TROPICAL MEDICINE MODULE

DENGUE HEMORRHARGIC FEVER (DHF)

in The Area of Sidotopo Wetan Community Health Center Coverage

Arranged by :
Group 5
Lu’lu’il Maqnun 011711133060
Aqidah Khariri 011711133061
Aulia Nur Fadilla 011711133062
Dian Awalia Sari 011711133063
Nadhifa Tanesha Aufazhafarin 011711133064
Andis Putri Nawangsari 011711133065
Muh. Daffa Tandry Lala 011711133066
Istianah 011711133067
Firmansyah Adhitama Prayoga 011711133068
Dita Mega Utami 011711133069
M. Abdurrahman Rasyid 011711133070
Desi Rianti Rahmadhani 011711133071
Muhammad Iqbal Mubarrok 011711133072
Muh. Zulkifly Tasman 011711133073

MEDICAL FACULTY
UNIVERSITAS AIRLANGGA
2018
 Table of Content

Cover ............................................................................................................ i

Table of Contents ........................................................................................... ii

CHAPTER 1 FIRST ENCOUNTER

1.1 Main Problem..................................................................................... 1

1.2 Keywords ........................................................................................... 1
1.3 First Hypothesis ................................................................................. 1
1.4 Cognitive Strategi .............................................................................. 1
1.5 List of Question.................................................................................. 2
1.6 List of Learning Issue ........................................................................ 7

CHAPTER 2 SECOND ENCOUNTER

2.1 Learning Issue ................................................................................... 9

2.2 Scenario Analysis and Scientific Information .................................. 39
2.3 Early Conceptual Framework ............................................................ 41

CHAPTER 3 THIRD ENCOUNTER

3.1 Questionnaire and Survey Form ........................................................ 43

CHAPTER 4 QUESTIONNAIRE AND SURVEY FORM

4.1 Questionnaire Result .......................................................................... 52

4.2 Flick Survey Result ............................................................................ 58
4.3 Larva Index ........................................................................................ 60
4.4 Spread of Mosquito Breeding........................................................... 61

CHAPTER 5 FOURT ENCOUNTER

5.1 Concept Maping ................................................................................. 63

5.2 Concept Maping Analysis .................................................................. 64
5.3 Final Hypothesis ................................................................................ 66
5.4 Solution Strategy................................................................................ 66
 5.5 Information List ................................................................................. 67

BIBLIOGRAPHY .......................................................................................... 68

ATTACHMENT

1. Critical Appraisal ............................................................................... 72

2. Quesionnaire ...................................................................................... 75
3. Leaflet ................................................................................................ 82
 CHAPTER 1

FIRST ENCOUNTER

Skenario :

The incidence of DHF in Surabaya fluctuates every month and year. Incidence
rate DHF will usually increase in the rainy season around January to June. DHF
incidence or Incidence Rate (IR) increased from 22.5 in 2015 to 32.8 per
100,000 population in 2016. In 2015 Kejadian Luar Biasa (KLB) of DHF
happened in several regions in East Java. In Surabaya, in January - September
2017 there have been 302 cases of dengue fever, but there is still convenience
Increase in Incidence Rate in 2018 if we are not keep alert. The incidence of
DHF can resolve by conducting an examination of mosquito nest eradication
activities seen from number of free larvae (ABJ) at each Puskesmas area in
Surabaya. In the last 3 years ABJ in the city of Surabaya is still on under target.

1.1. Main Problem

The number of free larvae (Angka Bebas Jentik / ABJ) are still high (under target) in
Sidotopo Wetan area.

1.2. Key Words

2. Incidence Rate
3. Kejadian Luar Biasa (KLB)
4. Dengue Hemorrhagic Fever (DHF)
5. Angka Bebas Jentik (ABJ)
6. Rainy Season

1.3. First Hypothesis

Preventive and eradication programs in Sidotopo Wetan area are still ineffective.

1.4. Cognitive Strategy

Cognitive Strategy is one or some specific method that is used by humans to solve a
problem. Cognitive strategies will always interact with various aspects, especially
"execution context", which is a continuation of cognitive strategies. According to Robert

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 M Gagne (1984), cognitive strategies are organized internal capabilities that can help
college students in learning process, such as the process of thinking, solving problems
and making decisions. Cognitive strategies applied in this Tropical Medicine Module are
based on the theory of metacognition, which includes problem solving, decision making,
critical thinking, and creative thinking. These skills must not be separated and must be
integrated with one another so that at the same time when students use their cognitive
strategies to solve problems, they directly use a variety of skills to make decisions by
thinking critically and thinking creatively.
There are 4 types of cognitive strategies that can be used in learning methods namely
Chunking, Spatial, Bridging, and Multipurpose. In this Tropical Medicine Module, the
cognitive strategy used is "Spatial" type. Spatial is a strategy to show the relationship
between one thing and another. In this category include "frames" (tables) and "concept
maps" (concept maps). Students are given a scenario that must then be found the problem,
what factors influence it, and how to deal with and the solution of the scenario. To make
it easier to solve the case, the student is guided by his supervisor to arrange an appropriate
concept map so that he can answer the initial hypothesis that has also been prepared by
the students. To improve thinking skills, students have also been given the opportunity to
conduct field surveys so that they can observe the phenomena that occur in the field and
obtain data in the field so that they better understand and know cases that are being
handled.

1.5. List of Question

Tutorial 1

a. What programs have been carried out by the health workers / Health Center to
prevent dengue hemorrhagic fever?
Reason: To assess the effectiveness of the program
b. Of the number of dengue cases in the scenario, what is the ratio of cases of
children: adults?
Reason: To find out risk factors based on age related to immune resistance
c. What is the surveillance case in this scenario?
Reason: To find out the accuracy of the data
Tutorial 4: Information from Health Center of Sidotopo Wetan

1. How many cases of DB in Sidotopo Wetan in 2017-2018?

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 2. How many Case Fatality Rate (CFR) of Dengue Hemorrhagic Fever in 2017-2018
in Sidotopo Wetan?
3. How many Incidence Rate of Dengue Hemorrhagic Fever in 2017-2018 in
Sidotopo Wetan?
4. How many “Angka Bebas Jentik” value of Dengue Hemorrhagic Fever in 2017-
2018 in Sidotopo Wetan?
5. How many House Index of Dengue Hemorrhagic Fever in 2017-2018 in Sidotopo
Wetan?
6. How is the mechanism of the Dengue Hemorrhagic Fever education program by
the Health Center?
7. When do the Dengue Hemorrhagic Fever education program routinely conducted?
8. Are there any data on residents who follow Dengue Hemorrhagic Fever education
program?
9. Has the 1 House 1 Jumantik program been implemented?
10. What other approaches has been done in order to educate the residents about
Dengue Hemorrhagic Fever?

Answer of Information from Health Center of Sidotopo Wetan

1. Case Number of DHF in 2017-2018

No. Month Number of case/ year
2017 2018
1. January 2 2
2. February 5 1
3. March 7 0
4. April 1 1
5. May 3 4
6. June 2 0
7. July 0 0
8. August 3 1

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 9. September 1 0
10. October 1 1
11. November 3 0
12. December 1 0
TOTAL 29 10

2. CFR of DHF in 2017-2018

No Year CFR (%)
1. 2017 3.44 %
2. 2018 0%

3. IR of DHF in 2017-2018
No Year IR (%)
1. 2017 0.05 %
2. 2018 0.01 %

4. ABJ of DHF in 2017-2018

No Year ABJ (%)
1. 2017 90 %
2. 2018 93 %

5. HI of DHF in 2017-2018
No Year HI (%)
1. 2017 9.3 %
2. 2018 7.3 %

6. Mechanism of DHF Counseling Program by Community Health Center DBD

counseling is carried out inside and outside the building:
A. Inside the building :
 Counseling to patients who seek treatment at the Community Health Center
in the the Community Health Center waiting room area
 Counseling for patients with environmental-based illness / clients in the
Environmental Health Unit at the the Community Health Center.

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  Routine Meeting of Bumantik Cadres (Mother of larvae monitoring)
 Revitalization of Bumantik Cadres
 Establishment of Wamantik (larvae monitoring students) and Rumantik
(larvae monitoring teacher) in the school environment
B. Outside the building :
 Counseling during the PSN
 Counseling during the PSN Festival
 Counseling in schools
 Counseling at the Posyandu Balita, Posyandu Lansia, PKK Kelurahan, PKK
RW
 Counseling during PSN in people's houses (Jumantik’s house)

7. Frequency of DHF Counceling

No. Jenis Kegiatan Frekuensi Waktu Pelaksanaan

Penyuluhan pada pasien yang

1. berobat ke Berkala

Puskesmas di Area Ruang

Tunggu Puskesmas

Penyuluhan serta konseling Senin s.d. Sabtu (hari dan jam

2. pada pasien dengan pelayanan)

penyakit berbasis lingkungan / - Senin s.d. Kamis : 07.30 WIB s.d.

klien di Unit 14.30 WIB

Kesehatan Lingkungan
(Kesling) di Puskesmas - Jumat : 07.30 WIB s.d 11.30 WIB

- Sabtu : 07.30 WIB s.d. 13.00 WIB

Pertemuan Rutin Kader 1 bulan sekali (Setiap hari Kamis pada

3. Bumantik (Ibu Pemantau Minggu

Jentik) Terakhir)

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4. Revitalisasi Kader Bumantik 5 kali dalam setahun

(pada pelaksanaan kegiatan BOK Tahun

2018)

Pembentukan Wamantik
5. (Siswa Pemantau Jentik) 1 kali dalam setahun

dan Rumantik (Guru Pemantau (pada pelaksanaan kegiatan BOK Tahun

Jentik) di 2018)

Lingkungan Sekolah

Penyuluhan pada saat

6. pelaksanaan PSN Bersama 1 minggu sekali

Penyuluhan pada saat

7. pelaksanaan Gebyar PSN 1 bulan sekali

8. Penyuluhan di Sekolah-sekolah 1 bulan sekali

Penyuluhan di Posyandu
9. Balita, Posyandu Lansia, 1 bulan sekali

PKK Kelurahan, PKK RW

Penyuluhan pada saat PSN di

10. rumah-rumah warga 1 minggu sekali

(rumah Jumantik)

8. DHF Counceling Target

Community Health Center patients, environmental-based patients / clients,
Bumantik cadres (flicking monitoring mothers), Jumantik home cadres (larva
monitoring monitors), school residents (wamantik, rumantik, students, teachers,
cleaning officers), community, PKK participants (women), implementation of “1
house 1 Jumantik” program.

9. 1R1J Effort

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 Efforts to implement the 1 House 1 Jumantik Program (1 R 1 J) were carried
out well and continued to be carried out with socialization and education on the
Jumantik house when the PSN was completed in the Jumantik houses by Bumantik
cadres on duty (every 1 week) and delivering information about DHF at the Routine
Locals Meeting.

10. Other Approach Efforts to do DHF Counseling

In addition to intensive efforts to carry out counseling regularly throughout the

Kel. Sidotopo Wetan, Kader Bumantik Kel. Sidotopo Wetan is also trying to find
alternatives / innovations related to prevention of dengue disease as early as possible
so that people are also motivated to find the latest breakthrough in preventing dengue
by cultivating basil as one type of mosquito repellent plant which is currently known
as Kampung Kemangi precisely located in RW. 13 on RT. 04 and 10 which are the
pilot areas of basil cultivation. This activity is a form of collaboration between
Bumantik Cadres and TOGA Cadres. Where Bumantik Cadres conducted PSN /
examination of mosquito larvae in Jumantik houses and the TOGA Cadres monitor
the condition of the basil plant owned by the Jumantik

1.6 List of Learning Issue

Dengue Hemorrhagic Fever’s Learning Issue

a. What is Dengue Hemorrhagic Fever?

b. What is the Dengue Hemorrhagic Fever vector life cycle?
c. What are the characteristics of Dengue Hemorrhagic Fever vectors?
d. What is the symptoms of Dengue Hemorrhagic Fever ?
e. What are the risk factors of dengue hemorrhagic fever in terms of host, agent, and
environment
f. What is the pathophysiology Dengue Hemorrhagic Fever ?
g. What is the method to identify Dengue Hemorrhagic Fever ?

Incidence Rate’s Learning Issue

h. What is Incidence Rate ?

i. How to calculate Incidence Rate ?
j. What is the Incidence Rate target value and how is the real condition?

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 Angka Bebas Jentik’s Learning Issue

k. What is Angka Bebas Jentik ?

l. How to calculate Angka Bebas Jentik?
m. What is the Angka Bebas Jentik target value and how is the real condition?

Case Fatality Rate’s Learning Issue

n. What is Case Fatality Rate?

o. How to calculate Case Fatality Rate?
p. What is the Case Fatality Rate target value and how is the real condition?

Disease Outbreaks’ Learning Issue

q. What is Kejadian Luar Biasa?

r. What is the criteria of Kejadian Luar Biasa?
s. How Kejadian Luar Biasa classified?

Environment’s Learning Issue

t. What are the effects of environmental condition towards Dengue Hemorrhagic Fever
and its vector?
u. What are the effects of climate towards Dengue Hemorrhagic Fever and its vector?
v. What are the strategies of Dengue Hemorrhagic Fever’s management and prevention?
w. What is the Surveillance Rate of Dengue Hemorrhagic Fever?
x. Who is vulnerable to being affected by Dengue Hemorrhagic Fever?

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 CHAPTER 2

SECOND ENCOUNTER

2.1 Learning Issue

2.1.1 Definition of Dengue Fever

Dengue fever (DF) is the fastest spreading infectious disease caused by the
dengue virus. The Dengue virus is transmitted by female mosquitoes from the genus
Aedes, mainly Aedes aegypti and a small portion of Aedes albopictus. This mosquito
can also transmit Chikungunya virus, Yellow fever, and Zika. This dengue mosquito
found in almost all corners of Indonesia, except in places that have more height from
1000 meters above sea level. Dengue virus is spread in the tropics. Variation of risk
Its spread is influenced by the intensity of rain, temperature, and urbanization.

The incidence of dengue fever has continued to increase since 1960. This
increase is believed is a result of global warming and urbanization. WHO recorded an
average of 980-925,896 cases reported annually from 1955-2007. More than 70% of
the population is at risk (population at risk) in the world lives in Southeast Asia and
Asia Pacific region which is close to the line equator. Dengue outbreaks are a major
health problem in the Southeast Asian region, in particular, Indonesia, because the
equatorial region is home to the distribution of both Aedes aegypti in the city and
village. In the equatorial region, the dengue virus will multiply quickly so much cause
cases of morbidity and death in children.

Based on the health profile of Surabaya City in 2016, the number of patients
with Dengue Hemorrhagic Fever (DHF) in 2016 amounted to 938 people with details
of male patients 503 people and 435 women. Whereas cases of death in DHF patients
are 7 people, with CFR 0.75%.

The Dengue virus has 4 serotypes namely DEN-1, DEN-2, DEN-3, and DEN-
4. Infection because one of the serotypes makes sufferers form immunity to the virus
with the serotype, but there is no cross-protective immunity for the serotype another.
second infection by another serotype will cause severe dengue.

This disease begins with an acute phase with symptoms of high fever
accompanied by a headache, pain muscle, joint pain, and the presence of a red

9
(maculopapular) rash that is similar to measles. On in some cases, fever can worsen
and bleeding (Dengue Haemorrhagic Fever), thrombocytopenia, blood plasma rupture
or even dengue shock syndrome.

This disease is classified as follows:

1. Dengue Fever

DF follows both primary and secondary infections and is most frequently

encountered in adults and older children. The onset of symptoms is
characterized by a biphasic, high-grade fever lasting for 3 days to 1 week. A
severe headache (mainly retrobulbar), lassitude, myalgia, and painful joint,
metallic taste, appetite loss, diarrhea, vomiting, and stomachache are the other
reported manifestations. Dengue is also known as breakbone fever because of
the associated myalgia and pain in joints. Of patients with DF, 50–82% report
with a peculiar cutaneous rash. The initial rash is the result of capillary
dilatation, and presents as transient facial flushing erythema, typically
occurring before or during the first 1–2 days of fever. The second rash is seen
at 3 days to 1 week following the fever and presents as an asymptomatic
maculopapular or morbilliform eruption.

2. Dengue Hemorrhagic Fever

The hemorrhagic episodes in DHF are associated with multifactorial

pathogenesis. Vasculopathy, deficiency, and dysfunction of platelets and
defects in the blood coagulation pathways are the attributed factors. Decreased
production of platelets and increased destruction of platelets may result in
thrombocytopenia in DHF. The impaired platelet function causes the blood
vessels to become fragile and this results in hemorrhage.

3. Dengue Shock Syndrome

DSS is defined as DHF accompanied by an unstable pulse, narrow pulse

pressure (<20 mmHg), restlessness, cold, clammy skin, and circumoral
cyanosis. Progressively worsening shock, multiorgan damage, and
disseminated intravascular coagulation account for a high mortality rate
associated with DSS. The shock persists for a short span of time and the
patient promptly recovers with supportive therapy.

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 Risk factors for severity of dengue fever

 Individual risk factors determine the severity of disease and include

secondary infection, age, ethnicity and possibly chronic diseases (bronchial
asthma, sickle cell anemia, and diabetes mellitus).
 Severe disease is more common in babies and young children, but in
contrast to many other infections, it is more common in children who are
relatively well nourished. Young children, in particular, may be less able
than adults to compensate for capillary leakage and are consequently at
greater risk of dengue shock.
 Other risk factors for severe disease include female sex, high body mass
index, and high viral load.
 Polymorphisms (normal variations) in particular genes such as TNFα have
been linked to an increased risk of severe complications of dengue.
Polymorphisms in the genes for the vitamin D receptor and Fc gamma
receptor (FcγR) seem to offer protection against severe disease in
secondary dengue infection.

2.1.2 Life Cycle of Aedes aegypti

1. Eggs

The first, the mosquitoes will enter into the water and then spread their
legs, then the segments on their stomach move back and forth after that the
mosquito dips its entire body until the last segment on the body touches the
surface of the water, then the mosquito rises again and flies several times and
dips its body again (Ejournal3 .[Link], 2018).

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 Aedes aegypti mosquitoes lay their eggs on the surface of the water,
usually on the edge of the water where the water is stored. Eggs hatch into
larvae within 2 days after the eggs are submerged in water, female Aedes
aegypti mosquitoes produce 100 eggs if they suck blood. Eggs in 10 dry places
(without water) can last up to 6 months ([Link], 2018). These eggs
will then hatch into larvae after about 1-2 days submerged in water (Herms,
2006)

2. Larvae / larvae

Larvae are the next phase after the egg. Larvae go to the surface of the
water in about every ½-1 minute, to get oxygen to breathe ([Link],
2018). Based on data from the Ministry of Health of the Republic of Indonesia
(2005), there is a level (instar) of larvae in accordance with the growth of
larvae, namely instar larvae I - IV. Instar I - III takes place quickly while
Instar IV takes up to 3 days and the total development time of all larval phases
is 6-8 days.

According to Christoper (1960), the growth of larvae into several

instars and pupae is influenced by the presence of detritus or organic material
as food ingredients, he also mentioned that the media used as breeding sites
for Ae mosquitoes. Egypt is usually clean water and has a sufficient amount of
organic matter, the content of organic matter also affects the light penetration
and oxygen content of a medium.

3. Pupa (Cocoon)

Pupa can move and respond to stimuli. Pupa does not need to eat and
the cocoon stage (pupa) lasts 2-4 days. Adult mosquitoes appear by
swallowing air to expand the size of the stomach so that the cocoon opens and
the head of the mosquito appears before flying into the air.

According to Aradilla (2009), the survival of pre-adult mosquitoes is

influenced by temperature, pH, and oxygen content in the media.

4. Adult Mosquitoes

12
 Aedes aegypti mosquito is known as a black-white mosquito or tiger
mosquito because its body has a distinctive characteristic, namely with the
presence of silvery white lines and patches on a black base.

Its main characteristic is two curved lines that are white on both sides
of the lateral and two curved lines parallel to the median line of the back
which has a black base shaped like a lyre-shaped marking. The growth of
mosquitoes from eggs to adults takes 12-14 days and the age of mosquitoes
can reach 2-3 months.

2.1.3 Characteristics Of Vectors

Aedes aegypti, the main mosquito vector of the dengue virus is an insect that is
closely related to humans and their place of residence. Humans not only provide
mosquitoes with blood that becomes "food" but also water storage containers in and
around the house that are needed to complete their development. Mosquitoes put their
eggs on the side of the container with water and the eggs hatch into larvae after rain or
flooding. The larvae turn into a cocoon for about one week and become mosquitoes in
two days. The mosquito's aquatic habitat is quite varied, starting from the tree cavity
to the toilet. People also provide shelter for Aedes aegypti accidentally. They like
darker and cooler areas, which unfortunately we often create like cabinets that lead to
biting capabilities in the room.

Inside the mosquito, the virus infects the mosquito in the middle of the
intestine and then spreads to the salivary glands for 8-12 days. After this incubation
period, the virus can be transmitted to humans during probing or subsequent eating.
Immature stages are found in water-filled habitats, mostly in artificial containers that
are closely related to human habitation and often indoors.

Their flight-related studies show that most female Aedes aegypti can spend
their lives in or around homes where they appear as adult mosquitoes and they usually
fly an average of 400 meters. This means that people quickly move the virus into and
between communities and places rather than the mosquitoes themselves. The rate of
dengue infection is higher outside the home and during the day, when the mosquito
bites most often. However, Aedes aegypti breeds indoors and is able to bite anyone
throughout the day. Indoor habitats are less susceptible to climate variations and
increase the lifespan of mosquitoes. Dengue outbreaks have also been linked to Aedes

13
albopictus, Aedes polynesiensis and several species of complex Aedes scutellaris.
Each of these species has certain ecological, behavioral and geographical distribution.

Adult Aedes aegypti mosquitoes have a medium size with a brownish black
body. His body and legs were covered in scales with silvery white lines. Scales on the
body of a mosquito are generally easy to fall off or detach, making it difficult to
identify old mosquitoes. The trunk is black even though the palp is white. Scutum has
a dorsal pattern of white scales in the form of a 'harp' with lateral curved lines and 2
midlines which contrast with the general cover of narrow dark scales. The wings are
relatively dark with hind limbs with a scaly pale femur for three quarters of the basal
with dark-colored scales on the apical two thirds and in the abdomen at the third
apical, dark tibia but terpites with pale basal bands in 1-4 and 5 all pale. Stomach with
medial and lateral patches or white-scale bands (maybe some white scales on the
apical edge), especially pale sternites scaly with subapical bands in the distal segment.
The size and color of this type of mosquito often varies between populations,
depending on environmental conditions and nutrients that mosquitoes obtain during
development. Male and female mosquitoes have no difference in size of male
mosquitoes which are generally smaller than females and the presence of thick hairs
on male mosquito antennas. These two characteristics can be observed with the naked
eye. Meanwhile, the eggs of Aedes aegypti have a dark and solitary characteristic and
are attached to the edges of the walls and wet and slippery containers.

2.1.4 Symptoms of DHF

Patients with dengue fever are generally accompanied by the following signs:

The first day it hurt: sudden heat, body weakness. At this stage it is difficult to
distinguish from other diseases

Second or third day: bleeding spots, bruising, or a rash on the skin of the face,
chest, arms, or legs and heartburn. Sometimes nosebleeds, blood loss or vomiting of
blood. Bleeding spots are similar to mosquito bites. To distinguish the skin stretched;
if lost is not a sign of dengue hemorrhagic fever.

Between the third and seventh day, the heat drops suddenly. The next
possibility:

14
The patient is cured, or a deteriorating condition characterized by restlessness, cold
end of hands and feet, lots of sweat. If the situation continues, there is a weak
weakening, the pulse is weak or not palpable). Sometimes the consciousness
decreases.

Degree of Severity of DHF The degree of DHF is classified in 4 degrees:

 Degree I: Fever and the only manifestation of bleeding is a positive

Tourniquet test.
 Degree II: There is spontaneous bleeding including skin bleeding (petechiae),
gum bleeding, epistaxis or other bleeding. (excessive transmission,
gastrointestinal bleeding).
 Degree III: Degrees I or II accompanied by circulatory failure, namely rapid
and slow pulse, decreased pulse pressure (20 mmHg or less) or hypotension,
cyanosis around the mouth, cold and moist skin, and the child looking
nervous.
 Degree IV: As with grade III accompanied by severe shock (profound shock),
the pulse cannot be touched and blood pressure is not measurable.

15
 Febrile phase

Patients typically develop high-grade fever suddenly. This acute febrile

phase usually lasts 2–7 days and is often accompanied by facial flushing, skin
erythema, generalized body ache, myalgia, arthralgia and headache. Some patients
may have sore throat, injected pharynx and conjunctival injection. Anorexia,
nausea and vomiting are common. It can be difficult to distinguish dengue
clinically from non-dengue febrile diseases in the early febrile phase. A positive
tourniquet test in this phase increases the probability of dengue. In addition, these
clinical features are indistinguishable between severe and non-severe dengue
cases. Therefore monitoring for warning signs and other clinical parameters
(Textbox C) is crucial to recognizing progression to the critical phase. Mild
haemorrhagic manifestations like petechiae and mucosal membrane bleeding (e.g.
nose and gums) may be seen. Massive vaginal bleeding (in women of childbearing
age) and gastrointestinal bleeding may occur during this phase but is not common.
The liver is often enlarged and tender after a few days of fever. The earliest

16
abnormality in the full blood count is a progressive decrease in total white cell
count, which should alert the physician to a high probability of dengue.

 Critical phase

Around the time of defervescence, when the temperature drops to 37.5–

38o C or less and remains below this level, usually on days 3–7 of illness, an
increase in capillary permeability in parallel with increasing haematocrit levels
may occur. This marks the beginning of the critical phase. The period of clinically
significant plasma leakage usually lasts 24–48 hours. Progressive leukopenia
followed by a rapid decrease in platelet count usually precedes plasma leakage. At
this point patients without an increase in capillary permeability will improve,
while those with increased capillary permeability may become worse as a result of
lost plasma volume. The degree of plasma leakage varies. Pleural effusion and
ascites may be clinically detectable depending on the degree of plasma leakage
and the volume of fluid therapy. Hence chest x-ray and abdominal ultrasound can
be useful tools for diagnosis. The degree of increase above the baseline
haematocrit often reflects the severity of plasma leakage. Shock occurs when a
critical volume of plasma is lost through leakage. It is often preceded by warning
signs. The body temperature may be subnormal when shock occurs. With
prolonged shock, the consequent organ hypoperfusion results in progressive organ
impairment, metabolic acidosis and disseminated intravascular coagulation. This
in turn leads to severe haemorrhage causing the haematocrit to decrease in severe
shock. Instead of the leukopenia usually seen during this phase of dengue, the
total white cell count may increase in patients with severe bleeding. In addition,
severe organ impairment such as severe hepatitis, encephalitis or myocarditis
and/or severe bleeding may also develop without obvious plasma leakage or shock
. Those who improve after defervescence are said to have non-severe dengue.
Some patients progress to the critical phase of plasma leakage without
defervescence and, in these patients, changes in the full blood count should be
used to guide the onset of the critical phase and plasma leakage. Those who
deteriorate will manifest with warning signs. This is called dengue with warning
signs (Textbox C). Cases of dengue with warning signs will probably recover with
early intravenous rehydration. Some cases will deteriorate to severe dengue (see
below).

17
  Recovery phase

If the patient survives the 24–48 hour critical phase, a gradual reabsorption
of extravascular compartment fluid takes place in the following 48–72 hours.
General well-being improves, appetite returns, gastrointestinal symptoms abate,
haemodynamic status stabilizes and diuresis ensues. Some patients may have a
rash of “isles of white in the sea of red”. Some may experience generalized
pruritus. Bradycardia and electrocardiographic changes are common during this
stage. The haematocrit stabilizes or may be lower due to the dilutional effect of
reabsorbed fluid. White blood cell count usually starts to rise soon after
defervescence but the recovery of platelet count is typically later than that of
white blood cell count. Respiratory distress from massive pleural effusion and
ascites will occur at any time if excessive intravenous fluids have been
administered. During the critical and/or recovery phases, excessive fluid therapy is
associated with pulmonary oedema or congestive heart failure.

2.1.5 Host, Agent and Environment Risk Factor

1. HOST
o Secondary infection
o Children, incomplete immune system
o Poor
o The educational programs
o The population should also be educated
o Behavior
o Antibody response to infection differs according to the immune status
of the host.
o The severity of disease and include secondary infection, age, ethnicity
and possibly chronic diseases (bronchial asthma, sickle cell anemia and
diabetes mellitus).
o Host genetic determinants
o The accuracy of target area
o Travelers
o Clothing that minimizes skin exposure during daylight hours
2. VECTOR
o Genetic (Agent)

18
 o Day time biter
o This mosquito is a tropical and subtropical species
o Ae. aegypti is relatively uncommon above 1000 metres.
o The vector abundance and distribution
o Typically, these mosquitoes do not fly far, the majority remaining
within 100 meters of where they emerged.
o They feed almost entirely on humans, mainly during daylight hours,
and both indoors and outdoors.
o Densities of vector populations
o Vector propagation and human contact with the vector-pathogen
o The time interval between infections and the particular viral sequence
of infections
o Vector resistance
3. ENVIRONMENT
o Tropical and subtropical area
o Urban and semi urban area
o Early notification of dengue cases
o The mass media and Workshops.
o During dengue epidemics, nursing and medical students together with
community activists can visit homes with the double purpose of
providing health education and actively tracing dengue cases.
o Ae. aegypti proliferates in many purposely-filled household containers
o Communication plans and strategies are often lacking, resulting in
short-term information campaigns and ad hoc activities in reaction to
outbreaks.
o Collaboration within the health sector and with other sectors
o Season
o Dengue surveillance systems
o Environmental and climate factors, host-pathogen interactions and
population immunological factors. Climate directly influences the
biology of the vectors and thereby
o The immature stages are found in water-filled habitats, mostly in
artificial containers closely associated with human dwellings and often
indoors.

19
 o Inadequate water supply and solid waste infrastructure

2.1.6 Pathophysiology of Dengue Fever

The pathophysiology of dengue fever begins when the Aedes aegypti

mosquito bites the person infected with dengue fever. All sufferers, both with and
without symptoms, both with bleeding and without bleeding, all contain viruses in
their body and are ready to transmit the disease. The dengue virus enters the body of
the mosquito with the blood it sucks. In the body of a mosquito, the virus will
multiply and spread to all parts of the mosquito's body including the salivary glands.
Saliva released by mosquitoes will then be released when biting other people with the
function of local anesthesia to prevent pain and also to release anticoagulants so that
blood does not freeze. (Sudjanal, 2010).

In the human body, the virus will replicate in the reticuloendothelial (RES)
system with the main target being APC (Antigen Presenting Cells) which is generally
in the form of monocytes or tissue macrophages such as Kupffer cells from the liver.
Dengue virus will circulate in peripheral blood in monocyte/macrophage cells, B
lymphocyte cells and T lymphocyte cells that will cause viremia. Viremia will occur
when the clinical symptoms appear before 5 to 7 days after. This results in the release
of bradykinin, serotonin, thrombin, and histamine which causes the hypothalamus
(temperature control center) to increase body temperature. (Martina, 2009)

Complementary activity in dengue virus infection is also known to increase

such as C3a and C5a. These mediators release histamine and are powerful mediators
as a factor in increasing the permeability of blood vessel capillary walls. As a result of
this event, extravasation of fluid from intravascular to extravascular occurs and causes
signs of plasma leakage such as hemoconcentration, hypoproteinemia, pleural
effusion, ascites, wall thickening of the vesica fella and hypovolemic shock that leads
to dengue shock syndrome (DSS). Different mechanisms have been hypothesized to
explain DENV-associated thrombocytopenia, including bone marrow and the
peripheral destruction of platelets. Moreover, anti-platelet antibodies would be
involved in peripheral platelet destruction as platelets interact with endothelial cells,
immune cells, and/or DENV. In patients with thrombocytopenia, there is bleeding
both in the skin such as petechiae, mucosal bleeding in the mouth or in another

20
mucosa. This results in the loss of the body's ability to carry out the normal
hemostatic mechanism. (Elzinandes, 2015)

2.1.7 Dengue Diagnosis Method

Laboratory diagnosis methods for confirming dengue virus infection may

involve detection of the virus, viral nucleic acid, antigens or antibodies, or a
combination of these techniques. After the onset of illness, the virus can be detected
in serum, plasma, circulating blood cells and other tissues for 4–5 days. During the
early stages of the disease, virus isolation, nucleic acid or antigen detection can be
used to diagnose the infection. At the end of the acute phase of infection, serology is
the method of choice for diagnosis.

In general, tests with high sensitivity and specificity require more complex
technologies and technical expertise, while rapid tests may compromise sensitivity
and specificity for the ease of performance and speed. Virus isolation and nucleic acid
detection are more labour-intensive and costly but are also more specific than
antibody detection using serologic methods.

21
The diagnosis of dengue virus infection can be done by virus isolation, serological
tests, or by molecular methods. Below are some methods of diagnosing dengue virus:
1. Virus isolation

Specimens for virus isolation should be collected early in the course of the
infection, during the period of viraemia (usually before day 5). Virus may be
recovered from serum, plasma and peripheral blood mononuclear cells and attempts

22
may be made from tissues collected at autopsy. Cell culture is the most widely used
method for dengue virus isolation. The mosquito cell line C6/36 (cloned from Ae.
albopictus) or AP61 (cell line from Ae. pseudoscutellaris) are the host cells of choice
for routine isolation of dengue virus.
2. Nucleic acid detection
RNA is heat-labile and therefore specimens for nucleic acid detection must be
handled and stored according to the procedures described for virus isolation.
o PCR (Polimerase Chain Reaction)

Dengue virus can be detected in blood (serum) from patients for

approximately the first 5 days when symptoms appear (CDC, 2017) l. At
present, several PCR tests are used to detect viral genomes in serum. Dengue
virus requires immediate treatment. So that in dengue virus infection, a fast
and accurate diagnostic method is needed. RT-PCR is a method that is able to
detect dengue virus at an early stage and is able to determine dengue virus
serotypes 1,2,3,4 (University of North Sumatra, 2009). In addition, viruses can
be isolated and sorted for additional characterization.
o Isothermal amplification methods
The NASBA (nucleic acid sequence based amplification) assay is an
isothermal RNAspecific amplification assay that does not require thermal
cycling instrumentation. The initial stage is a reverse transcription in which
the single-stranded RNA target is copied into a double-stranded DNA
molecule that serves as a template for RNA [Link] of the
amplified RNA is accomplished either by electrochemiluminescence or in
real-time with fluorescent-labelled molecular beacon probes. NASBA has
been adapted to dengue virus detection with sensitivity near that of virus
isolation in cell cultures and may be a useful method for studying dengue
infections in field studies.
3. Detection of antigens
o NS1 ELISA
Non-structural protein 1 (NS1) from the dengue virus genome has been
shown to be useful as a tool for the diagnosis of acute dengue infection.
Dengue NS1 antigen has been detected in the serum of dengue virus-infected
patients 1 day after symptom onset (day post onset / DPO), and up to 18 DPO.

23
 ELISA NS1-based antigen tests are commercially available for the dengue
virus and many researchers have evaluated this test for sensitivity and
specificity. The NS1 test can also be useful for differential diagnostics
between flaviviruses due to the specificity of the test.

4. Serological tests

o MAC ELISA

Catching ELM IgM antibodies (MAC-ELISA) is most often used in

laboratory diagnostics and commercially available diagnostic devices. This
test is based on taking human IgM antibodies on microtiter plates using anti-
human-IgM antibodies followed by addition of dengue virus-specific antigens
(DENV1-4). The antigen used for this test comes from a viral protein
envelope.

o IgG ELISA

IgG ELISA is used to detect dengue infection in the past using the
same viral antigen as the ELISA MAC. This test correlates with the
hemagglutination (HI) test used previously. In general IgG ELISA is less
specific in the serocomplex flavivirus group.

o IgM/IgG ratio

A dengue virus E/M protein-specific IgM/IgG ratio can be used to

distinguish primary from secondary dengue virus infections. IgM capture and
IgG capture ELISAs are the most common assays for this purpose. In some
laboratories, dengue infection is defined as primary if the IgM/IgG OD ratio is
greater than 1.2 (using patient’s sera at 1/100 dilution) or 1.4 (using patient’s
sera at 1/20 dilutions). The infection is secondary if the ratio is less than 1.2 or
1.4. This algorithm has also been adopted by some commercial vendors.
However, ratios may vary between laboratories, thus indicating the need for
better standardization of test performance

o IgA

24
 Positive detection for serum anti-dengue IgA as measured by anti-
dengue virus IgA capture ELISA (AAC-ELISA) often occurs one day after
that for IgM. The IgA titre peaks around day 8 after onset of fever and
decreases rapidly until it is undetectable by day 40. No differences in IgA
titres were found by authors between patients with primary or secondary
infections. Even though IgA values are generally lower than IgM, both in
serum and saliva, the two methods could be performed together to help in
interpreting dengue serology. This approach is not used very often and
requires additional evaluation.

o PRNT

Reduction Plaque and Neutralization Test (PRNT) and

microneutralization PRNT can be used when serological specific diagnostics
are needed because this test is the most specific serological tool for the
determination of dengue fever antibodies. The PRNT test is used to determine
the infecting serotype in patients who experience serval sera. This test
measures neutralizing antibody titers in the serum of infected individuals and
determines the level of protective antibodies this individual has against the
infecting virus.

25
2.1.8 Incidence Rate (IR)

The incidence rate is the number of new cases that occurs in a population in a
given time period.

Rate = x / y. k

x = Number of cases in the population

y = Number of population

k = Constants (base number)

Example:

The Paroon sub-district health center reported that in 2010 there were 300 cases of
Acute Respiratory Infection. It is known that the population of Paroon is 30,000.

Calculate the incidence rate of Acute Respiratory Infection in the Paroon District
Health Center.

26
IR = x / y. k

IR = (300/30000) x 1000 = 10 per 1000 poulation

Benefits of Incidence Rate :

a) Knowing the health problems faced.

b) Knowing the risk of health problems faced.

c) Knowing the workload that must be done by health service facilities.

In East Java

The number of dengue fever cases in 2016 was 25,338, indicating an increase
in the number of dengue cases compared to 2015 of 21,092. The population of East
Java Province in 2016 is 39,075,152 with details of 19,288,006 males and 19,787,146
females. The incidence rate of Dengue Hemorrhagic Fever (DHF) in East Java in
2016 was 64.8 per 100,000 population, experiencing an increase compared to 2015,
which was 54.18 per 100,000 population. This figure is still above the national target
of ≤ 49 per 100,000 population. Judging from the dengue morbidity in 2016, in some
districts/cities there was an increase in the number of dengue sufferers compared to
before.

In Surabaya

In 2016, there were 938 people with Dengue Hemorrhagic Fever (DHF) in
Surabaya, with details of 503 male sufferers and 435 females. The total population of
Surabaya city in 2016 was 2,862,406 people, with 1,414,025 males and 1,448,381
females. The sex ratio was 97.63 with a population density of 8,770 people / km2.
Based on these data, the Incidence Rate of DHF in Surabaya per 100,000 population
in 2016 was: (938 / 2,862,406) x 100,000 = 32.77.

2.1.9 Angka Bebas Jentik (ABJ)

Angka Bebas Jentik (ABJ) is an indicator in the form of numbers that describe
larvae density, which is the value of the number of houses not found larvae the
number of houses examined multiplied by 100% [with normal values 95%]

o How to measure by observation

27
 Observation is carried out by holding a jumantik system (larva monitor). The
Jumantik work system is to monitor homeowners conducting larva checks, with a
sticker in their homes, as a larva examination card. The aim is to visually monitor and
analyze the ABJ values that are analytical surveys. The sample collection was by
monitoring the presence of larvae and the installation of ovitrap to determine the
ovitrap index and ABJ values in 100 houses.

o Ovitrap Index

Ovitrap Index (OI) is one method for measuring mosquito density in addition to
other methods such as the Stegomyia Index and free larvae index. The ovitrap index is
cheaper, more applicable and sensitive to detect the activity of Aedes sp to lay eggs
on container walls.

OI is not always relevant to predict cases of dengue fever but can inform the risk
of DENV irregularities in certain areas. The community must make efforts to
minimize the potential of breeding grounds, especially containers that are not used
outdoors to reduce mosquito density.

The more active program of the Community Movement Cultivates One House
One Jumantik (Euphoric together). Each house has one person who is responsible for
monitoring and ensuring there are no mosquito larvae. So, they ( jumantik) who go
around every week to see the Flick Free Numbers card and then report it to the
coordinator RW, until later going up to the sub-district, health center, and mayor.
Then later from the health center that will confirm the data again. With this ABJ
assessment, Surabaya reduced the use of fogging as an effort to eradicate mosquito
nests because fogging can damage the environment and for a long time mosquitoes
can be immune, so now fogging is limited only if there are those affected by dengue.

2.1.10 Case Fatality Rate (CFR)

Case Fatality Rate is a number that is expressed as a percentage containing

data of people experiencing death from a particular disease. Basically, the Case
Fatality Rate is used to measure infectious diseases. The reported Case Fatality Rate
(CFR) is a measure of disease severity and is defined as the proportion of cases
reported from certain diseases or conditions that are fatal in a given time.

The following is the formula

28
 The CFR target set is less than 1% and in 2015 in Sby 2%, whereas in 2016
the CFR dropped to 0.75%. However, if reviewed again based on gender
classification, the male CFR in 2016 is 0.4% while in women it is 1.15%. In the data
below, the CFR in various regions of Surabaya is uneven, there are some that are
below the target and those above the target even have 0%.

29
2.1.11 Kejadian Luar Biasa (KLB)

o Definition

Kejadian Luar Biasa (KLB) is an occurrence or increased in the number of

morbidity and or with mortality which is epidemiologically significant in a certain
region and certain time, also a condition that can lead to the occurrence of outbreak.
(Regulation of the Minister of Health of the Republic of Indonesia Number 1501 year
of 2010 about certain types of infectious diseases that can cause outbreaks and
prevention efforts)

o Criteria of KLB

According to Regulation of the Minister of Health of the Republic of

Indonesia Number 1501 article 6, a region is defined as KLB if it meets one of the
conditions:

- The occurrence of an infectious disease that haven’t yet happened or not known in
a certain region.
- Increased of the morbidity continuously within 3 periods in consecutive hours,
days, or weeks according to the type of the disease.

30
- Double increased or more of the morbidity than the previous period in consecutive
hours, days, or weeks according to the type of the disease.
- The amount of new patient in a month of a period increased twice or more than
the average amount per month in previous years.
- The morbidity average per month in a year increased twice or more than the
average morbidity per month in previous years.
- Case Fatality Rate in one certain time increased 50% or more than mortality rate
of a disease in previous period in the same certain time.
- Proportional rate of the new patient in a period increased twice or more than the
previous period in the same certain time.

2.1.12 Environmet Factor

The environment is certainly very influential on the emergence of events and

the spread of dengue. The environment is divided into two, namely physical and non-
physical environments. Physical environment is a factor that exists and describes the
natural conditions that exist around humans, such as water containers, climate, hanged
clothes. Whereas the non-physical environment is a factor that arises because of
human relations, such as population density, population mobility, education,
population attitudes and health providers.

The water container is a breeding place for the aedes aegypti mosquito, it can
be inside or outside the house. So that more water containers inside or outside the
house will certainly increase the risk factors if they are not balanced with other
preventive measures such as draining, closing and burying (3M). Hanged clothes can
be a hiding place favored by the aedes aegypti mosquito.

Climate is a factor that influences the life cycle of aedes agypti mosquito. It
was said in WHO (2011), that dengue hemorrhagic fever mosquitoes live at a
temperature of 14-18 ° C as the lower limit up to 35-40 ° C as the upper limit, every 2
° C increase in DENV extrinsic incubation period will be shorter so it appears it takes
longer to bite and infect humans, besides that it will cause mosquitoes to become
dehydrated thereby increasing the risk of mosquito-human contact. Of course the data
supports the fact that Indonesia's climate conditions range in temperature from 18 to
38 ° C.

31
 Population density will affect the spread of the dengue virus. The denser the
population, the easier the aede aegypti mosquito to spread the virus in its body. It said
in WHO (2011) that uncontrolled urbanization would increase vector breeding
potential, related to population facilities, water supply and solid waste disposal.
Urbanization is the movement of people from rural areas to urban areas.

Counseling is done in the hope that the extension object can implement the
knowledge contained in the counseling itself so that it can improve the quality of their
lives, in this connection of course in terms of prevention of Dengue Fever. The
attitude or behavior of the population also plays a role in the spread of dengue fever,
even though the population has received as much counseling, but if in reality if after
counseling, the population does not change the pattern of life or in other words not
participate in the government-promoted program , then the results are the same.

Health providers are also one of the factors that play a big role in DHF
problems. Health providers, as the name suggests, should not only focus on treatment
but also must actively participate in the movement to prevent and eradicate DHF. It is
not solely focused on how much counseling is held, but also participates in
accompanying and guiding the population slowly so that they participate in
prevention programs that are encouraged by the government.

2.1.13 Effect of climate on dengue and vectors

Climate change will certainly greatly affect a species, including Aedes

Aegypti. The more suitable the climatic conditions with the ideal conditions of
mosquito development, the higher the population growth will be.

The climate itself consists of various elements, such as temperature, rainfall,

etc. The ideal climate conditions for mosquitoes include:

- Temperature 25 - 27 ° C

- Monthly rainfall> 300mm

- 70-80% air humidity

- Wind speed <22 knots

2.1.14 Prevention of DHF

32
 Prevention of dengue fever is a very complex and interconnected aspect
between one aspect with another aspect, so far the dbd prevention is best prevented in
terms of vectors because prevention of hosts such as vaccines is still not found to be
effective and the treatment of this disease has not been found yet. it is only
sympathetic.

According to the epidemiology triangle of infectious diseases there are 3

influential factors, namely the host, agent and environment. Prevention of dbd can be
done in 3 aspects but according to who and the most important preventive health
department is through eradication of vectors that carry the dengue virus.

Prevention of HOST factors:

1. Vaccine

The vaccine for dbd has actually been found but in the trial of its use. The
results obtained are not as expected.

2. Protective Clothing

The clothing is risky enough if the cloth is sufficiently thick or loosely fitting.
Long sleeves and trousers with stockings may protect the arms and legs, the preferred
sites for mosquito bites. School children should adhere to these practices whenever
possible. Impregnating clothing with chemicals such as permethrin can be especially
effective in preventing mosquito bites.

3. Repellent

Repellents are a common means of protection against mosquitoes and other

biting insects. These are broadly classified into two categories, natural repellents and
chemicals.

4. Mats, coil, and aerosols

Household insecticidal products, namely mosquito coils, pyrethrum space

spray and aerosols have been used extensively for personal protection against
mosquitoes. Electric vaporizer mats and liquid vaporizers are more recent additions
which are marketed in practically all urban areas.

5. Insecticide-treated mosquito nets and curtains

33
 Insect-treated mosquito nets (ITMN) have limited utility in dengue control
programs, since the vector species bites during the day. However, treated can be
effectively utilized to protect infants and night workers who sleep by day. They can
also be effective for people who generally have an afternoon sleep. For details of
insecticide treatment of mosquito nets and curtains, see Annex VII.

"Olyset net", a wide mesh net woven from polyethylene thread containing 2%
permethrin, is yet another improvement in ITMN technology. This net has two
advantages over traditional nets in the wide mesh permits better ventilation and light,
and a slow release of permeate to the fiber surface, a long residual effect (over a year).
In studies were carried out in Malaysia, four washings with soap and water were not
evaluated by the efficacy and mortality of Aedes aegypti was 86.7%. For control of
DF / DHF in Vietnam, Olyset net curtains were hung on the inside against doors /
windows; Aedes aegypti was adversely affected and dengue virus transmission was
interrupted. Further studies on impregnated warranted fabrics appear.

Prevention of ENVIRONMENT factors:

A clean environment cannot always avoid dengue fever because dengue fever
mosquitoes that act as vectors actually need clean water as a place breeding to lay
eggs.

In Indonesia itself, based on the regulations of the Ministry of Health, the most
effective and efficient DHF prevention program to date is the Eradication of Mosquito
Nest (PSN) activities by 3M Plus. Abbreviation of 3M, among others: 1) Drain / clean
places that are often used as water reservoirs such as bathtubs, water buckets, drinking
water reservoirs, refrigerator water reservoirs and others 2) Close tightly water
reservoirs such as drums , jugs, toren water, etc .; and 3) Reuse or recycle used goods
that have the potential to become mosquito breeding sites that transmit DHF.

Plus what is meant by all forms of preventive activities such as 1) Spread

larvacide powder (better known as abate) in water reservoirs that are difficult to clean;
2) Using mosquito repellent or mosquito repellent; 3) Using a mosquito net while
sleeping; 4) Maintain mosquito larvae predators; 5) Plant mosquito repellent plants, 6)
Regulate light and ventilation in the house; 7) Avoid the habit of hanging clothes in a
house that can be a place for resting mosquitoes, and others.

34
 More important than the prevention of dbd is the public's knowledge about the
dangers of dengue fever so that changes in healthy lifestyles can be started from the
smallest component of the family, because no matter how good a program is if the
executor cannot run well it will be useless.

Prevention of AGENT factors:

1. Biological Control

The application of biological control agents which are directed against the
larval stages of dengue vectors in South East Asia has been somewhat
restricted to small-scale field operations.

o Fish

Larvivorus fish (Gambusia affinis and Poecilia reticulata) have been

extensively used for the control of An. stephensi and/or Ae. aegypti in large
water bodies or large water containers in many countries in South-East Asia.
The applicability and efficiency of this control measure depend on the type of
containers.

o Bacteria

Two species of endotoxin-producing bacteria, Bacillus thuringiensis

serotype H-14 (Bt.H-14) and Bacillus sphaericus (Bs) are effective mosquito
control agents. They do not affect non-target species. Bt.H-14 has been found
to be most effective against An. stephensi and Ae. aegypti, while Bs is the
most effective against Culex quinquefasciatus which breeds in polluted waters.
There is a whole range of formulated Bti products produced by several major
companies for control of vector mosquitoes. Such products include wettable
powders and various slow-release formulations including briquettes, tablets
and pellets. Further developments are expected in slow-release formulations.
Bt.H-14 has an extremely low-level mammalian toxicity and has been
accepted for the control of mosquitoes in containers storing water for
household use.

o Cyclopoids

35
 The predatory role of copepod crustaceans* was documented between
1930-50, but scientific evaluation was taken up only in 1980 in Tahiti, French
Polynesia, where it was found that Mesocyclops aspericornis could effect a
99.3% mortality rate among Aedes (Stegomyia) larvae and 9.7% and 1.9%,
respectively among Cx. quinquefasciatus and Toxorhynchities amboinensis
larvae. Trials in crab burrows against Ae. polynesiensis and in water tanks,
drums, and covered wells met with mixed results. In Queensland, Australia,
out of seven speci es evaluated i n the laboratory, all but M. notius were found
to be effective predators of both Ae. aegypti and An. farauti but not against
Cx. quinquifasciatus. Field releases in both northern and southern Queensland,
however, showed mixed results. In Thailand, results were also mixed, but in
Vietnam, results were more successful, contributing to the eradication of Ae.
aegypti from one village. Although the lack of nutrients and frequent cleaning
of some containers can prevent the sustainability of copepods, they could be
suitable for large containers which cannot be cleaned regularly (wells,
concrete tanks and tyres). They can also be used in conjunction with Bt.H-14.
Copepods have a role in dengue vector control, but more research is required
on the feasibility of operational use.

o Autocidal ovitraps

Autocidal ovitraps were successfully used in Singapore as a control

device in the eradication of Ae. aegypti from the Changgi international airport.
In Thailand, this autocidal trap was further modified as an auto-larval trap
using plastic material available locally. Unfortunately, under the local
conditions of water storage practices in Thailand, the technique was not very
efficient in reducing natural populations of Ae. aegypti. Better results can be
expected if the number of existing potential larval habitats is reduced, or more
autocidal traps are placed in the area under control, or both activities are
carried out simultaneously. It is believed that, under certain conditions, this
technique could be an economical and rapid means of reducing the natural
density of adult females as well as serve as a device for monitoring
infestations in areas where some reduction in population densities of the
vector have already taken place. However, the successful application of

36
autocidal ovitraps/larval traps depends on the number placed, the location of
placement, and their attractiveness as Ae. aegypti female oviposition sites.

2. Chemical Control

Chemicals have been used to control Ae. aegypti since the turn of the
century. In the first campaigns against the yellow fever vector in Cuba and
Panama, in conjunction with widespread clean-up campaigns, Aedes larval
habitats were treated with oil and houses were fumi gated with pyrethri ns. W
hen the insecticidal properti es of DDT were discovered in the 1940s, this
compound became a principal method of Aedes aegypti eradication
programmes in the Americas. When resistance to DDT emerged in the early
1960s, organophosphate i nsecti cides, including fenthion, malathion and
fenitrothion were used for Ae. aegypti adult control and temephos as a
larvicide. Current methods for applying insecticides include larvicide
application and space spraying.

o Chemical larviciding

Larviciding or “focal” control of Ae. aegypti is usually limited to

domestic-use containers that cannot be destroyed, eliminated, or otherwise
managed. It is difficult and expensive to apply chemical larvicides on a long-
term basis. Therefore chemical larvicides are best used in situations where the
disease and vector surveillance indicate the existence of certain periods of
high risk and in localities where outbreaks might occur. Establishing the
precise timing and location are essential for maximum effectiveness. Control
personnel distributing the larvicide should always encourage house occupants
to control larvae by environmental sanitation. There are three insecticides that
can be used for treating containers that hold drinking water.

o Temephos 1% sand granules

One per cent temephos sand granules are applied to containers using a
calibrated plastic spoon to administer a dosage of 1 ppm. This dosage has been
found to be effective for 8-12 weeks, especially in porous earthen jars, under
normal water use patterns. The quantity of sand granules required to treat
various size water containers is shown in Annex VIII. Although resistance to

37
temephos in Ae. aegypti and Ae. albopictus populations has not been reported
from the South-East Asia Region, the susceptibility level of Aedes mosquitoes
should be monitored regularly in order to ensure the effective use of the
insecticide.

o Insect growth regulators

Insect growth regulators (IGRs) interfere with the development of the

immature stages of the mosquito by interference of chitin synthesis during the
molting process in larvae or disruption of pupal and adult transformation
processes. Most IGRs have extremely low mammalian toxicity (LD50 value of
acute oral toxicity for methoprene (Altosid) is 34 600 mg/kg). In general,
IGRs may provide long-term residual effects (three to six months) at relatively
low dosages when used in porous earthen jars. Because IGRs do not cause i
mmedi ate mortalit y of the i mmature mosquit oes, countri es with
legislation stipulating that the breeding of Aedes larvae is an offense, will
require some alteration of the law, so as not to penalize home owners who use
these compounds.

o Bacillus thuringiensis H-14 (Bt.H-14)

Bt .H-14, which is commercially available under a number of trade

names, is a proven, envi ronmentally-noni ntrusi ve mosquit o larvicide. It is
entirely safe for humans when the larvicide is used in drinking water in normal
dosages. Slow-release formulations of Bt .H-14 are being developed. Briquette
formulations that appear to have greater residual activity are commercially
available and can be used with confidence in drinking water. The use of Bt.H-
14 is described in the section on biological control. The large parabasal body
that forms in this agent contains a toxin that degranulates solely in the alkaline
environment of the mosquito midgut. The advantage of Bt . H-14 i s that an
application destroys larval mosquitoes but spares any entomophagus predators
and other non-target species that may be present. Bt.H- 14 formulations tend
to rapidly settle at the bottom of water containers, and frequent applications
are therefore required. The toxin is also photolabile and is destroyed by
sunlight.

o Space sprays

38
 Space spraying involves the application of small droplets of insecticide
into the air in an attempt to kill adult mosquitoes. It has been the principal
method of DF/DHF control used by most countries in the Region for 25 years.
Unfortunately, it has not been effective, as illustrated by the dramatic increase
in DHF incidence in these countries during the same peri od of time. Recent
studi es have demonstrated that the method has little effect on the mosquito
population, and thus on dengue transmission (53,54,55). Moreover, when
space spraying is conducted in a community, it creates a false sense of security
among residents, which has a detrimental effect on communit y-based
source reducti on programmes. From a political point of view,
however, it is a desirable approach because it is highly visible and conveys the
message that the government is doing something about the disease. This,
however, is poor justification for usi ng space sprays. The current
recommendations are that space spraying of insecticides (fogging) should not
be used except in the most extreme conditions during a major DHF epidemic.
However, the operations should be carried out at the right time, at the right
place, and according to the prescri bed i nstructi ons with maximum coverage,
so that the fog penetration effect is complete enough to achieve the desired
results. When space sprays are employed, it is important to follow the
instructions on both the application equipment and the insecticide label and to
make sure the application equipment is well maintained and properly
calibrated. Droplets that are too small tend to drift beyond the target area,
while large droplets fall out rapidly. Nozzles for ultra-low volume ground
equipment should be capable of producing droplets in the 5 to 27 micron range
and the mass median diameter should not exceed the droplet size
recommended by the manufacturer. Desirable spray characteristics include a
sufficient period of suspension in the air with suitable drift and penetration
into target areas with the ultimate aim of impacting adult mosquitoes.
Generally, there are two forms of space-spray that have been used for Ae.
aegypti control, namely “thermal fogs” and “cold fogs”. Both can be
dispensed by vehicle-mounted or hand- operated machines.

o Thermal fogs

39
 Thermal fogs containing insecticides are normally produced when a
suitable formulation condenses after being vaporized at a high temperature.
Generally, a thermal fogging machine employs the resonant pulse principle to
generate hot gas (over 200oC) at high velocity. These gases atomize the
insecticide formulation instantly so that it is vaporized and condensed rapidly
with only negligible formulation breakdown. Thermal fogging formulations
can be oil-based or water-based. The oil (di esel)-based formulations
produce dense clouds of white smoke, whereas water-based formulations
produce a colorless fine mist. The droplet (particle) size of a thermal fog is
usually less than 15 microns in diameter. The exact droplet size depends on
the type of machine and operational conditions. However, uniform droplet size
is difficult to achieve in normal fogging operations.

o Ultra-low volume (ULV), aerosols (cold fogs) and mists

ULV involves the application of a small quantity of concentrated liquid

insecticides. The use of less than 4.6 litres/ha of an insecticide concentrate is
usually considered as an ULV application. ULV is directly related to the
application volume and not to the droplet size. Nevertheless, droplet size is
important and the equipment used should be capable of producing droplets in
the 10 to 15 micron range, although the effectiveness changes little when the
droplet size range is extended to 5-25 microns. The droplet size should be
monitored by exposure on teflon or silocone-coated slides and examined
under a microscope. Aerosols, mists and fogs may be applied by portable
machines, vehicle- mounted generators or aircraft equipment.

o House-to-house application using portable equipment

Portable spray units can be used when the area to be treated is not very
large or in areas where vehicle-mounted equipment cannot be used effectively.
This equipment is meant for restricted outdoor use and for enclosed spaces
(buildings) of not less than 14m3. Portable application can be made in
congested low- income housing areas, multistoried buildings, godowns and
warehouses, covered drains, sewer tanks and residential or commercial
premises. Operators can treat an average of 80 houses per day, but the weight
of the machine and the vibrations caused by the engine make it necessary to

40
 allow the operators to rest, so that two or three operators are required per
machine.

2.2 Scenario Analysis and Scientific Information

Based on the scenario and information from the Health Center and additional questions, it is
known that Incidence Rate (IR) and Case Fatality Rate (CFR) of dengue fever in Sidotopo Wetan is
decreased in number from 2017 until 2018. In 2017, Health Center of Sidotopo Wetan recorded the IR
of dengue fever is 0.05% per 100.000 population. In 2018, the IR of dengue fever in Sidotopo Wetan
is 0.01% per 100.000 population. Compared to the national target, which is less than 55 % per
100.000 population, the number is considered very low.

In addition, Sidotopo Wetan only delivered 29 cases from 302 total cases of dengue fever in
Surabaya in 2017 (noted that 302 cases of dengue fever in Surabaya was reported only in January –
September 2017). Compared to 2018, there is a decreased in number of cases from 29 cases in 2017 to
10 cases of dengue fever in Sidotopo Wetan. Implicitly, the number of cases decreased more than
50%.

Following the number of cases, the CFR of dengue fever in Sidotopo Wetan in 2017 is fairly
high, which is 3,44%. Surprisingly, in 2018, the CFR of dengue fever in Sidotopo Wetan is zero
percent (0%). Obviously it fulfills the national target of CFR, which is less than 1%.

The ABJ (Angka Bebas Jentik) in Sidotopo Wetan in two recently consecutive years already
meets the national target. It reached the number of 90% in 2017 and 93% in 2018, knowing the
national target of ABJ is less than 95%. It proves that Health Center of Sidotopo Wetan manages to
improve the number ABJ. Because of the limited data, the rate of ABJ and CFR in Surabaya snd
Sidotopo Wetan cannot be compared.

From the information given in tutorial lesson, the IR of dengue fever in Surabaya is 22,5%
per 100.000 population in 2015 and 32,8% per 100.000 population in 2016. These numbers obviously
exceed the national target, but government still needs be aware of the possibility of the increasing
number of IR in the after years. The CFR of dengue fever in Surabaya is 2% in 2015 and 0,7% in
2016. The high number of CFR in 2015 is related to the Kejadian Luar Biasa (KLB) of dengue fever
which happened in 2015 in some regions of East Java. Surabaya City Government has been
successfully lowers the CFR of the dengue fever in Surabaya from 2% to 0,7% in 2016. Surabaya City
Government also monitors the rate of Rumah Sehat in Surabaya in 2015 (83,38%) and 2016 (85,98%).
These numbers meet the national target which is 80%. Monitoring Rumah Sehat needs to be done to
determine the condition of population’s health with the aim to intervene and improve the population’s
quality of health.

41
2.3 Early Conceptual Framework

 Genetic
 Level of host’s
immunity
 Education &
knowledge
 Habit & behavior
 Personal hygiene
 Nutritional status

Host

Dengue Fever

Agent Environment

 Virulence
 Environmental
 Vector’s immunity
sanitation
 Number of vectors
 Geographical
condition (climate)
 Physical condition
of environment
 Health care system
 Economical status

The incidence of dengue fever is influenced by several factors which are explained
through the epidemiology trias of disease, they are the host, agent, and environment. The
imbalance between these three factors leads to the incidence of dengue fever. These three
factors determine the IR and CFR of dengue cases in Surabaya. Factors that are attached
in host factors include: genetic, host immunity level, education and knowledge, habits and
behavior, personal hygiene, and nutritional status. Genetic factors affect the level of host
immunity against dengue virus, which is sensitive or becomes insensitive towards the
dengue virus. Host immunity is also influenced by other causes such as the intensity of
exposure to the dengue virus. If the host is often exposed to the dengue virus, it will form
a mature state of immunity in the host's body. Education and knowledge affect the habits
and behavior of patients in the application of prevention and control of dengue fever.
Caring behavior towards personal hygiene is one of the factors that can control the vector
of dengue virus, namely Aedes aegypti, at the stage of eggs, larvae / larvae, and adult

42
mosquitoes. Nutritional status is also one of the factors that influence the severity of
dengue fever (Permatasari, 2012).
Agent factors are the cause of the disease. The agent factor are: virulence, vector
immunity, and number of vectors. Virulence is the agent's ability to cause severe disease
and can lead to death. This is what affects the level of emergency dengue fever in an area.
Vector immunity is one of the causes that must be considered in vector eradication. The
number of vectors influences the speed of transmission of the dengue virus. The number
of vectors can be influenced by environmental sanitation, community behavior, climate,
and the ineffectiveness of government programs in efforts to eradicate vectors.
Environmental factors are extrinsic factors that support the occurrence of dengue
fever. These factors include: sanitation, geographical conditions, physical conditions,
health care systems, and social status. Environmental sanitation, geographical conditions,
and physical environmental conditions directly affect the vector of dengue virus in
breeding sites, nests, and vector’s flying distace. The health care system not only plays a
role in the treatment of dengue fever, but also in the prevention of dengue fever.
Economic status influences the practice of prevention and treatment of dengue fever.
People with low economic conditions have difficulty to fulfill dengue fever prevention
facilities such as mosquito nets, mosquito repellent lotion, abate powder, mosquito coils
or spray, and so on. In addition, people with low economic conditions experience
difficulties in treating dengue fever for reasons of cost. Economic status is also often
associated with education level.

43
 CHAPTER III

THIRD ENCOUNTER

3.1. Questionnaire and Survey Form

In this Tropical Medicine Modul we hope that we could identify the factors
which help the raising of tropical disease especially Dengue Hemorrhagic Fever and find the
solution to prevent the spreading of the disease and decrease the number of cases. To fulfill
those purposes we need some questionnaire for the people which ever had the disease or been
living in endemic environment of Dengue Hemorrhagic Fever and also doing the survey of
the availability of Aedes’ larva in their house.

We are also connected to one of the Health Service Center in Surabaya located in
Sidotopo Wetan. We get some datas about the number of Dengue Hemorrhagic Fever around
in Sidotopo Wetan and also get some instruction so that the survey would be well done.

The questionnaire we made are including the personal identity of each the responden
and will be knowing more about the responden’s knowledge about Dengue Hemorrhagic
Fever. This questionnaire also including their actions and natural tendency about Dengue
Hemorrhagic Fever during all this time.

Besides the questionnaire there is also the survey form which we could fill from many
kinds of potential breeding place of the mosquito in their house. From the survey form we
hope that we could analysis the cause of the high number of case especially in Sidotopo
Wetan and make the learning issue to find the solution on this case.

Here is the Questionnaire list and Survey Form which we made to do the survey in
Sidotopo Wetan.

44
 KUESIONER IDENTIFIKASI EFEKTIVITAS PROGRAM PENANGGULANGAN
DAN PENCEGAHAN DEMAM BERDARAH DENGUE DI KELURAHAN
SIDOTOPO WETAN
KELOMPOK 5

PERNYATAAN KESEDIAAN MENJADI RESPONDEN PENELITIAN

Dengan menandatangani lembar ini, saya:

Nama :

Jenis Kelamin :

Alamat :

Memberikan persetujuan untuk menjadi responden dalam kuesioner yang berjudul

“Survei Identifikasi Efektivitas Program Penanggulangan dan Pencegahan Demam Berdarah
Dengue di Kelurahan Sidotopo Wetan” yang akan dilakukan oleh Mahasiswa Kelompok 5
Modul Kedokteran Tropis Program Studi Kedokteran Fakultas Kedokteran Universitas
Airlangga.

Saya telah dijelaskan bahwa jawaban kuesioner ini hanya digunakan sebagai proses
pembelajaran dan saya secara suka rela bersedia menjadi responden.

Surabaya, 15 Desember 2018,

Yang menyatakan,

( )

45
 KUESIONER SURVEI IDENTIFIKASI EFEKTIVITAS PROGRAM
PENANGGULANGAN DAN PENCEGAHAN DEMAM BERDARAH DENGUE
DI KELURAHAN SIDOTOPO WETAN

Informed Consent

Selamat pagi.

Perkenalkan, kami mahasiswa Fakultas Kedokteran Universitas Airlangga semester 3

mohon izin untuk melakukan survei terkait Identifikasi Faktor Resiko Kejadian Demam
Berdarah Dengue di Kelurahan Sidotopo Wetan untuk kepentingan proses pembelajaran
modul Kedokteran Tropis. Apakah bapak/ibu bersedia untuk berpartisipasi dalam survei ini?

Jika iya, saya mulai dengan pertanyaan terkait identitas bapak/ibu dibawah ini (langsung ke
pertanyaan pada halaman selanjutnya , halaman ini dilengkapi di akhir) :

Identitas

 Nama :
 Alamat asal :
 Alamat Surabaya :
 Tinggal sejak :
 Nomor HP :
 Umur :
 Jenis Kelamin :
 Status Pendidikan :
 Pekerjaan :
 Pendapatan* :
 Status Perkawinan* :

*Bapak / Ibu boleh menjawab atau tidak

46
 Hari, Tanggal pengisian : Sabtu, 15/12/2018

Petugas :
Kode responden :

 Umur :
 Jenis Kelamin :
 Status Pendidikan :
 Pekerjaan :

I. Pengetahuan
Interviewer: Selanjutnya, saya akan menanyakan pertanyaan terkait dengan hal-hal yang
bapak/ibu ketahui tentang Demam Berdarah.

No Pertanyaan Jawaban
1 Apakah bapak/ibu tahu mengenai Demam  Ya
Berdarah? a. Virus
Jika ya, apa penyebab demam berdarah? b. Bakteri
c. Makanan/ minuman
d. Jamur

 Tidak
2 Apakah Demam Berdarah ditularkan oleh  Ya
gigitan nyamuk?  Tidak

4 Tahukah bapak/ibu mengenai nyamuk  Ya

Demam Berdarah? Warna apa? a. Hitam
b. Hitam putih
c. Coklat
d. Abu-abu

 Tidak
5 Apakah bapak/ibu tahu kapan nyamuk  Ya
Demam Berdarah menggigit? a. Pagi
b. Siang
c. Sore
d. Malam

47
  Tidak
6 Apakah bapak/ibu tahu tempat nyamuk  Ya
Demam Berdarah bersarang? Jika ya, di o Didalam rumah
mana? o Diluar rumah
 Tidak
7 Apakah menurut bapak/ibu penyakit  Ya
Demam Berdarah itu berbahaya?  Tidak
8 Apakah penghuni rumah ada yang pernah  Ya
terkena Demam Berdarah?  Tidak
9 Apakah tetangga sekitar ada yang pernah  Ya
terkena demam berdarah dalam 3 bulan  Tidak
terakhir?
10 Menurut bapak/ibu, apakah air bersih  Ya
yang tergenang dapat digunakan sebagai  Tidak
tempat nyamuk Demam Berdarah
bertelur?
11 Apakah bapak/ibu mengetahui program  Ya
PSN 3M Plus (Pemberantasan Sarang  Tidak
Nyamuk)?
12 Apakah kepanjangan dari 3M Plus?
13 Apakah bapak/ibu mengetahui manfaat  Ya
fogging? Jika ya, apa manfaatnya? a. Membunuh jentik-jentik
b. Membunuh nyamuk dewasa
c. Membunuh telur nyamuk
d. Lainnya,…………
 Tidak
14 Apakah bapak/ibu tahu mengenai  Ya
Jumantik?  Tidak
15 Apakah bapak/ibu mengetahui fungsi  Ya
bubuk abate? Jika ya, apa fungsinya? a. Menjernihkan air
b. Membunuh jentik nyamuk
c. Menghilangkan bau pada
air

48
 d. Membuat air jadi tahan
lama
 Tidak
16 Apakah bapak/ibu mengetahui cara  Ya
menggunakan bubuk abate?  Tidak

II. Sikap
Interviewer:
Berikutnya, saya akan menanyakan beberapa pertanyaan terkait dengan sikap bapak/ibu
mengenai Demam Berdarah.

Pertanyaan Jawaban
1 Menurut bapak/ibu, apakah penyuluhan mengenai Demam  Ya
Berdarah perlu dilakukan?  Tidak
2 Apakah bapak/ibu setuju dengan pelaksanaan fogging di  Ya
lingkungan rumah?  Tidak
3 Apakah setelah fogging Bapak/ibu merasa aman dari  Ya
penyakit Demam Berdarah?  Tidak
4 Apakah bapak/ibu setuju dengan pemakaian bubuk abate?  Ya
 Tidak
5 Apakah bapak/ibu setuju dengan pelaksanaan program Satu  Ya
Rumah Satu Jumantik?  Tidak
6 Menurut bapak/ibu, apakah pengawasan terhadap jentik perlu  Ya
dilakukan?  Tidak
7 Apakah bapak/ibu sering menggantung pakaian?  Ya
 Tidak

III. Perilaku
Interviewer: Berikutnya, saya akan menanyakan beberapa pertanyaan terkait dengan perilaku
bapak/ibu mengenai Demam Berdarah.

49
 Pertanyaan Jawaban
1 Apakah Bapak/ibu menguras tempat- tempat  Bak mandi
berikut ini?  Vas bunga
 Tempat minum burung
 Tatakan dispenser
 Ban bekas
 Penampungan air
lemari es
ss2 Berapa kali Bapak/ibu menguras bak kamar mandi  1x seminggu
dalam seminggu?  2x seminggu
 3x seminggu
 Lainnya………………
…..
3 Apakah Bapak/ibu menutup tempat penampungan  Ya
air seperti gentong dan ember?  Tidak
4 Apakah Bapak/ibu mengubur barang- barang bekas  Ya
yang bisa menampung air hujan?  Tidak
5 Apakah pernah diadakan fogging di rumah  Ya
Bapak/ibu?  Tidak
6 Apakah Bapak/ibu memakai pelindung dari gigitan  Ya
nyamuk? a. Kelambu
Jika ya, berikan centang pada tempat berikut! b. Obat nyamuk bakar
c. Obat nyamuk
semprot
d. Raket nyamuk
elektrik
e. Lotion anti nyamuk
 Tidak
7 Apakah di rumah ini ada yang berperan sebagai  Ya
Jumantik?  Tidak
8 Apakah Bapak/ibu sudah/pernah memakai bubuk  Ya
abate?  Tidak
9 Apakah Bapak/ibu memelihara ikan di bak mandi?  Ya

50
  Tidak
10 Apakah Bapak/ibu pernah mengikuti penyuluhan  Ya
Demam Berdarah?  Tidak
11 Apakah ada program bersih bersih lingkungan  Ya
sekitar yang diadakan oleh kelurahan maupun rt/rw  Tidak
bapak/ibu ?

IV. Evaluasi Progrm Penanggulangan dan Pencegahan DBD

Interviewer: Selanjutnya saya akan menanyakan pendapat Bapak/ibu mengenai beberapa hal
berikut

1. Menurut Bapak/Ibu manfaat apa saja yang Bapak/Ibu dapat setelah mendapat
penyuluhan dari kader/puskesmas?
(Jika responden pernah mendapat penyuluhan)

2. Menurut Bapak/Ibu seberapa efektif program pemerintah dalam menanggulangi dan

mencegahan demam berdarah pada kelurahan Sidotopo Wetan?

3. Menurut bapak/ibu apa saja usaha yang dapat dilakukan masyarakat setempat untuk
menurunkan angka kejadian demam berdarah?

51
52
 CHAPTER IV
QUESTIONNAIRE AND SURVEY FORM RESULT

4.1 Questionnaire Result

KUESIONER IDENTIFIKASI EFEKTIVITAS PROGRAM
PENANGGULANGAN DAN PENCEGAHAN DEMAM BERDARAH DENGUE DI
KELURAHAN SIDOTOPO WETAN
KELOMPOK 5

PERNYATAAN KESEDIAAN MENJADI RESPONDEN PENELITIAN

Dengan menandatangani lembar ini, saya:

Nama :

Jenis Kelamin :

Alamat :

Memberikan persetujuan untuk menjadi responden dalam kuesioner yang berjudul

“Survei Identifikasi Efektivitas Program Penanggulangan dan Pencegahan Demam Berdarah Dengue
di Kelurahan Sidotopo Wetan” yang akan dilakukan oleh Mahasiswa Kelompok 5 Modul
Kedokteran Tropis Program Studi Kedokteran Fakultas Kedokteran Universitas Airlangga.

Saya telah dijelaskan bahwa jawaban kuesioner ini hanya digunakan sebagai proses
pembelajaran dan saya secara suka rela bersedia menjadi responden.

Surabaya, 15 Desember 2018,

Yang menyatakan,

( )

53
 KUESIONER SURVEI IDENTIFIKASI EFEKTIVITAS PROGRAM
PENANGGULANGAN DAN PENCEGAHAN DEMAM BERDARAH DENGUE
DI KELURAHAN SIDOTOPO WETAN

Informed Consent

Selamat pagi.

Perkenalkan, kami mahasiswa Fakultas Kedokteran Universitas Airlangga semester 3 mohon

izin untuk melakukan survei terkait Identifikasi Faktor Resiko Kejadian Demam Berdarah Dengue di
Kelurahan Sidotopo Wetan untuk kepentingan proses pembelajaran modul Kedokteran Tropis.
Apakah bapak/ibu bersedia untuk berpartisipasi dalam survei ini?

Jika iya, saya mulai dengan pertanyaan terkait identitas bapak/ibu dibawah ini (langsung ke
pertanyaan pada halaman selanjutnya , halaman ini dilengkapi di akhir) :

Identitas

 Nama :
 Alamat asal :
 Alamat Surabaya :
 Tinggal sejak :
 Nomor HP :
 Umur :
 Jenis Kelamin :
 Status Pendidikan :
 Pekerjaan :
 Pendapatan* :
 Status Perkawinan* :

*Bapak / Ibu boleh menjawab atau tidak

54
 Hari, Tanggal pengisian : Sabtu, 15/12/2018

Petugas :
Kode responden :
 Umur :
- 15 -20 th : 2,86 %
- 20-30 th : 5,71 %
- 30-40 th : 25,71 %
- 40-50 th : 20 %
- 50-60 th : 31,43 %
- >60 th : 14,29 %
 Jenis Kelamin :
- Perempuan : 85,71 %
- Laki-laki : 14,29 %
 Status Pendidikan :
- Tidak bersekolah : 11,77 %
- SD/MI : 35,3 %
- SMP/MTs : 22,86 %
- SMA/MA : 20,59 %
- Perguruan Tinggi S1: 8,82 %
V. Pengetahuan
Interviewer: Selanjutnya, saya akan menanyakan pertanyaan terkait dengan hal-hal yang
bapak/ibu ketahui tentang Demam Berdarah.
No Pertanyaan Jawaban
1 Apakah bapak/ibu tahu mengenai Demam  Ya
Berdarah? e. Virus : 14,29 %
Jika ya, apa penyebab demam berdarah? f. Bakteri : 8,57 %
g. Makanan/ minuman: 2,86 %
h. Jamur : -
i. Lain-lain
(nyamuk) : 40 %
(larva) : 2,86 %
 Tidak Tahu : 31,43 %
2 Apakah Demam Berdarah ditularkan oleh  Ya : 88,57 %
gigitan nyamuk?  Tidak : 11,43 %

4 Tahukah bapak/ibu mengenai nyamuk  Ya

Demam Berdarah? Warna apa? e. Hitam : 2,86 %
f. Hitam putih : 62,86 %
g. Coklat : -

55
 h. Abu-abu : -
i. Lain-lain
(merah kehitaman) : 2,86 %

 Tidak Tahu : 31,43 %

5 Apakah bapak/ibu tahu kapan nyamuk  Ya
Demam Berdarah menggigit? e. Pagi : 54,76 %
f. Siang : 16,67 %
g. Sore : 7,14 %
h. Malam : 4,76 %

 Tidak Tahu : 16,67 %

6 Apakah bapak/ibu tahu tempat nyamuk  Ya
Demam Berdarah bersarang? Jika ya, di o Didalam rumah : 50 %
mana? o Diluar rumah : 40,74 %
 Tidak Tahu : 9,26 %
7 Apakah menurut bapak/ibu penyakit Demam  Ya : 97,14 %
Berdarah itu berbahaya?  Tidak : 2,86 %
8 Apakah penghuni rumah ada yang pernah  Ya : 51,43 %
terkena Demam Berdarah?  Tidak : 48,57 %
9 Apakah tetangga sekitar ada yang pernah  Ya : 32,35 %
terkena demam berdarah dalam 3 bulan  Tidak Tahu :67,65 %
terakhir?
10 Menurut bapak/ibu, apakah air bersih yang  Ya : 62,86 %
tergenang dapat digunakan sebagai tempat  Tidak : 40 %
nyamuk Demam Berdarah bertelur?  Tidak Tahu : 2,86 %
11 Apakah bapak/ibu mengetahui program PSN  Ya : 54,29 %
3M Plus (Pemberantasan Sarang Nyamuk)?  Tidak : 45,71 %
12 Apakah kepanjangan dari 3M Plus?
13 Apakah bapak/ibu mengetahui manfaat  Ya
fogging? Jika ya, apa manfaatnya? e. Membunuh jentik-jentik : 28,81 %
f. Membunuh nyamuk dewasa : 47,46 %
g. Membunuh telur nyamuk : 22 %
h. Lainnya,…………
 Tidak : 6,78 %
14 Apakah bapak/ibu tahu mengenai Jumantik?  Ya : 68,57 %

56
  Tidak : 31,43 %
15 Apakah bapak/ibu mengetahui fungsi bubuk  Ya
abate? Jika ya, apa fungsinya? e. Menjernihkan air : 2,78 %
f. Membunuh jentik nyamuk : 77,78 %
g. Menghilangkan bau pada air : 2,78 %
h. Membuat air jadi tahan lama : -
 Tidak Tahu : 16,67 %
16 Apakah bapak/ibu mengetahui cara  Ya :82,86 %
menggunakan bubuk abate?  Tidak : 17,14 %

VI. Sikap
Interviewer:
Berikutnya, saya akan menanyakan beberapa pertanyaan terkait dengan sikap bapak/ibu mengenai
Demam Berdarah.

Pertanyaan Jawaban
1 Menurut bapak/ibu, apakah penyuluhan mengenai Demam  Ya : 94,29 %
Berdarah perlu dilakukan?  Tidak : 5,71 %
2 Apakah bapak/ibu setuju dengan pelaksanaan fogging di  Ya : 97,14 %
lingkungan rumah?  Tidak : 2,86 %
3 Apakah setelah fogging Bapak/ibu merasa aman dari penyakit Demam  Ya : 62,86 %
Berdarah?  Tidak : 37,14 %
4 Apakah bapak/ibu setuju dengan pemakaian bubuk abate?  Ya : 91,43 %
 Tidak : 5,71 %
 Tidk tahu : 2,86 %
5 Apakah bapak/ibu setuju dengan pelaksanaan program Satu Rumah  Ya : 94,29 %
Satu Jumantik?  Tidak : 5,71 %
6 Menurut bapak/ibu, apakah pengawasan terhadap jentik perlu  Ya : 100 %
dilakukan?  Tidak : -
7 Apakah bapak/ibu sering menggantung pakaian?  Ya : 82,86 %
 Tidak : 17,14 %

VII. Perilaku
Interviewer: Berikutnya, saya akan menanyakan beberapa pertanyaan terkait dengan perilaku
bapak/ibu mengenai Demam Berdarah.

57
 Pertanyaan Jawaban
1 Apakah Bapak/ibu menguras tempat- tempat berikut  Bak mandi : 58,62 %
ini?  Vas bunga : 5,17 %
 Tempat minum burung : 13,79 %
 Tatakan dispenser : 10,34 %
 Ban bekas : -
 Penampungan air lemari es :
12,01%
ss2 Berapa kali Bapak/ibu menguras bak kamar mandi  1x seminggu : 19,44 %
dalam seminggu?  2x seminggu : 41,67 %
 3x seminggu : 16,67 %
 Lainnya (tiap hari) : 22,22%
3 Apakah Bapak/ibu menutup tempat penampungan air  Ya : 91,18 %
seperti gentong dan ember?  Tidak : 8,82 %
4 Apakah Bapak/ibu mengubur barang- barang bekas  Ya : 5,71 %
yang bisa menampung air hujan?  Tidak : 94,29 %
5 Apakah pernah diadakan fogging di rumah Bapak/ibu?  Ya : 85,71 %
 Tidak : 14,29 %
6 Apakah Bapak/ibu memakai pelindung dari gigitan  Ya
nyamuk? f. Kelambu : 8,57 %
Jika ya, berikan centang pada tempat berikut! g. Obat nyamuk bakar : 17,14 %
h. Obat nyamuk semprot : 37,14 %
i. Obat nyamuk elektrik : 8,57 %
j. Lotion anti nyamuk : 40 %
 Tidak : 11,43 %
7 Apakah di rumah ini ada yang berperan sebagai  Ya : 31,43 %
Jumantik?  Tidak : 68,57 %
8 Apakah Bapak/ibu sudah/pernah memakai bubuk abate?  Ya :82,86 %
 Tidak : 17,14 %
9 Apakah Bapak/ibu memelihara ikan di bak mandi?  Ya : 14,29 %
 Tidak : 85,71 %
10 Apakah Bapak/ibu pernah mengikuti penyuluhan  Ya : 28,57 %
Demam Berdarah?  Tidak : 71,43 %
11 Apakah ada program bersih bersih lingkungan sekitar  Ya : 80,56 %
yang diadakan oleh kelurahan maupun rt/rw bapak/ibu ?  Tidak : 17,14 %

58
4.2 Flick Survey Result
No Address Number of Positive Larvae Larvae Number in Species
Container Container Container
In door Out In Out In Out door
door door door door
1 Bulak Banteng 2 - 1 - 10 - A. aegypti
Kidul VIII/4
2 Bulak Banteng 2 - 1 - 1 - A. aegypti
Kidul VIII/8
3 Bulak Banteng 3 - 2 - 75 - A. aegypti
Kidul VIII/4B
4 Bulak Banteng 1 - 1 - 30 - A. aegypti
Madya VIII/27
5 Bulak Banteng 2 - - - - - -
Madya VIII/28
6 Bulak Banteng 2 - - - - - -
Madya VIII/25
7 Bulak Banteng 4 - 1 - 90 - A. aegypti
Wetan XVII/10
8 Bulak Banteng 1 1 - - - - -
Wetan VIII/42
9 Bulak Banteng 1 4 - - - - -
Wetan VIII/33
10 Bulak Banteng 2 1 - - - - -
Wetan VIII/42
11 Kedung Mangu 3 1 - - - - -
Selatan VI/1
12 Kedung Mangu 2 4 2 1 >54 >50 A. aegypti
Selatan VI/14
13 Kedung Mangu 4 - 2 - >55 - A. aegypti
Selatan VI/7
14 Sidomulyo 2 - - - - - -

59
 IVD/11E
15 Kedung Mangu 2 1 - - - - -
Selatan II/11C
16 Bulak Banteng 2 - 1 - >20 - Pupa
Baru Gg.
Flamboyan I/2
17 Bulak Banteng 2 1 - - - - -
Baru Gg.
Flamboyan I/8A
18 Bulak Banteng 2 2 - - - - -
Baru Gg.
Flamboyan I/5
19 Bulak Banteng 2 - - - - - -
Wetan XIII/2
20 Bulak Banteng 3 1 1 - 200 - -
Wetan XIII/2A
21 Bulak Banteng 3 - - - - - -
Wetan XIII/32
22 Bulak Banteng 3 - - - - - -
Madya I/23
23 Bulak Banteng 4 - 2 - >57 - -
Madya I/23A
24 Bulak Banteng 4 1 - - - - -
Madya I/23B
25 Bulak Banteng 3 1 2 - 50 - -
Wetan XV/9
26 Randu Barat III/36 2 - - - - - -
27 Randu Barat III/33 2 - - - - - -
28 Randu Barat III/31 4 - - - - - -
29 Bulak Banteng 2 - 1 - >10 - -
Madya VI/15 0
30 Bulak Banteng 2 - - - - -
Madya VI/14

60
 31 Bulak Banteng 1 1 1 - 1 - -
Kidul VII/35A
32 Bulak Banteng 1 1 - - - - -
Kidul VII/35B
33 Kedung Mangung 3 - - - - - -
Selatan III/2B
34 Kedung Mangung 3 - 1 - 10 - -
Selatan III/14B
35 Kedung Mangung 3 - 1 - >20 - -
Selatan III/12B
TOTAL 84 20 20 1 >77 >50 A. aegypti
House Observed: 35 3
Positive larvae house
[Link]: 8

Container A. aegypti Number of A. Species of

Observed= 114 positive aegypti larvae= larvae
container=21 >823 found= A.
aegypti

4.3 Larva Index

𝐽𝑢𝑚𝑙𝑎ℎ 𝑙𝑎𝑟𝑣𝑎 𝐴𝑒𝑑𝑒𝑠
Larva Density Index (LDI) = 𝐽𝑢𝑚𝑙𝑎ℎ 𝑟𝑢𝑚𝑎ℎ 𝑦𝑎𝑛𝑔 𝑑𝑖𝑝𝑒𝑟𝑖𝑘𝑠𝑎
>823
= 35
= >23,5

𝐽𝑢𝑚𝑙𝑎ℎ 𝑟𝑢𝑚𝑎ℎ 𝑦𝑎𝑛𝑔 𝑝𝑜𝑠𝑖𝑡𝑖𝑓 𝑙𝑎𝑟𝑣𝑎 𝐴𝑒𝑑𝑒𝑠

House Index (HI) = x 100%
𝐽𝑢𝑚𝑙𝑎ℎ 𝑟𝑢𝑚𝑎ℎ 𝑦𝑎𝑛𝑔 𝑑𝑖𝑝𝑒𝑟𝑖𝑘𝑠𝑎

8
= x 100%
35

= 22,8%

𝐽𝑢𝑚𝑙𝑎ℎ 𝑐𝑜𝑛𝑡𝑎𝑖𝑛𝑒𝑟 𝑦𝑎𝑛𝑔 𝑝𝑜𝑠𝑖𝑡𝑖𝑓 𝑙𝑎𝑟𝑣𝑎 𝐴𝑒𝑑𝑒𝑠

Container Indeks (CI) = 𝐽𝑢𝑚𝑙𝑎ℎ 𝑐𝑜𝑛𝑡𝑎𝑖𝑛𝑒𝑟 𝑦𝑎𝑛𝑔 𝑑𝑖𝑝𝑒𝑟𝑖𝑘𝑠𝑎
x 100%
21
= 114
x 100%

= 18,4%

61
 ABJ (Angka Bebas Jentik) = 100% - House Index
= 100% - 22,8%= 77,2%

Menurut WHO, suatu daerah dikatakan aman dari resiko penularan DBD bila
tiap indeks larva Aides tersebut ≤ 5%.
Menurut Kemerntrian Kesehatan RI, target Angka Bebas Jentik adalah >95%,
sehingga ABJ rumah sasaran survey masih dibawah target nasional.

4.4 Spread of Mosquito Breeding

Container Type Number of Larvae Positive Mosquito Percentage of
Container Container Species Larvae Found
Container
Bathtub 39 13 [Link] 33%
Bucket 18 3 [Link] 17%
Toilet tub 4 - - 0%
Refrigerator 2 - - 0%
water reservoir
Dispenser’s 2 - - 0%
water container
Aquarium 1 1 [Link] 100%
Well 1 1 [Link] 100%
Drum 10 2 [Link] 20%
Jar (Tempayan) 4 - - 0%
Small tub 1 - - 0%
Other waterway 1 - - 0%
Bird’s water 1 - - 0%
container
TOTAL 84 20 [Link] -

Conclusion

62
1. Places that can be a potential breeding place for the mosquito is bathtub, tub, drum,
aquarium and well for indoor breeding place. And for outdoor breeding place include
outdoor tub.
2. Indoor breeding place percentage is higher (24%) than the outdoor breeding place
(5%).
3. [Link] breeding place is in a container filled with clean and calm water, both
indoor and outdoor.

63
 CHAPTER 5
FOURTH ENCOUNTER
5.1 Concept Maping

AGENT
(Has no significant effect)

ABJ(Angka bebas
jentik) target in
Surabaya still
hasn't been
reached

ENVIRONMENT HOST

low knowledge
about dengue Population
fever and its density
prevention

Water Vector
resources density

5.2 Concet Maping Analysis

64
 After holding a larva survey on Saturday, 15 December 2018, we found that the cause
of the low number of ABJ in Surabaya when it was connected to the area where we were
have to survey (Sidotopo Wetan health center). There are two main factors, Host and
Environment. The First is host factor, according to our observation there are two point in
host factor that has big contribution in this case the first is the society have low
knowledge about dengue fever and its prevention and the second is the society density.

1. low knowledge about dengue fever and its prevention :

when we conducted an interview with the masyrakan in the sidotopo wetan area
by using quisoners, it turned out that there were many people who did not
understand about dengue fever, there were even cases where members of his
family had been exposed to dengue fever but he did not know what dengue fever
was important, because when the community has knowledge of the dangers and
the effects of dangerous dengue fever, awareness of the importance of preventing
dengue fever will be higher. This is the key to the success of all government
programs in eradicating dengue fever because if we observe the implementation of
the 3M PSN program which is the best strategy it is still not effective to reduce
ABJ in Surabaya. Why did this happen, of course it was all because the
implementers of the 3M PSN program still could not implement the program
properly. most of the interviews with respondents revealed that they had not
received information about dengue fever, of course this was very worrying, even
though the data from the Sidotopo Wetan Community Health Center already had a
time line to carry out periodic counseling on dengue fever. In Indonesia, the
jumantik (Juru pengawas jentik) program has been implemented, but the program
is still not running optimally because again the community does not yet know the
importance of regular larval supervision, so when there are jumantik officers who
come to their homes to check, they feel bored and unnecessary they only said that
the house was clean and the bathroom had been drained so there were no mosquito
larvae and the jumantik officers immediately believed it without doing the proper
checking.
2. Population density:
The high population density makes sanitation in both Surabaya and the Sidotopo
Wetan sub-district not too good. house houses that are attached do not provide
enough space for ventilation so that light can enter to reduce the high humidity in

65
 the house, while mosquitoes aides mainly aides aegypti like dark and humid
places and homes for people with dengue fever are mostly damp and dark houses.

The second is environment factor, environment is an important factor that must

always be considered, there are two factors why abj in Surabaya is still low based on
environmental factors, namely water sources and vector density.
1. Water resources:
Not all regions in surabaya have avaible source of clean water will affect the daily
habits of the community, people who always get clean water sources tend not to
hold or store water in barrels or other containers of water containers while areas
with poor water sources tend to store water in barrels and water storage containers
for fear of shortages water. This community habit is the reason why the Aides
mosquito breeds easily, because the clean water they collect is a potential
breeding place for aides mosquitoes plus the people's unwillingness to close water
storage and drainage of water storage regularly will increase house index
numbers.
2. Vector density:
Vector density is of course one of the reasons why ABJ target has not been
achieved in Surabaya because it is impossible for larvae to exist without
mosquitoes to breed, the density of the vector itself is caused by the community
habits described above and added to the rainy season which means a potential
season for Aides mosquitoes breed, not only in the house but also in natural
breeding places, such as standing water due to rain in trees. Vector density also
indicates that the mosquito eradication program still has not been successful. in
certain cases mosquitoes actually experience resistance due to fogging that is not
in accordance with the rule.

the 3M PSN program that has been implemented by the government through
ministerial regulations is a very good program, but we must realize that the ultimate
goal of this program is the achievement of empowered communities in the prevention
and prevention of dengue cases, when the community is empowered then this
program by itself will be carried out by the community on the basis of their own
desires in an effort to achieve a healthy life coupled with the existence of a jumantik

66
 program that helps the public to always be aware of their environment which turns out
that they are still not free of mosquito larvae.

Jumantik is important, but the most important of these programs is the

empowerment of the community for awareness.

Everyone is jumantik at least for his own family.

“Satu rumah satu jumantik, indonesia bebas jentik, 2019 indonesia sehat”

5.3 Final Hypothesis

The minimal target of ABJ (Angka Bebas Jentik), more than 95%, is not achieved yet
in Sidotopo Wetan due to the lack of knowledge in the community because of the
unevenly distributed information and the low awareness of the community.
5.4 Solution Strategy

The implemented solution strategy is aimed to increase the number of ABJ in Sidotopo
Wetan in the following ways

1. Increase community education and awareness on dengue fever by giving them

Dengue Fever Leaflet to be stored and read so the respondents understand what is
dengue fever, how dengue fever occur, and how to control the environment so the
vector (Aedes mosquito) can’t proliferate.
2. Increase community knowledge, especially respondents, by explaining dengue fever
through the given leaflet. The purpose of it so the respondent knows better and
understands the importance of protecting the environment to reduce dengue fever
vectors.
a. Cleaning places that might be a water or rainwater reservoir
b. Drain and brush the water tank and water tub to eliminate mosquito’s breeding
places
c. If there is any kind of water reservoir, don’t forget to close it so the mosquito
can’t lay its egg
3. Asking the help of Sidotopo Wetan Community Health Center to explain more to the
community about the function of abate powder and the correct way to use the abate
powder so the use of it is more effective.

67
 4. Inform the community about government programs that have been carried out, such as
3M+ (menguras, menutup, mengubur, plus), one house one JUMANTIK (Juru
Pemantau Jentik), fogging, abatitation, etc., so the respondent recognizes and knows
government effort regarding the handling and prevention of dengue fever.
5. Provide the dengue fever survey data result in Sidotopo Wetan to the community
health center so the health center knows the lacks of program implementation seen
from the distribution of information in the community that’s not evenly distributed.
5.5 Information List
Based on the data on quesionnare and survey, we got the fact that people still does
not know about Dengue Haemorrhagic Fever. So, we need to do more aggressive
conseling to provide the right information as on of a health promotion strategy to
prevent the spread of the disease.
These are the information lists of the things we need to deliver to the society:
1. The definition of Dengue infection
2. The characteristics of the vector (Aedes)
- Physical characteristics
- The biting habits
- The flying distance
- The breeding places
- The life cycle
3. The causes and the spread methods of Dengue infection
4. The signs and symptoms of Dengue Haemorrhagic Fever
5. The first aid for Dengue Haemorrhagic Fever
6. Prevention of Dengue infection
- 3M plus
- How to use abate
- 1 rumah 1 bumantik program

68
 BIBLIOGRAPHY

Departemen kesehatan. 2015. Demam Berdarah Biasanya Mulai Meningkat di Januari.

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DetikNews. 2017. Januari-September Jumlah Penderita DBD di Surabaya 302 Kasus.

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september-jumlah-penderita-dbd-di-surabaya-302-kasus

[Link]. (2018). [online] Available at:

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Dinas Kesehatan Pemerintah Kota Surabaya. (2016). PROFIL KESEHATAN TAHUN 2016.
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tim_Kota_Surabaya_2016.pdf [Accessed 8 Dec 2018].

Dini, Amah Majidah Vidyah, et all. 2010. Faktor Iklim Dan Angka Insiden Demam Berdarah
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2015“Thrombocytopenia in Dengue: Interrelationship between Virus and the Imbalance
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Hasan, Samimul, et all. 2016. Dengue virus: A global human threat: Review of literature. J
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Penyehatan Lingkungan. Modul Pengendalian Demam Berdarah Dengue. Jakarta. 2011.

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Kementerian Kesehatan Republik Indonesia, 2015. Demam Berdarah Biasanya Mulai
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[Link]. [Accessed 17 Dec. 2018].
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JAWA TIMUR TAHUN 2016. [online] Available at:
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m_2016.pdf [Accessed 8 Dec 2018].

Kurniawan, Tri Puji. 2016. Studi Angka Bebas Jentik (Abj) Dan Indeks Ovitrap Di Perum
Pondok Baru Permai Desa Bulakrejo Kabupaten Sukoharjo. Jurnal Kesehatan, ISSN 1979-
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REJO_KABUPATEN_SUKOHARJO
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%20dengan%[Link]

Martina BE, Koraka P, Osterhaus AD. 2009. Dengue virus pathogenesis: an integrated
view. Clin Microbiol Rev. 2009;22(4):564-81.
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Media, K. (2018). Begini Siklus Hidup Nyamuk Aedes Aegypti Penyebar DBD - [Link].
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di Instalasi Rawat Inap Anank RSUD Tangerang Tahun 2011 [Online]. Dapat diakses di :
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Sudjana, Primal. 2010. Buletin Jendela Epidemologi Demam Berdarah Dengue Departemen
Kesehatan Republik Indonesia.“Diagnosis Dini Demam Berdarah Dengue Dewasa”.Page21-
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U.S. Department Of Health And Human Services. 2009. Dengue and Dengue Hemorrhagic
Fever. American: CDC. [online] Available at:
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practitioners_2009.pdf [Accessed 18 Dec. 2018].
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KEPADATAN NYAMUK DI DAERAH ENDEMIS DEMAM BERDARAH DENGUE (DBD)
KABUPATEN BANYUMAS. [Online] available at:
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5C997AACD57A79D00D62E9F01EB1D3D?sequence=1

71
 ATTACHMENT

1. Critical Appraisal
SCIENTIFIC PAPER APPRAISAL

Group :5

Title of paper : Dengue fever: a Wikipedia clinical review

Published on : Open Medicine
Date of published : October 2nd 2014

1. FORMAT PAPER
Item A/NA (page)

 Title A (page 105 )

 Abstract and or Summary A (page 105 and 113)

 Introduction, background A (page 105-106)

 Method A (page 106-111)

 Result A (page 111-112)

 Discussion A (page 112-113)

 acknowledgement A (page 113)

 Reference A (page 114-115)

Conclusions: complete

2. VALIDITY OF RESEARCH
The Objective of Study: to identify the symptoms, treatment, and how to eliminate the
mosquitoes

72
Methodology:

Item

design Systematic reviews (page 105)

hierarchy of evidence Level 1

Sample People with dengue in world

population (page 111)

sample size 50 millions – 528 millions people (page

111)

eligibility criteria Severe disease is 1%–5% and may be

less than 1% with adequate treatment
With shock can reach 26% if treatment
is inadequate (page 111)

sampling frame Random sampling

Methodology Through the collecting of data in

several years

measurement and or assessment The severe dengue and dengue with

shock

Instrument Figure 1, maculopapular rash of dengue

fever

Figure 4, dengue virus

Figure 5, Aedes aegypti mosquito

Figure 7, dengue vector control in the US

Figure 8, global dengue distribution in

2006

Figure 9, Public health officers release

Poecilia reticulata (guppy) fry into an
artificial lake in Brasília, Brazil, as part

73
 of dengue vector control
Randomisation Simple random

Intervention Observation of the severe dengue and

dengue with shock incidence

analysis method Adjusted analysis

a) Was the instruments suitable for the data that the researchers wants to measure? Yes
b) Was the study design appropriate for the research question or objectives of the study? Yes

c) Did the study methods address the most important potential sources of bias? Yes
d) Was the study performed according to the original protocol? Yes
e) Were the statistical analyses performed correctly? Yes
f) Do the data justify the conclusions? Yes
g) Are there any conflicts of interest? No

Conclusions: valid

3. THE IMPORTANCE OF THE RESEARCH

From the references used by the journal, we know that the authors uses data from the
results of dengue fever research in several endemic countries. This journal is intended for
the world so everyone understands the importance of handling and preventing dengue
fever with vector control.

74
 2. Quesionnaire

KUESIONER IDENTIFIKASI EFEKTIVITAS PROGRAM PENANGGULANGAN

DAN PENCEGAHAN DEMAM BERDARAH DENGUE DI KELURAHAN
SIDOTOPO WETAN
KELOMPOK 5

PERNYATAAN KESEDIAAN MENJADI RESPONDEN PENELITIAN

Dengan menandatangani lembar ini, saya:

Nama :

Jenis Kelamin :

Alamat :

Memberikan persetujuan untuk menjadi responden dalam kuesioner yang berjudul

“Survei Identifikasi Efektivitas Program Penanggulangan dan Pencegahan Demam Berdarah Dengue
di Kelurahan Sidotopo Wetan” yang akan dilakukan oleh Mahasiswa Kelompok 5 Modul
Kedokteran Tropis Program Studi Kedokteran Fakultas Kedokteran Universitas Airlangga.

Saya telah dijelaskan bahwa jawaban kuesioner ini hanya digunakan sebagai proses
pembelajaran dan saya secara suka rela bersedia menjadi responden.

Surabaya, 15 Desember 2018,

Yang menyatakan,

( )

75
 KUESIONER SURVEI IDENTIFIKASI EFEKTIVITAS PROGRAM
PENANGGULANGAN DAN PENCEGAHAN DEMAM BERDARAH DENGUE
DI KELURAHAN SIDOTOPO WETAN

Informed Consent

Selamat pagi.

Perkenalkan, kami mahasiswa Fakultas Kedokteran Universitas Airlangga semester 3 mohon

izin untuk melakukan survei terkait Identifikasi Faktor Resiko Kejadian Demam Berdarah Dengue di
Kelurahan Sidotopo Wetan untuk kepentingan proses pembelajaran modul Kedokteran Tropis.
Apakah bapak/ibu bersedia untuk berpartisipasi dalam survei ini?

Jika iya, saya mulai dengan pertanyaan terkait identitas bapak/ibu dibawah ini (langsung ke
pertanyaan pada halaman selanjutnya , halaman ini dilengkapi di akhir) :

Identitas

 Nama :
 Alamat asal :
 Alamat Surabaya :
 Tinggal sejak :
 Nomor HP :
 Umur :
 Jenis Kelamin :
 Status Pendidikan :
 Pekerjaan :
 Pendapatan* :
 Status Perkawinan* :

*Bapak / Ibu boleh menjawab atau tidak

76
 Hari, Tanggal pengisian : Sabtu, 15/12/2018

Petugas :
Kode responden :

 Umur :
 Jenis Kelamin :
 Status Pendidikan :
 Pekerjaan :

VIII. Pengetahuan
Interviewer: Selanjutnya, saya akan menanyakan pertanyaan terkait dengan hal-hal yang
bapak/ibu ketahui tentang Demam Berdarah.

No Pertanyaan Jawaban
1 Apakah bapak/ibu tahu mengenai Demam  Ya
Berdarah? j. Virus
Jika ya, apa penyebab demam berdarah? k. Bakteri
l. Makanan/ minuman
m. Jamur

 Tidak
2 Apakah Demam Berdarah ditularkan oleh  Ya
gigitan nyamuk?  Tidak

4 Tahukah bapak/ibu mengenai nyamuk  Ya

Demam Berdarah? Warna apa? j. Hitam
k. Hitam putih
l. Coklat
m. Abu-abu

 Tidak
5 Apakah bapak/ibu tahu kapan nyamuk  Ya
Demam Berdarah menggigit? i. Pagi
j. Siang
k. Sore
l. Malam

 Tidak
6 Apakah bapak/ibu tahu tempat nyamuk  Ya

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 Demam Berdarah bersarang? Jika ya, di o Didalam rumah
mana? o Diluar rumah
 Tidak
7 Apakah menurut bapak/ibu penyakit Demam  Ya
Berdarah itu berbahaya?  Tidak
8 Apakah penghuni rumah ada yang pernah  Ya
terkena Demam Berdarah?  Tidak
9 Apakah tetangga sekitar ada yang pernah  Ya
terkena demam berdarah dalam 3 bulan  Tidak
terakhir?
10 Menurut bapak/ibu, apakah air bersih yang  Ya
tergenang dapat digunakan sebagai tempat  Tidak
nyamuk Demam Berdarah bertelur?
11 Apakah bapak/ibu mengetahui program PSN  Ya
3M Plus (Pemberantasan Sarang Nyamuk)?  Tidak
12 Apakah kepanjangan dari 3M Plus?
13 Apakah bapak/ibu mengetahui manfaat  Ya
fogging? Jika ya, apa manfaatnya? i. Membunuh jentik-jentik
j. Membunuh nyamuk dewasa
k. Membunuh telur nyamuk
l. Lainnya,…………
 Tidak
14 Apakah bapak/ibu tahu mengenai Jumantik?  Ya
 Tidak
15 Apakah bapak/ibu mengetahui fungsi bubuk  Ya
abate? Jika ya, apa fungsinya? i. Menjernihkan air
j. Membunuh jentik nyamuk
k. Menghilangkan bau pada air
l. Membuat air jadi tahan
lama
 Tidak
16 Apakah bapak/ibu mengetahui cara  Ya
menggunakan bubuk abate?  Tidak

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IX. Sikap
Interviewer:
Berikutnya, saya akan menanyakan beberapa pertanyaan terkait dengan sikap bapak/ibu mengenai
Demam Berdarah.

Pertanyaan Jawaban
1 Menurut bapak/ibu, apakah penyuluhan mengenai Demam  Ya
Berdarah perlu dilakukan?  Tidak
2 Apakah bapak/ibu setuju dengan pelaksanaan fogging di  Ya
lingkungan rumah?  Tidak
3 Apakah setelah fogging Bapak/ibu merasa aman dari penyakit Demam  Ya
Berdarah?  Tidak
4 Apakah bapak/ibu setuju dengan pemakaian bubuk abate?  Ya
 Tidak
5 Apakah bapak/ibu setuju dengan pelaksanaan program Satu Rumah  Ya
Satu Jumantik?  Tidak
6 Menurut bapak/ibu, apakah pengawasan terhadap jentik perlu  Ya
dilakukan?  Tidak
7 Apakah bapak/ibu sering menggantung pakaian?  Ya
 Tidak

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X. Perilaku
Interviewer: Berikutnya, saya akan menanyakan beberapa pertanyaan terkait dengan perilaku
bapak/ibu mengenai Demam Berdarah.

Pertanyaan Jawaban
1 Apakah Bapak/ibu menguras tempat- tempat berikut  Bak mandi
ini?  Vas bunga
 Tempat minum burung
 Tatakan dispenser
 Ban bekas
 Penampungan air lemari
es
ss2 Berapa kali Bapak/ibu menguras bak kamar mandi  1x seminggu
dalam seminggu?  2x seminggu
 3x seminggu
 Lainnya…………………..
3 Apakah Bapak/ibu menutup tempat penampungan air  Ya
seperti gentong dan ember?  Tidak
4 Apakah Bapak/ibu mengubur barang- barang bekas  Ya
yang bisa menampung air hujan?  Tidak
5 Apakah pernah diadakan fogging di rumah Bapak/ibu?  Ya
 Tidak
6 Apakah Bapak/ibu memakai pelindung dari gigitan  Ya
nyamuk? k. Kelambu
Jika ya, berikan centang pada tempat berikut! l. Obat nyamuk bakar
m. Obat nyamuk
semprot
n. Raket nyamuk
elektrik
o. Lotion anti nyamuk
 Tidak
7 Apakah di rumah ini ada yang berperan sebagai  Ya
Jumantik?  Tidak
8 Apakah Bapak/ibu sudah/pernah memakai bubuk abate?  Ya

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  Tidak
9 Apakah Bapak/ibu memelihara ikan di bak mandi?  Ya
 Tidak
10 Apakah Bapak/ibu pernah mengikuti penyuluhan  Ya
Demam Berdarah?  Tidak
11 Apakah ada program bersih bersih lingkungan sekitar  Ya
yang diadakan oleh kelurahan maupun rt/rw bapak/ibu ?  Tidak

XI. Evaluasi Progrm Penanggulangan dan Pencegahan DBD

Interviewer: Selanjutnya saya akan menanyakan pendapat Bapak/ibu mengenai beberapa hal berikut

4. Menurut Bapak/Ibu manfaat apa saja yang Bapak/Ibu dapat setelah mendapat penyuluhan
dari kader/puskesmas?
(Jika responden pernah mendapat penyuluhan)

5. Menurut Bapak/Ibu seberapa efektif program pemerintah dalam menanggulangi dan

mencegahan demam berdarah pada kelurahan Sidotopo Wetan?

6. Menurut bapak/ibu apa saja usaha yang dapat dilakukan masyarakat setempat untuk
menurunkan angka kejadian demam berdarah?

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3. Leaflet

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