Unnes Journal of Public Health 7 (1) (2018)

Unnes Journal of Public Health

http://journal.unnes.ac.id/sju/index.php/ujph

Review of Environmental Aspects and Community Behavior in the

Determination of Filariasis Risk Vulnerability Zone

Nurul Khikmah1, Eram T. Pawenang2 

Public Health Science Study Program, Universitas Negeri Semarang, Indonesia.

12

Info Artikel Abstract

Article History: Pekalongan City is a filariasis endemic area with the highest number of filariasis cases in Cen-
Submitted October 2017 tral Java. One of the factors influencing the risk of transmission of filariasis is environmental
Accepted November 2017 factors and community behavior. The purpose of this research was to know the potential areas
Published January 2018 of filariasis transmission risk in terms of environmental condition and behavior of society.
This research was conducted on 6 urban villages in Pekalongan City on May-June 2017.
Keywords: It was quantitative descriptive research based on Geographic Information System (GIS) with
Environment; Commu- the object of research in the form of environmental factors and community behavior in the
nity Behavior;Filariasis mapping unit. The sample technique used proportional random sampling with 387 respond-
Vulnerability; ents in a sample area. Data analysis used univariat and spatial analysis with buffer, overlapping
and overlay techniques.
The result of this study were still there region that categorized very vulnerable to transmission
of filariasis with amount each variable as many as 55.3% (21 RWs) based on sewerage condi-
tion, 57.8% (22 RWs) based on the presence of stagnant water, 23.7% (9 RWs) based on the
night outdoor habit, 86.9% (33 RWs) based on the habit of using mosquito nets, and 39.5%
(15 RWs) based on the overlay of vulnerability to environmental conditions and community
behavior.

Abstrak
Kota Pekalongan merupakan daerah endemik filariasis dengan jumlah kejadian filariasis tertinggi
di Jawa Tengah. Salah satu faktor yang mempengaruhi tingkat risiko penularan filariasis di Kota
Pekalongan adalah faktor lingkungan dan perilaku masyarakat. Tujuan penelitian ini adalah untuk
mengetahui daerah potensial penularan filariasis ditinjau dari kondisi lingkungan dan perilaku ma-
syarakat. Penelitian ini dilakukan pada 6 kelurahan di Kota Pekalongan pada bulan Mei-Juni 2017.
Jenis penelitian ini adalah penelitian deskriptif kuantitatif berbasis Sistem Informasi Geografis (SIG)
dengan objek penelitian berupa faktor lingkungan dan perilaku masyarakat dalam unit pemetaan.
Pengambilan sampel perilaku dilakukan dengan teknik proporsional random sampling menggunakan
sampel wilayah terdahap 387 responden. Analisis data menggunakan analisis univariat dan analisis
spasial dengan teknik buffer, pengharkatan dan overlay.
Hasil penelitian menunjukkan bahwa masih terdapat wilayah yang masuk kategori sangat rentan
penularan filariasis proporsi sebanyak 55,3% (21 RW) berdasarkan kondisi SPAL, 57,8% (22 RW) ber-
dasarkan keberadaan genangan air, 23,7% (9 RW) berdasarkan kebiasaan keluar rumah pada malam
hari, 86,9% (33 RW) berdasarkan kebiasaan memakai kelambu, dan 39,5% (15 RW) berdasarkan
overlay kerentanan kondisi lingkungan dan perilaku masyarakat.

© 2018 Universitas Negeri Semarang


Corespondence Address:
F5 Building, 2nd Floor, Universitas Negeri Semarang, Sekaran, pISSN 2252-6781
Gunungpati, Semarang 50229 Central Java, Indonesia eISSN 2584-7604 ZZZZ
E-mail: eramtepe@mail.unnes.ac.id
 Nurul Khikmah & Eram T. Pawenang / Unnes Journal of Public Health 7 (1) (2018)

INTRODUCTION determinants of the filariasis elimination program

in the area are influenced by several aspects, namely
Filariasis is an infectious disease caused by the level of early endemicity in the filariasis region,
filarial worms through various types of mosquitoes. the effectiveness of mosquito vector, the procedure
This disease can cause permanent disability and eco- of mass treatment and population adherence. In ad-
nomic losses due to decreased productivity of pa- dition, based on research of Windiastuti et al (2013),
tients in endemic areas (Siwiendrayanti et al, 2016). Pekalongan City is still very potential as transmis-
WHO data show that in 2004, there were 1.3 billion sion area of filariasis and endemic with Mf Rate of
(65%) of the world’s population at risk of filariasis 6.67% (Windiastuti, 2013).
transmission in more than 83 countries, and 60% of The potential for transmission of filariasis
cases were in Southeast Asia, including Indonesia. disease is influenced by three things, namely the
In 2014 in Indonesia there was an increase of filaria- source of disease, vectors and vulnerable humans.
sis cases from 12,714 cases to 14,932 cases (Ministry The source of the disease is closely related to the
of Health Republic of Indonesia, 2014). presence of patients and reservoir hosts, the vector
Filariasis incidence in Indonesia is spread is highly dependent on the carrying capacity of the
throughout the province. In Central Java Provin- environment as a mosquito habitat, and the vul-
ce, in 2012 there were 565 cases and in 2015 there nerable human being associated with the behavior
were 508, which 108 cases were found in Pekalongan of the community in an effort to avoid themselves
City, the rest of which were spread in 33 other ci- from the bites of infectious mosquitoes (Ministry
ties/regencies. From 2004 to 2012, there were 2 sub- of Health Republic of Indonesia, 2014).This is in
districts (kecamatan) in Pekalongan City with the line with the research of Syuhada et al (2012)thatt-
highest number of cases namely Pekalongan Utara he most dominant environmental risk factors that
Sub-district (Bandengan and Padukuhan Kraton ur- influence the transmission of filariasis in Pekalon-
ban villages (kelurahan)) of 176 cases and Pekalon- gan City are the existence of stagnant sewerage, and
gan Selatan Sub-District (Kertoharjo, Kuripan Yoso- water puddles such as rice fields and swamps that
rejo, Jenggot, and Banyurip Ageng urban villages) of can become a breeding ground for filariasis vector
83 cases. In addition to the high number of cases, mosquitoes. While the behavior aspects of people
Pekalongan City is filariasis endemic area with MF who are more at risk of getting bites by the transmit-
Rate> 1%. Results of Finger-Prick Survey (SDJ) in ter vector are the habit of going out at night and the
2012 showed that urban villages which have MF habit of using mosquito nets while sleeping (Amelia,
rate> 1% that are Jenggot (5%), Kuripan Kertoharjo 2014). The results of this study were also reinforced
(2.4%), Padratuhan Kraton (3,7%), and Bandengan by the results of mapping conducted by Arum Siwie-
(2%). ndrayanti et al (2015) which shows that the location
Based on data of regional endemicity level of filariasis patients in Pekalongan City is located in
and international commitment in “The Global Goal the risky areas namely stagnant sewerage, swamps,
of Elimination of Lymphatic Filariasis as a Public and water puddles with community behavior that
Health by the Year 2020”, Pekalongan City imple- still tends to be prone to contact directly with the
mented a filariasis elimination program through transmitter vector.
Mass Drug Administration (MDA) for filariasis Based on a preliminary study conducted in
and treatment to prevent patient’s disability starting January 2017, it was known that six filariasis ende-
from year 2011 and was expected to end in 2015. mic villages in Pekalongan City have characteristics
However, based on the evaluation of post-five-year of various environmental and behavioral conditions
implementation of MDA for filariasis, the results of and have the potential to facilitate the transmission
the program were less optimal in breaking the chain of filariasis. Bandengan and Padukuhan Kraton ur-
of filariasis transmission so that Pekalongan City ban villages are coastal area and tidal flood prone
needs to continue the MDA. Program evaluation is area which during rainy and dry seasons there are
performed by examining antigen-antibody on 300 many stangnant sewerage that mixed with puddle
children aged 2 to 4 years old. If positive result is of tidal flood which has potency as breeding place
found in 1 person, then the mass treatment needs to of filariasis vector. While the other four urban vil-
be continued (Ministry of Health Republic of Indo- lages are not tidal flood-prone area but there are
nesia, 2014). still many rice fields and stagnant sewerage that can
During this time, filariasis elimination pro- increase the number of resting place and breeding
gram in Pekalongan City still focused on MDA for placce of filariasis vector. The diversity of behavior
filariasis and clinical case implementation without can be seen from the diversity of occupations that
reinforced by termination in the chain of transmis- will determine the intensity of outdoor activities at
sion. According to Kyelem et al (2008), the success night. The majority of coastal communities have jobs

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as fishermen, while the majority of urban communi- Pekalongan Utara subdistrict was performed in two
ties work as factory workers and entrepreneurs. In urban villages namely Bandengan and Padukuhan
addition, the people of Pekalongan City are also still Kraton (Pabean). While in the Pekalongan Selatan
full of religious routine activities (pengajian) which subdistrict conducted on four villages of Banyurip
activities are more often performed at night. (Banyurip Ageng), Jenggot, Kuripan Yosorejo (Ku-
In relation to the less optimal of MDA pro- ripan Lor), and Kuripan Kertoharjo (Kertoharjo).
gram for Filariasis in 2011-2015 and the condition The number of filariasis case in the study area was
of Pekalongan City both in terms of environment 54 cases.
and community behavior that still potential in fila- The type of research used in this research
riasis transmission, it is necessary to have an alter- is quantitative descriptive research based on Geo-
native problem solving which is integrated between graphic Information System (GIS). This descriptive
health services (MDA for filariasis) and the envi- research was performed by analyzing the data in
ronment or region planning to optimize the further aggregate using GIS approach to the environmental
filariasis elimination program in Pekalongan City to condition and behavior of the people, namely the
be implemented in 2017 and 2018. The alternative is existence and condition of sewerage, the existence
integrated management of area-based disease cont- of water puddles, the habit of going out at night, and
rol through spatial analysis. the habit of using mosquito net.
The previous research had seen the relation- The research objects were environmental fac-
ship between filariasis incidence with risk factors. tors and community behavior in the mapping unit.
Whereas the analysis of filariasis incidence is also The community behavior objects in this research
important to be seen in macro through the map of were 387 respondents in the research location that
vulnerability area that had never been done in Pe- met the criteria of inclusion-exclusion. Sampling
kalongan City. The spatial approach to vulnerability technique used was the technique of proportional
area is very effective in providing regional informa- random sampling with details of the number of each
tion support for environmental management and urban village by 69 families in Bandengan urban vil-
regional planning related to the solving of envi- lage, 44 families in Pabean urban village, 59 fami-
ronmental problems more comprehensively. A vul- lies in Banyurip Ageng urban village, 113 families
nerability map also provides data that can help in in Jenggot urban village, 28 families in Kertoharjo
epidemiology such as the most appropriate location urban village and 74 families in Kuripan Lor urban
suggestion for the delivery of health interventions village.
(Masimalai, 2014). The research data sources were primary data
Based on the urgency of the problem and and secondary data. In this study, primary data were
unknown pattern of post-mass endemic vulnerabi- obtained through direct observation of environmen-
lity area about the distribution of filariasis cases in tal conditions and in-depth interviews with respon-
terms of environmental factors and behavior of the dents to know the behavior of respondents. While
people of Pekalongan City in the image actualiza- secondary data in this research were obtained from
tion, the purpose of the research was to determine Pekalongan City Health Office, Pekalongan Selatan
the pattern of vulnerability areas of filariasis trans- Health Center (Puskesmas), Buaran Health Center,
mission based on environmental aspects and com- Jenggot Health Center, and Dukuh Health Center in
munity behavior in Pekalongan City in the form of the form of filariasis patient data based on the last
sewerage, the existence of water puddles, the habit FBS (Finger Blood Survey) result in the research lo-
of going out at night and habit of using mosquito cation. In addition, other secondary data sources in
net. This study is a part of the research scheme en- the form of image maps and spatial plans data of Pe-
titled “AKTIF-MANDIRI Program as Acceleration kalongan City were obtained from the Department
Enhancment of Filariasis Elimination in Lowering of Public Works (DPU) of Pekalongan City.
MF-Rate of Endemic Filariasis Area in Pekalongan The research instruments used in this study
City” (Program AKTIF-MANDIRI sebagai Penyem- were patient medical records, questionnaires, Glo-
purna Akselerasi Eliminasi Filariasis dalam Menu- bal Positioning System (GPS), baseline map of RW
runkan Mf-Rate Wilayah Endemis Filariasis di Kota (hamlet), satellite imagery, and Geographic Infor-
Pekalongan). mation Systems (GIS) software. This medical record
was used to find out data of filariasis patient which
METHODS include patient name, age, gender and patient’s
address. Questionnaire sheets were used when in-
This research was conducted in the filariasis- terviewing respondents to find out the habits or be-
endemic area in Pekalongan City, Pekalongan Utara havior of the respondents. The Global Positioning
and Pekalongan Selatan Subdistricts. Research in System (GPS) device was used to digitize the locati-

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on of filariasis patients and environmental variables behavior in accordance with the rule of the Ministry
including sewerage conditions, the presence of water of Health Republic of Indonesia that is not going out
puddles which is then inputted into the geographic at night and use mosquito net while sleeping. The
information system software (GIS). boundaries of each category based on community
Data collection techniques in this research behavior can be seen in Table 2.
were observation, interview, and documentation. The overlay technique was used by overlap-
The observation was performed by direct observa- ping several parameters that affect the vulnerabili-
tion of the environment variable condition and at ty of filariasis transmission in the same area. While
the same time digitize the existence of the variable overlapping was performed to facilitate the overlay
for reference correction materials of spatial plans activity by scoring each parameter so that will be
that have been obtained. In addition, the observa- obtained vulnerability area of filariasis transmissi-
tion was made to determine the location of filaria- on. Overlapping was performed by using a sturgess
sis patients who were then digitized with the help formula with a score boundary of each vulnerability
of Global Positioning System (GPS) tool. The inter- zone classification as shown in Table 3.
view was conducted by using questionnaires sheet to
know the habit or behavior of the respondent. While RESULTS AND DISCUSSION
the documentation was performed by taking pictu-
res on the condition of environmental variables and The vulnerability of filariasis transmission
research stages that had been done. risk in Pekalongan City in this study was observed
Spatial data analysis was performed by using from environmental conditions and community be-
SPSS application in univariate analysis of respon- havior which include vulnerability of sewerage con-
dent behavior and geographic information system dition, the vulnerability of water puddle, vulnerabi-
software (GIS). Data processing that uses SPSS was lity of night outdoor habit and vulnerability of using
performed to analyze the percentage of habits or be- mosquito net habit. Vulnerability distribution of
havior of respondents which was inputted into GIS filariasis transmission risk in Pekalongan City 2017
devices. Spatial analysis was performed by using can be seen in Table 4.
buffer, overlay, and overlapping techniques.
The buffer technique was used to obtain the Vulnerability of The AreaIn Terms of SEWER-
percentage of area within the flight distance of fila- AGE Existence and Condition
riasis transmitter mosquitoes in the research area. Based on Table 4, it is known that 7 RWs in
Variables of research which analyzed by using buffer Pekalongan Utara subdistrict that included in very
technique that are condition variables of open and vulnerable area namely the RWs of 1, 3, 4, and 5 in
stagnant sewerage and water puddle. After buffer Bandengan urban village and the RWs of 12, 13 and
was performed and percentage of buffer area was 15 in Pabean urban village. While the area of Peka-
obtained, then the categorization of vulnerability longan Selatan subdistrict that was categorized very
analysis of filariasis with the rules as shown in Table vulnerable area namely Banyurip Ageng urban villa-
1. ge (the RWs of 1, 2, and 3), Jenggot urban village (the
As for the categorization of community be- RWs of 1, 2, 3, 4, 5, 6, 7, 8, and 9), and Kertoharjo
havior in the form of the habit of going out at night urban village (the RWs of 7 and 9). It shows that the
and habit of using mosquito net was performed by condition of sewerage in Pabean, Bandengan, Bany-
doing the percentage of respondent who have good urip Ageng, Jenggot, and Kertoharjo urban villages

Table 1. Boundaries of Vulnerability Category of Sewerage and Water Puddles

Variable Vu l n e r a b i l i t y Statistical Rules Boundary Score
Category
Very vulnerable X > SD+Mean Very vulnerable= X > 98% 1
Sewerage Con- Vulnerable Mean-SD ≤X≤ Vulnerable
2
dition SD+Mean = 73.2% ≤ X ≤ 100%
Not vulnerable X < Mean-SD Not vulnerable= X < 73.2% 3
Very vulnerable X > Mean+SD Very vulnerable= X > 66.49% 1
Mean-SD ≤X≤ Vulnerable
Water Puddle Vulnerable 2
Mean+SD = 58.63% ≤X≤ 66.49%
Not vulnerable X < Mean-SD Not vulnerable= X < 58.63% 3

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Table 2. Boundaries of Vulnerability Category of The Night Outdoor Habit and The Habit of Using Mosquito
Net
Variable Vulnerability Category Batasan Score
Very vulnerable >66.7% of respondents have a night outdoor 1
habit
The Night Out- Vulnerable 33.3-66.7% of respondents have a night outdoor 2
door Habit habit
Not vulnerable < 33.3% of respondents have a night outdoor 3
habit
Very vulnerable >66.7% of respondents have a habit of not using 1
The Habit of mosquito nets
Using Mos- Vulnerable 33.3-66.7% of respondents have a habit of not 2
quito Net using mosquito nets
Not vulnerable < 33.3% of respondents have a habit of not us- 3
ing mosquito nets
there were still open and stagnant areas that enter a larger number of mosquito eggs will increase the
the buffer> 98% from the area which stated that the number of infectious vectors, which in turn will in-
average sewerage condition in the filariasis endemic crease the vulnerability of the area to get infected by
area in Northeast of Brazil amounted to 65.4% in the filariasis due to mosquito habitat. As Mutheneni et
form of open and stagnant sewerage. The open and all (2015) study stated that poor drainage conditions
stagnant sewerage strongly supports the proliferati- increase the risk of infected by filariasis with OR of
on of the transmitter vector as it is known that the 3.5.
potential vector in Pekalongan City comes from the In addition to the polluted sewerage condi-
Culex quinquefasciatus mosquito species (Nurjazuli, tions, there were some sewerage puddles in areas
2015). that is very vulnerable namely Kertoharjo Urban Vil-
Sewerage condition in RW areas which were lage where there were mosquito larvae. The presence
included in the very vulnerable area of Pekalon- of puddles with larva indicated that the location is
gan Utara Subdistrict that were open and stagnant suitable for breeding place by mosquito vectors. The
as well as mixed with tidal flood water and garba- presence of puddles with mosquito larvae may inc-
ge along sewerage track, either right or left of the rease the risk of occurrence of filariasis transmission
road. While in Pekalongan Selatan subdistrict, water with OR of 6.00 (Sarungu et al, 2012).
in sewerage was dominated by domestic waste and Meanwhile, based on filariasis patients it
home industry in the form of soap water, detergent is known that the highest proportion of filariasis
water, and leaf litter. The presence of sewerage con- patients were found in very vulnerable area based
taminated with open and stagnant waste was very on sewerage condition of 69.1% (38 patients) that
beneficial in the formation of vector mosquito bree- spread in the RWs of 1, 3, 4, and 5 in Bandengan
ding habitat (Ladan, 2014). Breeding habitat of fila- Urban Village, the RWs of 12, 13 and 15 in Pabean
riasis transmitter mosquitoes according to Nguyen Urban Village, the 4 RW in Banyurip Ageng Urban
et al (2012) is a polluted sewer that has adequate Village, the 5 RWs of Jenggot Urban Village, and
nutrients for seasonal oviposition processes. Higher the 9 RW of Kertoharjo Urban Village. The results
nutritional concentrations according to research by are in accordance with the study of Upadhyayula et
Dowling et al (2013) also make more microbes as al (2012) which suggested that areas with high risk
food sources of vector larvae and reduce predator due to open drainage and more water puddle have a
competition. In addition, contaminated sewerage greater number of filariasis positive cases compared
can also make the number of Culex quinquefasciatus to areas with closed drainage conditions.
mosquito become more numerous. The presence of The existence of a very vulnerable area due
Table 3. Scoring of Vulnerability Zone Classification
No Vulnerability Zone Classification Overlapping Score
1 Very vulnerable 4-6
2 Vulnerable 7-9
3 Not vulnerable 10-12

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Table 4. Overlapping and Categorization Results of Risk Vulnerability of Filariasis Transmission in Pe-
kalongan City 2017
Urban Village RW A B C D Total Score Level of Area Vulnerability
Pabean 12 1 1 2 2 6 Very vulnerable
13 1 1 1 2 5 Very vulnerable
14 2 1 2 1 6 Very vulnerable
15 1 3 2 2 8 Vulnerable
Bandengan 1 1 3 2 1 7 Vulnerable
2 2 1 1 1 5 Very vulnerable
3 1 1 2 1 5 Very vulnerable
4 1 1 3 2 7 Vulnerable
5 1 1 2 1 5 Very vulnerable
6 2 1 2 1 6 Very vulnerable
Banyurip Ageng 1 1 1 1 1 4 Very vulnerable
2 1 3 2 1 7 Vulnerable
3 1 1 1 1 4 Very vulnerable
4 2 1 2 1 6 Very vulnerable
5 2 1 1 1 5 Very vulnerable
6 2 1 2 1 6 Very vulnerable
Jenggot 1 1 3 2 1 7 Vulnerable
2 1 3 2 1 7 Vulnerable
3 1 3 2 1 7 Vulnerable
4 1 1 2 1 5 Very vulnerable
5 1 3 2 1 7 Vulnerable
6 1 3 2 1 7 Vulnerable
7 1 3 3 2 9 Vulnerable
8 1 3 2 1 7 Vulnerable
9 1 3 2 1 7 Vulnerable
10 2 3 1 1 7 Vulnerable
11 2 3 2 1 8 Vulnerable
Kertoharjo 5 3 1 2 1 7 Vulnerable
6 2 1 2 1 6 Very vulnerable
7 1 1 1 1 4 Very vulnerable
8 2 1 1 1 5 Very vulnerable
9 1 1 1 1 4 Very vulnerable
10 3 1 2 1 7 Vulnerable
Kuripan Lor 1 3 3 2 1 9 Vulnerable
2 3 2 2 1 8 Vulnerable
3 3 2 2 1 8 Vulnerable
4 3 1 2 1 7 Vulnerable
5 3 1 2 1 7 Vulnerable
Information:
A : Score of Risk Vulnerability of Filariasis Transmission Based On Sewerage Condition
B : Score of Risk Vulnerability of Filariasis Transmission Based On Water Puddle Existence
C : Score of Filariasis Transmission Risk Vulnerability Based OnThe Night Outdoor Habit
D : Score of Filariasis Transmission Risk Vulnerability Based On The Habit of Using Mosquito Net

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to the open and stagnant sewerage conditions re- (the RWs of 5, 6, 7, 8, 9, and 10), and Kuripan Lor
quires community care and participation to clean (the RWs of 4 and 5).
it up in an attempt to decrease the potential level Results of survey in the field indicated that
in the transmission of filariasis to the surrounding the very vulnerable areas in Pekalongan Utara Sub-
environment. The research of Amelia (2014)also district (Pabean and Bandengan urban villages)
mentioned that by cleaning the mosquito habitat of have characteristics of water puddles in the form of
sewerage can decrease 8.556 times of filariasis inci- swamps with aquatic plants with a distance from the
dence risk. In addition to the need for an active role settlement that is not too far (<200 m). The research
of the community to clean the habitat of mosquito- of Ikhwan et al (2016)mentioned that settlements
es, this case also needs a cross-sectoral cooperation that close to water puddle in the form of swamps
by local governments in an effort to improve the are more significant for the occurrence of filariasis
condition of open and stagnant sewerage in order to transmission or filariasis incidence with OR of 1.358.
become the sewerage that in accordance with exis- This is in line with the research of Jontari et al (2014)
ting regulations. which showed the presence of swamp puddles at a
distance <100 m which increases the incidence of
Vulnerability of The Area In Terms of Water filariasis occurrence with OR 6.2. This association
Puddle Existence occurs because the characteristics of swamps with
Based on Table 4, it is known that the RW aquatic plants can be used as breeding grounds and
areas in the Pekalongan Utara subdistrict and Peka- increase the number of mosquitoes. Culex quinque-
longan Selatan subdistrict were still in the category fasciatus mosquito larvae are found to be highest
of very vulnerable (buffer area> 66.49%) and vulne- in permanent water habitats such as swamps with
rable (buffer area between 58.63- 66.49%). The pro- aquatic vegetation especially in summer (Grech et
portion of area in Pekalongan Utara subdistrict that al, 2013).
included in the very vulnerable zone was 83,33% (5 Meanwhile, the areas in Pekalongan Selatan
RWs that are 2, 3, 4, 5, and 6) in Bandengan and 75% District that included in very vulnerable zone have
(3 RWs that are 12, 13, and 14) in Pabean. While the characteristic of water puddle in the form of wet rice
areas in Pekalongan Selatan subdistrict that inclu- field area which is united with residential area.This
ded in very vulnerable zone namely Banyurip Ageng is in line with the research of Mulyonoet al (2008)
Urban Village (the RWs of 1, 3, 4, 5, and 6), Jenggot in Pekalongan Regency,that the existence of water
Urban Village (the 4 RW), Kertoharjo Urban Village puddle in the form of rice fields around the house

Table 5. Filariasis Patients Location Based On Environmental Condition and Behavior of Communityin
Pekalongan City 2017
Vulnerability Category Vulnerability Number of Pa- Pecentage (%)
Level tients (people)
Vulnerability Based On Sewerage Very vulnerable 38 69.1
Condition Vulnerable 15 27.3
Not vulnerable 2 3.6
Vulnerability Based On Water Pud- Very vulnerable 33 60
dle Existence Vulnerable 0 0
Not vulnerable 22 40
Vulnerability Based On The Night Very vulnerable 25 45.4
Outdoor Habit Vulnearble 29 52.7
Not vulnerable 1 1.9
Vulnerability Based On The Habit Very vulnerable 48 87.3
of Using Mosquito Vulnerable 7 12.7
Not vulnerable 0 0
Vulnerability Based On environ- Very vulnerable 30 54.5
mental condition and behavior of Vulnerable 25 45.5
community
Not vulnerable 0 0

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increases the risk of 10.31 times greater to get filaria- nerable areas (RWs of 9 and 10 in Kertoharjo Urban
sis disease. The association occurs because the rice Village), but filariasis patients in Jenggot (RWs of 5
field becomes a risky habitat for filariasis vector be- and 11) and Banyurip Ageng urban village (the 2
cause the fields have water puddle that can be used RW) are in not vulnerable areas. It shows that there
by mosquitoes to lay eggs and breed until the pupa are other factors besides the existence of water pud-
stage. dle that more support the filariasis incidence both
Culex quinquefasciatus vectors are generally from the environment and community behavior as-
in a dirty habitat, but they also have high adaptive pects.
and invasive behaviors to survive in puddles such
as rice fields when ecological changes occur. Thus, Vulnerability of The Area In Terms of The Habit
these mosquitoes have the potential to initiate and of Going Out at Night
facilitate the transmission of disease by establishing Based on Table 6, it is known that all urban
a vector-host transmission cycle in different Indo- villages that included in the category of very vulne-
nesian environments (Bhattacharya & Basu, 2016). rable tofilariasis transmission (except Kuripan Lor)
Based on filariasis patients in the study sites, namely Bandengan (the 2 RW), Pabean (the 13 RW),
it can be seen that the highest proportion is in vul- Banyurip Ageng of 50% (3 RWs that are 1, 3, and 5),

Figure 1. Distribution Map of Filariasis Transmission Risk Vulnerability In Terms of

Environmental Condition and Community Behavior with Patients Distribution in North
Pekalongan Subdistrict

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Figure 2. Distribution Map of Filariasis Transmission Risk Vulnerability In Terms of

Environmental Condition and Community Behavior with Patients Distribution in South
Pekalongan Subdistrict

Jenggot (the 10 RW) and Kertoharjo of 50% (3 RWs including Pekalongan City (Amelia, 2014). The re-
that are 7, 8, and 9). While the area that included search of Ardias (2012) showed that people in fila-
into the not vulnerable area only found in the 4 RW riasis-endemic areas who have a night outdoor habit
in Bandengan and the 7 RW in Jenggot Village. The are more vulnerable to filariasis with OR 39.054.
results also showed the average percentage of res- The habit of going out at night increases the
pondents from all urban villages who have the night potential for filariasis transmission. It is based on
outdoor habit as much as 57.4%. This indicated that bionomic of Culex quinfasciatus mosquito which
the average of the six urban villages which was the acts as a filariasis transmitter in Pekalongan City
research area included into the category of vulne- that more active biting at night after sunset until
rable areas of filariasis transmission. sunrise with peak density on 20.00-21.00 WIB and
The habit of going out at night affects the 22.00-23.00 WIB (Ramadhani & Wahyudi, 2015). In
transmission and occurrence of filariasis in a filaria- addition, Culex quinfasciatus mosquitoes prefer to
sis endemic area (Ardias, 2012; Sapada et al, 2014), suck human blood in than the others (Janssen et al,

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 Nurul Khikmah & Eram T. Pawenang / Unnes Journal of Public Health 7 (1) (2018)

2015). longan City, 87.3% of patients (48 patients) were lo-

When doing the night out activities, it is re- cated in the very vulnerable areas. Other cases were
commended by the Ministry of Health of the Re- the vulnerability area of filariasis transmission but
public of Indonesia in an effort to prevent filariasis adjacent to very vulnerable areas.
to use anti-mosquito lotion and wear long-sleeved Theoretically, the habit of using mosquito net
clothes. So the greater the percentage of people in is one method of community self-protection against
an area that has a habit of going out at night without the transmission of vector-borne disease such as fi-
using anti-mosquito lotion and wearing long-slee- lariasis disease (Sarungu, 2012). The high percenta-
ved shirts when mosquitoes are active foraging, the ge of people who do not do self-protection shows
area is more vulnerable to filariasis, especially in en- the greater the probability of the community to oc-
demic areas such as Pekalongan City. Endemic areas cur filariasis transmission, so that filariasis inciden-
with high microfilaria densities allow vector mos- ce may occur in the area. In the filariasis occurrence
quitoes to transmit microfilariae in their bodies at in areas with very low percentage of self-protection
the time of sucking blood (Wahyudiet al, 2016). The or very vulnerable areas of filariasis transmission,
interview results of people who have a habit of going it will facilitate the mobility of filariasis transmissi-
out at night in the study area are known that people on in the area. So the habit of using mosquito nets
still often perform activities at night such as recita- during sleep affects the spread and transmission of
tion activities, working overtime, night patrol, and filariasis disease.
chat outside the home without using anti-mosquito The results of in-depth interviews on the
lotion. As it is known that Culex mosquitoes have community that use the mosquito net in Pekalon-
exophilic and exophagic properties that more often gan City, obtained that 97.8% of the mosquito net
bite when outside the room, so people who do ac- condition is perfectly closed and without the hole,
tivities outside the home have more mosquito bites while the rest of the condition is net with holes. The
frequency compared with people who do activities use of mosquito nets recommended by the Ministry
in the house (Anindita, 2016). of Health of the Republic of Indonesia that the mos-
Based on the location of the patient, the pro- quito net should be in a perfectly closed condition
portion of filariasis case location was the very vul- and without hole either ordinary mosquito nets
nerable zone of 45.4% (25 patients), the vulnerable and insecticide-treated nets (dyed in insecticide na-
zone of 52.7% (29 patients) and the not vulnerab- mely Insecticide Bed Net type). So if the mosquito
le zone of 1.9% (1 patient). The results are also in net with hollow bigger than the mosquito body, the
line with research Windiastuti (2014) that filariasis mosquito will easily enter the mosquito net and bite
cases in endemic areas more commonly found in the human. However, on the principle of use, mos-
respondents who have a habit of going out at night quito nets will not be meaningless if not followed by
with a percentage of 51.3%. Therefore, people in are- regular use.
as that are very vulnerable are advised to conduct
self-protection when going outdoors at night such Filariasis Transmission Risk Vulnerability In
as wearing long-sleeved shirts and apply mosquito Terms of Environmental Condition and Commu-
repellent. nity Behavior
The environmental and behavioral compo-
Vulnerability of The Area In Terms of The Habit nents of the community that are the focus of rese-
of Using Mosquito Net arch namely the existence and condition of sewera-
Based on Table 4, it is known that from all ge, the existence of water puddle, the habit of going
areas of the research area, there are still very vulne- out at night and the habit of not using mosquito net
rable areas with a total proportion of of 60% (6 RWs while sleeping. Based on figures 1 and 2. it is known
that are 1, 2, 3, 5, and 6 in Bandengan Urban Village, that in Pekalongan City there were 17 RWs (44.7%)
and the 14 RW in Pabean Urban Village) in Kecama- which included into very vulnerable category and 21
tan Pekalongan Utara and 96.4% (27 RW ie all areas RWs (55,3%) which were categorized as vulnerable
of RW except RW 7 Kelurahan Jenggot) in Pekalon- based on environmental aspect and community be-
gan Selatan Subdistrict. The other 5 RWs included havior, with the RWs of 1, and 3 in Banyurip Ageng,
into the category of vulnerable areas. The proporti- and the 9 RW in Kertoharjo were the very vulnerable
on of Urban Village with the most vulnerable zone area of the highest risk of filariasis transmission that
was found in Banyurip Ageng Urban Village(100%), is based on high vulnerability in all aspects of envi-
Kertoharjo Urban Village (100%) and Kuripan Lor ronmental conditions and community behavior.
Urban Village (100%) with the percentage of res- In terms of each variable of filariasis trans-
pondents who did not use bed nets <16.67%. While mission risk vulnerability, between RW areas have
reviewing the location of filariasis patients in Peka- various risk factors that affect a region into a very

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 Nurul Khikmah & Eram T. Pawenang / Unnes Journal of Public Health 7 (1) (2018)

vulnerable zone category. The RW areas in Pabean ment condition and community behavior in Peka-
and Bandengan that included into the very vulne- longan City, with the areas ofthe RWs of 1and 3 in
rable category were dominated by sewerage con- Banyurip Ageng, and the 9 RW in Kertoharjo were
ditions and the existence of very vulnerable water the very vulnerable area of the highest risk of filaria-
puddles. The RW in Banyurip Ageng which is cate- sis transmission that is based on high vulnerability
gorized as very vulnerable was more dominated by in all aspects of environmental conditions and com-
the presence of water puddle, the habit of going out munity behavior.
at night and the habit of using mosquito net. The RW
in Jenggot which included into the very vulnerable ACKNOWLEDGEMENT
category was dominated by sewerage condition fac-
tor and habit of using mosquito net. While the RW This study is a part of the research scheme en-
in Kertoharjo which is categorized as very vulnerab- titled “AKTIF-MANDIRI Program as Acceleration
le which was dominated by the existence of water Enhancement of Filariasis Elimination in Lowering
puddle, the habit of going out at night and the habit Mf-Rate of Endemic Filariasis Area in Pekalongan
of using mosquito net, but at the RWs 7 and 9 there City (Program AKTIF-MANDIRI sebagai Penyem-
was additional factor that is condition of sewerage. purna Akselerasi Eliminasi Filariasis dalam Menu-
Based on the location of the patient, the lo- runkan Mf-Rate Wilayah Endemis Filariasis di Kota
cation of filariasis patients were all located in the Pekalongan)” which is funded by the Directorate of
vulnerable and very vulnerable areas based on en- Research and Community Service, Ministry of Re-
vironmental conditions and community behavior in search Technology and Higher Education. The aut-
Pekalongan City 2017. The proportion of patients at hor express the gratitude to Arum Siwiendrayanti,
each level of vulnerability is 54.5% (30 patients) were Eram Tunggul Pawenang, and Sofwan Indarjo who
in very vulnerable and 45.5% (25 patients) were in had allowed author to be involved in the research.
vulnerable areas. This is in accordance with the the-
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