Empowerment of Infant Mother to Elimination Diphtheria Disease

through Environmental Management

Hiswani, Fitri Ardiani

Faculty of Public Health, Universitas Sumatera Utara, Medan, North Sumatra, Indonesia

Keywords: Mother, empowerment, environmental arrangement, elimination of diphtheria

Abstract. Diphtheria disease in Indonesia continues to occur even tend to increase in 2011 identified 511 cases with 2.3%

case fatality rate in January to 593 cases spread 95 districts and 20 provinces with death cases 32 cases in

November 2017. The extraordinary case of diphtheria has spread to 28 provinces in Indonesia. This suggests

that some of the factors contributing to the current high incidence of diphtheria in Indonesia support the

occurrence of diphtheria. Factor causes are unhealthy environment. Therefore the environment becomes a

very potential intermediary for preventing diphtheria or disease. The target of this devotional activity is self-

protection and early detection of diphtheria disease in children and society in general. This is done by the

healthy arrangement of the environment. The government efforts to prevent and reduce health problems and

socio-economic losses due to diphtheria disease in the community. Empowering mother for the elimination

of diphtheria disease through environmental arrangement is an effective effort in preventing diphtheria

disease in toddlers because it can break the chain of diphtheria circulation. In addition to improving

knowledge of mother and children that support the attitude and right action about diphtheria so that can

protect themselves not to contract with diphtheria disease.

INTRODUCTION

1.1

Background

Infectious diseases in children under five this time

there is an increase in the form of extraordinary

because there is a decrease in endurance of children

under five and associated with socioeconomic and

nutritional impacts. The low purchasing power of

the people can not provide nutritious food for their

children. The child's immune system can be

enhanced by providing nutritious good nutrition and

complete immunization for optimal immune system.

Diphtheria is one of the most contagious

diseases. The disease is caused by a bacterial

infection of corynebacterium diphtheriae, a

bacterium that infects the respiratory tract, especially

the tonsils, nasopharynx (the part between the nose

and the pharynx/throat) and the larynx. Transmission

of airborne diphtheria (air borne disease) through

coughing or sneezing of the patient who airs the air

or other objects it contacts with the cough splashes

of the patient. In addition diphtheria can also infect

skin burns and mucous membranes.

Diphtheria is a potentially life-threatening

infection that can cause death from complications in

vital organs in the body. According to the World

Health Organization (WHO) in 2016, there are 7.097

cases of diphtheria worldwide. Indonesia found 342

cases of diphtheria sufferers. Nearly 90% of infected

people do not have a complete history of diphtheria

immunization. This suggests that immunization is

very important in preventing the occurrence of

diphtheria. Complete basic immunization was

administered 3 times, followed by DT immunization

(Tetan tetanus) when the child was in primary

school age, continued to be immunized with Tetanus

Diphtheria (TD) to keep immune to diphtheria.

Diphtheria disease in Indonesia continues to occur

even tend to increase in 2011 identified 511 cases 12

cases died with case fatality rate of 2.3% in January

to November 2017 recorded 593 cases spread 95

districts and 20 provinces with cases of death 32

cases of CFR in Indonesia is 9.3%. Based on basic

health research in 2013, immunization coverage for

children aged 2-6 years in Indonesia is only 75.6%,

below of the coverage 90%. It means there are still

24.6% of children who have not been immunized

that potentially infected with diphtheria and the

668

Hiswani, . and Ardiani, F.

Empowerment of Infant Mother to Elimination Diphtheria Disease through Environmental Management.

DOI: 10.5220/0010083206680672

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

668-672

ISBN: 978-989-758-449-7

cause of the spread of diphtheria. The low DPT

immunization coverage was Papua 40.8% Maluku

53.8% and Aceh 52.9%.

The spread of diphtheria-causing bacteria

generally occurs easily in patients in densely

populated environments and hygiene is not

maintained. Transmission that generally occurs is

exposed to splashes of patients when sneezing or

coughing, contaminated items such as children's

toys, towels, and others, or direct touch through the

wound or skin of the patient. Based on this, the

community service activities that aim to manage the

environment are very important in the effort to

eliminate and prevent diphtheria disease.

Environmental arrangement aims to prevent the

existence of bacteria that cause diphtheria by

cleaning the environment from garbage or other

impurities in the house, around the house, and

environment in the village. To prevent diphtheria

disease need to maintain cleanliness of the

environment with a clean air circulation, maintain

personal hygiene and avoid direct contact with

patients.

The success of clean environmental arrangement

can prevent transmission of diphtheria disease. This

is because the nearest mother in children who hold

the decision in environmental management around

the house. The environment in which children love

to gather for example at school, in the playground is

necessary to note because in case of extraordinary

events most often contact with friends in the school

or housing environment. The 100-meter radius from

the patient's home is a high- risk area.

In Kelurahan Padang Bulan Selayang II and

Kelurahan Asam Kumbang is a densely populated

area with a lot of children under five that is 30% of

population is toddler. This suggests that this area is

very risky with the occurrence of diphtheria cases. In

addition, this area is also classified as a region with

lower middle-class economy and the level of

community education is still low. Ten of the biggest

diseases in this region are respiratory infection and

diarrhea. This indicates that the environmental

arrangement in this region is still not running well.

Rainfall and high humidity in this area often

found inundated and flooded water, in this

environment when heavy rain and long time also

proves that environmental management in the

Padang Bulan Selayang II area allows the

development of infectious diseases caused by

bacteria and viruses. Community service activities

undertaken with empowerment of mother in these

two urban villages with the arrangement of the

environment are expected to eliminate diphtheria

and other diseases and can be creating a well-

organized, clean and healthy environment.

1.2

Objective

To empower mother in sub-district of PB Selayang

and Kelurahan Asam Kumbang is one effort to

prevent and eliminate diphtheria disease. With the

arrangement of this environment is expected to

prevent acute respiratory infection disease one of his

diphtheria and diarrhea that has been experienced by

many toddlers. It also creates a clean and healthy

environment.

1.3

Benefit

Against children and society can protect

themselves against transmission of diphtheria

disease.

To the community can create a clean and healthy

environment.

Against the government can prevent and reduce

socio-economic losses due to diphtheria disease.

METHOD OF SCIENCE AND

TECHNOLOGY APPLICATION

2.1

Method of Approach Used in

Program Devotion

The method of approach taken during the devotion

to partners is by empowering the mother through

various stages of training, guidance and assistance to

targeted children and health officers who become

partners. Measurement of knowledge changes and

attitudes toward the mother who became the target

of dedication activity can be seen from before and

after activity of devotion. Mother becomes aware of

the cause of diphtheria so that it can prevent it

through controlling the determinants of the disease.

Through this devotion activities partners and all

parents of children who became the target of

devotion activities are also expected to organize a

clean and healthy environment. The place where

children play has a healthy air circulation to interfere

with the emergence of diphtheria extraordinary.

The socialization conducted in the form of

educational education by mobilizing health officers

to the residents related to anticipation of

transmission of diphtheria, urged parents to bring

their child to immunize DPT, Complete for primary

prevention stage. People also keep the environment

Empowerment of Infant Mother to Elimination Diphtheria Disease through Environmental Management

669

clean, wash hands before eating, when coughing

must shut up

2.2

Implementation of Activities

Implementation of activities undertaken for problem

solving, such as:

Socialization of service activities that is

explanation about the plan of activity devotion.

Socialization of devotion activities provided to

all mothers under five, puskesmas officials and

urban village officials in two villages with the

aim to understand about the meaning and

purpose of the activities of dedication. In

addition, this socialization will also form the

attitude and desire to want to be fully involved in

the activities of dedication. Based on this case,

the implementation of recruitment of infant

mothers as participants more easily.

Recruiting toddlers as participants.

Recruitment is done after the socialization of

activities. All the mothers in the two urban

villages who are motivated to follow the

devotion activities will be asked about their

willingness and commitment by the team.

Recruited mothers will then follow the training.

Training on diphtheria

Training on diphtheria disease involves

transmission of diphtheria, the causes,

symptoms, prevention and treatment of

diphtheria performed by a team and health

workers from the puskesmas. Health workers

from puskesmas are the most appropriate and

accurate person to provide information and facts

about diphtheria so that they are invited to

submit material about diphtheria. This training is

required to provide a sufficient level of

understanding of the purpose and

implementation of service activities. The

existence of a good understanding of the

activities and implementation of activities will

facilitate the achievement of the purpose of

community service activities.

Training on environmental arrangement Training

on the management of the environment includes

activities that must be done by the mother in

creating clean and healthy environment.

Structuring the environment by clearing garbage

in two urban villages, piling up stagnant water

and repairing a compressed water channel, and

providing facilities and infrastructure of

environmental cleanliness such as garbage.

RESULTS AND DISCUSSION

3.1

Preparation for Devotional

Activities

Preparation of service activities begins with a survey

to PB Selayang and Asam Kumbang health center in

Medan Kumbang on May 9, 2018 by the team. In

the survey, the team conveyed the purpose and

objectives of the activity as well as the socialization

of the activities. Then plan the time of the activity

and discuss the things that are needed in the

implementation of the activity.

3.2

Recruit Participant of the Activities

Devotion

On May 16th, 2018, the teams go to PB Selayang

and Asam Kumbang Health Center to perform

recruitment of participant of devotion activity ie

mother who will be given training about diphtheria

disease and environmental arrangement relationship

with diphtheria prevention. Mother to be recruited

strived for at least as many as 20 people from each

puskesmas so that for 2 puskesmas recruited 40

mother's mother. Recruit mother is done openly and

every mother has the same rights to be elected.

However, the chosen mother is determined based on

the assessment of the devotion team with certain

characteristics that have good communication skill,

support and liked by many other mothers.

3.3

Socialization of Activity on

Posyandu Cadres, Head of

Puskesmas, and Children of under

Five Years Mothers

After recruiting the mother is held then the next

team to socialize the activities. This socialization

conveys about things that must be understood by the

mother. In addition, training plan for improving

maternal knowledge about diphtheria disease,

causative factors and prevention efforts. In addition,

the improvement of mother's knowledge about

environmental arrangement. The implementation of

counseling of diphtheria, and environmental

arrangement done on Wednesday, June 6, 2018. In

this counseling in addition to the attended mother

was also attended by cadres and puskesmas officers.

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

670

3.4

Training on Diphtheria and

Environmental Improvement on

Children

After the socialization then the next activity is to

conduct training on diphtheria and environmental

arrangement. In this training the participants were

not only mother, but also followed by several cadres

and puskesmas officers from PB Selayang Public

Health Center and Puskesmas Asam Kumbang. This

is because they have a great curiosity about what is

meant by diphtheria disease and environmental

management. The material of this training is an

understanding of diphtheria and its pathogenesis, its

causes and prevention; understanding of the

environment arrangement and its scope, the benefits

and impact of environmental arrangement. In this

training also presented how to do environmental

arrangement to prevent diphtheria. During the

training with lecture and discussion methods while

playing using flipchart media and distribution of

brochures about diphtheria and environmental

arrangement. In the lecture exercise, it is seen that

the mother, cadres and puskesmas officers are very

serious and enthusiastic to listen and actively ask

about things that have not been understood. Besides,

it also commented on the experiences and

phenomena that exist in the community. This lecture

is very satisfying for mothers, cadres, and

puskesmas officers who see that many of them are

bluntly pointed out that this training enhances their

real knowledge. In addition to improving the health

of toddlers who can prevent or reduce diphtheria

disease in children. The lecture materials include:

Definition of diphtheria, pathogenesis and its

prevention.

Understanding of environmental management, its

benefits and impacts and activities in the

application of environmental management.

Monitoring the implementation of environmental

management

In addition to lectures and discussions, the training

materials are also given in the form of brochures,

posters and textbooks that can be a reference for the

cadres and also improve the knowledge of mother in

general.

3.5

Structuring the Environment

Structuring a clean and healthy environment is a

series of activities to organize a particular area to be

optimally beneficial and have a good air circulation

in order to create environmental sustainability and

welfare of living creatures a clean environment can

prevent transmission of diseases such as diphtheria

and other diseases.

After the mother gets counseling by the team of

subsequent devotion to environmental stewardship,

by cleaning the garbage, piling up the stagnant water

and repairing the drain in the two puskesmas. The

garbage scattered in the health center's yard was

swept away, collected, and dumped into a waste

shelter. Stagnant water at risk of mosquito breeding

is closed. In addition, ditch ditch is cleaned to flow

smoothly and does not have the potential to flood

when heavy rain.

The implementation of this activity was carried

out in mutual assistance by the parents who

participated in the training and elimination of

diphtheria disease and the team to the two

Puskesmas. The team also provides tools for

environmental management such as broom yard,

waste basket and garbage pod. After the

management of the environment with social

cooperation and Puskesmas officers then visible

Puskesmas yield to be cleaner than before the

devotion activities. If an officer in charge of

sweeping the Puskesmas yield is unable to attend,

then it will be replaced by a friend in the next turn.

The garbage that has been swept and collected is

then disposed of in the trash which is also provided

by the community service team. The implementation

of this activity is monitored and evaluated by the

Head of the health center of the Puskesmas in the

Padang Bulan Selayang.

3.6

Evaluation of Mother

Empowerment in Diphtheria

Elimination

Evaluation result of team devotion to empowering

mother of toddler to eliminate diphtheria disease

found that there is increasing knowledge of mother

about diphtheria disease with environmental hygiene

counseling the participant can comprehend

accumulated learning and experience so that it can

be applied in prevention of disease that is

environment-based transmission, so hopefully can

prevent or eliminate diphtheria. In addition, the

knowledge of mother about the effort of elimination

of diphtheria through environmental management

also increased with the existence of community

service activity.

Based on the evaluation of the team as well as

the discussion of the team with the cadres, the

puskesmas officers and the mothers stated that the

devotion activities performed by the team are very

satisfactory and provide significant and significant

Empowerment of Infant Mother to Elimination Diphtheria Disease through Environmental Management

671

benefits to them. The obvious change seen is that the

mother increased knowledge in managing the

environment. The rooms and courtyards of

Puskesmas also look neater and cleaner than before

any community service activities. If this can take

place continuously it will create a clean and healthy

environment with better health of children so it will

greatly support the prevention and reduction of

disease.

CONCLUSION

Empowerment of mother managed to increase

knowledge and skill of mother in doing

environmental arrangement.

Mother increased her knowledge about

diphtheria disease.

Empowerment activities for mothers can help

heads of puskesmas in implementing prevention

policy of diphtheria in children.

The existence of environmental regulation on a

regular basis can prevent diphtheria in children.

It is expected that the head of puskesmas always

monitor the environmental arrangement around

the puskesmas.

Puskesmas officers at certain times can do

counseling about diphtheria.

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