gender and prevention of dengue haemmorragic fever at malang city - lilikz

8/3/2019 Gender and Prevention of Dengue Haemmorragic Fever at Malang City - Lilikz

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GENDER AND PREVENTION OFDENGUE HAEMMORRAGIC FEVERAT SAWOJAJAR AREA, MALANGCITY, EAST JAVA, INDONESIA

Lilik Zuhriyah

Loeki Enggar Fitri

Harun Al Rasyid

This had been presented at 16trh Qualitative Health Research Conference 'Challengingthe Boundaries'16th Annual Qualitative Health Research ConferenceVenue: Coast Plaza Hotel and Suites, Vancouver, British Columbia, October 3-5, 2010


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INTRODUCTION


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INCIDENCE OF DHF AT MALANG CITY2008

Sawojajar Area

30 cases, 1 died

Klojen Sub District

109 cases, 2 died

LarvaFree Index inMalang City = 85,7%

vs target 95%


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BLUM THEORY

Healthstatus

Environmental(OR = 40,765;Ganeshan et

al., 2007)

Genetic

Health service

Behavioralfactors (OR =

5,604;Ganeshan et

al, 2007)


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(HEALTH) CADRES

PosyanduCadres

Othertypes

Jumantikcadres

CommunityHealth Center

Otheragency/

party

society


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GENDER ISSUE

lesscooperativeattitude of

someresidents

Jumantik roleFailure of

DHF

Prevention

how far women's voice is heard by thesociety so that the prevention of DHF will be

successful


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SELF MONITORING TOREDUCE RISKYBEHAVIOROF DHF AND LARVA DENSITY INDEX

QualitativeResearch

BaselineSurvey

Intervention

: applicationof Self

MonitoringCalendar

End lineSurvey


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DESIGN STUDY

a qualitative research

method of data collection :

Focus Group Discussion(FGD)

community leadershealth cadres/Jumantik

discussions with key figures

Local Community Health Center

observations.

the existence of larva

the ability of cadres in observing larva


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TIMEANDPLACE

Sawojajar area Kedung Kandang Sub districtMalang city

July to November 2009.


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MANAGEMENTANDANALYSISOFDATA

Data of FGD transcript Summary

Data of Discussion Summary

Data of Observation Summary

SourceTriangulation

MethodTriangulation

DataTriangulation

Thematic AnalysisMethod


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THETHEMES

1. job division

2. DHF causes

3. prevention of DHF

4. the constraints in the prevention of DHF

5. the expectations of Jumantiks role

6. the expectations of the potential role of

health centers7. the community involvement.


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RESULTS


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STRUCTUREOFTHEGOVERNMENT

Province

City

SubDistrict

Area

RW

RT

SubDistrict

Area

RW

RT

District

SubDistrict

Village

RW

RT

SubDistrict

Village

RW

RT

In formalOrgani-zation

FormalOrgani-zation

LegislativeBoard


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CHARACTERISTICSOF FGD PARTICIPANTS

Session 1 Session 2

26 community leader 36 health/ jumantikcadres and PKK cadres

Mostly male Women/ mothers

Divided into 4 groups Divided into 5 groups

Member within eachgroup were not toohomogenous

Member within eachgroup were not toohomogenous


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INCIDENCEOF DHF

community leader health/ jumantik / PKK cadres

concern about the number of DHFpatients

concern about the number of DHFpatients

patients were infected at school oroutside their environment/neighborhood

patients were infected at school oroutside their environment/neighborhood

the DHF become the primary concern of the society


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CAUSE FACTORSOF DHF

Community Leader Health/ Jumantik/ PKK Cadres

Malnutritionnon immunityEnvironment (uncultivated land,

water plants, covered ditches,stagnant pools)empty houseswrong methods of applyingfogging

Unsimultanously eradicationpeople's behaviorpublic unawarenessneglect of Jumantik

Environmental (Shrubs, plantslush and juicy plant, coveredditches)

Building (empty houses, moistand damped building)weak physical conditionpoor lifestyle3M (Menguras, Menutup,

Mengubur/ Draining, Covering,Burying)


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CAUSE FACTORSOF DHF

Community Health Center (CHC) staff of Gribig :

the behavior of society had more contribution to the highcases of DHF than the other factors.

The sampling of water drains by investigators : Aedeslarva was not found in the sewage.


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PREVENTION METHODS

Community Leader Health/ Jumantik/ PKKCadres

the fumigation (fogging)method done by CHC (withappropriate dose) and with thefumigation done independentlyby communityBut some others did not agreebecause foggingis just a

temporary preventive actionand could raise new problems.maintain fish and/ or applyabateChanges in community

behavior

3 M was more effective thanfogging.warned peopleactivate residentstried to make themselvesinvolved in any activities/program held by existing

institutionparticipated in any hygienecompetitionsocialized 3 M moreintensively


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PREVENTION OBSTACLES


lack of hygiene awarenessrefusal of citizens to apply abatepeople ignorance to prevent DHFabsence of mothers (women) in

PKK meetingrefusal of people to welcome thecounseling cadreslimited manpower of the healthagency

the citizens being scared of foggingjumantikcould not monitoring larvain the empty houses

refusal of home visits from richpeople and people with intenseactivitiesno entry into the empty houses

limited time to conduct survey onevery housefalse condition of larva monitoringbecause of prior noticeschools often escaped from the

observation.the residential occupants weremore difficult to be monitoredLimited land to bury the old stuff


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THE ROLEOF COMMUNITY HEALTH CENTER


more active in monitoring orsurveyingfacilitating the cadressocializing DHF to citizensconducting fumigationregularlydistribute abategive detailed information

directly to the communitygive free treatmentrespond to reports of DHFinstantlyset up a calendar of mosquito

monitoring.

larva monitoringapplying fogging and abatefacilitating cadresconduct socializing and

campaigning more intensively.


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JUMANTIKROLES


Monitoring mosquito larvaroutinelyAll people can assisst jumantik

cadres

give examples of healthy livingand environmental hygiene,visit people affected by DHF

remind peopletheir welfare should beconsideredcitizens would cooperate,inform the chief of RT and RW.

Observations by the research team :health cadres had so many activities that the larva monitoringresult was not as expected.the percentage of houses with positive larva in residential housingwas less than in Kampong environment (50%)


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COMMUNITY POTENTIAL


great and very necessaryDHF problem had never beendiscussed formally

foggingwith government fundsand voluntary workpromote healthy life behavior andconduct anti-DHF Campaign.community leaders opinion : the

success of DHF eradication was inthe hands of housewives due tothe existing organizationalstructure, like PKK.

High in terms of behavior changesand increasing awareness.Easy for higher consciousness

due to high education level.The housewives also believe thatcleanliness inside the houses is

the responsibility of mothers andchildren, while outside the housesit is the responsibility of fathers(men) such as cleaning the ditchesin organized voluntary work.


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CONCLUSION & SUGGESTIONS


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CONCLUSION

Community leaders represented more men than women.

Women have a lot of role on DHF primarily asjumantik.But the role in terms of policy at the local level was stilllacking. This is because of the lack of women'sinvolvement in forums attended by community leadersand the lack of public confidence in the ability of

jumantikcadres. Jumantikcadres should get coaching skills, such as

monitoring of larva and communicating

Cadre can be considered as potential community groupsto be activated.

Cadres welfare should be increased by enhancing theease of access to health facilities or by giving moreattention to them.


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CONCLUSION

The big difference in the views of communityleaders andjumantikcadres in terms of causefactors had implication on DHF prevention to betaken.

The difference was the emphasis on the use oftechnologies such as fogging and abates stated bycommunity leaders and the emphasis on changesin behavior promoted byjumantikcadres.

Community had potential to be involved in theresponse to handle DHF but need a stimulusespecially with the presence of the outsider.


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SUGGESTIONS

Mediation by local CHC through socializing tocommunity leaders is needed to overcome thedisparity of opinion between community leadersand Jumantikcadres.

Trained Jumantikcadres can be empowered bygiving the intention to their welfare.


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THANKYOU


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gender and prevention of dengue haemmorragic fever at malang city - lilikz

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