CD Disertasi

Model Penanggulangan Pneumonia Berbasis Lingkungan Pada Balita Di Kabupaten Rokan Hilir Provinsi Riau = Environmental Based Pneumonia Prevention Model For Under-Five In Rokan Hilir, Riau Province

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Pneumonia is the leading cause of death among children under 11 months of age, accounting for 14.5% of the cases. In the 12–59-month age group, pneumonia was ranked as the second most common cause of death, with a proportion of approximately 5.05%. The Rokan Hilir District, located in Riau Province, has a high prevalence of under-five pneumonia (2.04 %). This prevalence surpasses the regional average in the Riau Province, highlighting issues with case identification coverage and suboptimal pneumonia management. Managing airborne diseases, such as pneumonia, is complex and is influenced by fluctuating determinant factors, climatology, and spatial distribution patterns. The success of under-five pneumonia management depends on adaptation to these dynamic variables. This study aimed to establish a comprehensive and sustainable model for pneumonia prevention. The model extends beyond medical interventions and public health services by incorporating innovative approaches, such as risk factor integration, climatology, spatial distribution patterns, and dynamic system modeling. The outcome will be a more realistic, effective, and efficient countermeasure scenario tailored to regional vulnerability priorities in Rokan Hilir District. Materials and Methods: This study employed a mixed-methods approach that combined quantitative, spatial, and system dynamics methodologies. This study encompasses various determinant dimensions of under-five pneumonia cases, including demographic factors (population density and under-five population), social factors (exclusive breastfeeding, personal hygiene, and cleanliness practices), economic factors (malnutrition, healthy housing conditions, and poverty levels), health facility factors (under-five health services, health workforce, and healthcare facilities), and environmental factors (air temperature, humidity, rainfall, and PM 2.5 µm concentration). Data on under-five pneumonia cases were gathered through observations and screening of P2-ISPA data from 20 healthcare centers. Concurrently, determinant factors were acquired through observations and screening of secondary data obtained from various relevant Regional Apparatus Organizations (OPDs). Environmental data, such as air temperature variability, humidity, rainfall, and PM 2.5 µm concentration, were sourced from NASA-USA MERRA-2 and USGS CHIRPS data repositories. The analysis of the existing conditions, determinant factors, and the relationship between determinant factors and under-five pneumonia cases employed a quantitative approach utilizing boxplot and Generalized Poisson Regression (GPR) methods, supported by RStudio software version 2022.07.1+554. The analysis of spatial distribution patterns of determinants and vulnerability levels in under-five pneumonia cases utilized the Breusch-Pagan, Moran's I, and Flexibly Shaped Spatial Scan Statistic methods, aided by GeoDa software version 1.20.0.20, FlexScan version 3.1.2, and ArcGIS Desktop version 10.8. The modeling of the under-five pneumonia case management adopted a dynamic system approach with the assistance of Powersim Studio 10 Academic 64-bit software, version 10.14.5555.6. Results and Discussion: The study revealed a 2.45% annual increase in pneumonia cases among children under-five years of age in the Rokan Hilir District from 2015 to 2021. The peak occurred in 2021, with an average of 111 cases per subdistrict. Boxplot analysis indicated positive skewness, signifying that certain sub-districts had more cases than the district average. Spatial analysis using natural breaks categorized sub-districts, with Bangko, Bagan Sinembah Raya, Bagan Sinembah, Bangko Pusako, Tanjung Medan, and Tanah Putih in the high category (146-246 cases), Pasir Limau Kapas, Kubu, Simpang Kanan, Balai Jaya, Pujud, and Rimba Melintang in the medium category (50-145 cases), and Sinaboi, Kubu Babussalam, Pekaitan, Batu Hampar, Tanah Putih Tj. Melawan and Rantau Kopar were in the low category (18-49 cases). Poisson regression identified key determinants, including population density, rainfall, malnutrition, exclusive breastfeeding, healthy homes, under-five health service coverage, and health facility count. A 1% increase in under-five malnutrition was correlated with a 6-case increase in under-five pneumonia. Similarly, a 1% increase in population density, rainfall, and health facilities resulted in one more case of under-five pneumonia cases. Conversely, a 1% increase in exclusive breastfeeding, under-five health service coverage, and healthy homes led to a 1-case decrease. Spatially, the under-five pneumonia cases exhibited a random distribution, lacking spatial autocorrelation between the subdistricts. The Flexibly Shaped Spatial Scan Statistic identified two hotspots: the first in Bagan Sinembah Raya with a 2.26 times higher risk, and the second in Tanah Putih Tj. Melawan, Tanjung Medan, Simpang Kanan, Kubu, Pasir Limau Kapas, Bangko, and Bangko Pusako had a 1.12 times higher risk. This study employed an innovative DDSM-UPI (Dianad's Dynamic Spatial Model for Under–Five Pneumonia Intervention) approach, integrating variables and spatial patterns into a dynamic model. Under the business-as-usual scenario (BAU), the number of cases increases by 7.20% annually. A moderate intervention in 2023 resulted in an annual reduction of 4.29%. A more ambitious progressive intervention yielded a 23.14% yearly decrease in the number of cases of under-five pneumonia. Conclusion: The rising trend of under-five pneumonia cases in the Rokan Hilir District is driven by determinants such as population density, malnutrition, exclusive breastfeeding, housing conditions, coverage of under-five health services, and the spatial distribution of health facilities in high-risk hotspot areas. Simulations using DDSM-UPI under the BAU scenario revealed a significant increase in under-five pneumonia cases at the end of the simulation period. Considering the availability of human resources, budgets, facilities, and multi-stakeholder cooperation, the moderate scenario emerges as the most suitable and practical approach for addressing under-five pneumonia cases in Rokan Hilir District, with a focus on high-risk hotspots.

Reference: 175 (from 2001th – 2023th)

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Ketersediaan

Informasi Detail

Judul Seri

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No. Panggil

2010347386

Penerbit

Pekanbaru : Universitas Riau – PASCASARJANA – S3 Ilmu Lingkungan., 2024

Deskripsi Fisik

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Bahasa

Indonesia

ISBN/ISSN

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Klasifikasi

2010347386

Tipe Isi

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Tipe Media

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Tipe Pembawa

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Edisi

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Subjek

PASCASARJANA (DISERTASI) ILMU LINGKUNGAN

Info Detail Spesifik

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Pernyataan Tanggungjawab

Mutia

Versi lain/terkait

Lampiran Berkas

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