan hasil bahwa ISPU pada bulan Juli sampai Oktober 2015 berada pada rentang yang cukup lebar yaitu sebesar 34,7 sampai dengan 778,0. Rerata ISPU pada bulan September dan Oktober 2015 lebih tinggi dibandingkan dengan periode Juli dan Agustus 2015. Analisis korelasi Spearman rho menunjukkan bahwa nilai ISPU berhubungan secara signifikan (p = 0,000) dengan gangguan pernapasan. Korelasi antara ISPU dengan ISPA, asma, dan pneumoni paling tinggi terjadi pada lag time 0, yaitu masing-masing 0,779; 0,237; dan 0,436. Dapat disimpulkan bahwa meningkatnya ISPU akan meningkatkan ISPA pada hari yang sama. Kata kunci : Kebakaran hutan, ISPU, ISPA, asma, pneumoni

The DHF prevention efforts have been continually conducted by the local health office, but some technical obstacles such as surveillance system is still very weak, and this is known as an important part in decision making process to handle the problem using evidence based information. The research objective is to obtain information on dengue endemic mapping through GIS (Geographic Information Systems) to strengthen district surveillance system in district level. Most DHF cases occur in the productive age and located in urban areas with the larva-free rate is low. The direction of movement of the case are local diffusion. Karawang district is a low-lying areas prone to flooding. The rainy season occurs in late October to early May, but the rise of dengue cases at the turn of the rainy season to dry season, this indicates that the humidity in Karawang district supports the mosquito vector breeding.Foging will only kill adult mosquitoes, dengue control programs need to involve community participation and emphasized on public areas like schools and offices because a lot of dengue cases occurred in the productive age. GIS is capable of producing a map factors of risk and map of the case to allow for planning and evaluation of area-based dengue eradication program. GIS is useful in surveillance environmentally based disease, health interventions, and disease prevention strategies.

Abstract . West Karawang is a part of Karawang District that have high case incidence in three years la ter. This research uses cross sectional study method was conducted that aimed to gain information of map ping DHF endemie region use GIS (Geographic Information sys­tems) as a part of surveillance informatics system 2008. The special goals are to know the spatial aspect of the movement pattern , socio-demographic, larvae index, vector control programs, land systems and precipitation. The results of study are movement pattern of DHF in West Karawang is local, the socio-demographic of sex and marital status there are no special different, group of class age 15 - 44 years old (53,70%), non-formal working (81,48%) is the h igh est. The socio-demographic of education Senior High School (38,89%) is the highest too. Almost of The housing type permanent (94,44%) is the dominant and the average wide building 50-100 meters (66,67%) is the h igh est. House index larvae is 55,10% and container larvae index is 15,51 %. The vector control program of fogging in study area 70,37% is done and PSN program activity (81,48%) this fact shown that there are many possibility for breeding place in this district. The Use of GIS helps to handle huge of data easily and much more information can be display clearly. Key Words : DHF, GIS, PSN, Fogging, Larvae Index

Abstract. Ciamis district is dengue hemorrhagic fever (DHF) endemie area that significantly increased of number of cases on last three years period (2004-2006). This fact is areason to conduet research that aimed to know a description a society 's knowledge, attitude and practice (KAP) and also to know relationships between that one with the occurrences of DHF. The research was design ed using cross sectional study; 195 respondents was inter­viewed to know the level of society 's KAP. The final results of this research was showed that the respondent's KASP is good but does not give impact on occurrences of DHF cases be­cause its practice was not done yet by societies in control DHF disease. Key words: Knowledge, Attitude, Practice, Dengue Hemorrhagic Fever.

Geographic Information System (GIS) atau Sistem Informasi Geografis (SIG) diartikan sebagai sistem informasi yang digunakan untuk memasukkan, menyimpan, memanggil kembali, mengolah, menganalisis dan menghasilkan data bereferensi geografis atau data geospatial. Arti lainnya, SIG merupakan sebuah sistem, yang digunakan untuk mengelolageographic information. Sistem informasi geografi adalah informasi yang sifatnya geografis yang menjelaskan suatu keadaan ruang, wilayah atau yang dikenal dengan istilah spasial (spatial), sehingga analisa dalam SIG biasanya dikenal dcngan analisa spasial (analisa keruangan). Pemanfaatan informasi kesehatan yang didapat dari berbagai sumber dan diintegrasikan dengan pengenalan wilayah tersebut (baca: melalui GIS), nantinya akan menjadi sangat bermanfaat terutama untuk intervensi kesehatan yang dipercaya dan lebih cost-effective. Oleh karena itu, GIS dapat berperan penting, atau sebagai alat yang dapat memperlihatkan masalah kesehatan masyarakat, terutama berdasarkan kepada wilayah atau area yang lebih spesifik. Pokoknya, GIS di bidang kesehatan adalah teknologi atau alat yang dapat dikembangkan untuk membantu pelayanan dan intervensi kesehatan yang berbasis kepada analisis wilayah (spatial analysis).