Strategi Pengendalian Filariasis Berbasis Kajian Entomologik dan Peran Institusi Kesehatan Di Kabupaten Bogor, Jawa Barat

Abstract

Lymphatic filariasis being a global health problem and the second leading cause of disability globally. Indonesia is a country with filariasis endemic status. In 2016, the disease were reported endemic in 29 provinces and 239 districts/cities of Indonesia, with an estimated 102.279.739 people at risk of being infected with filariasis. Bogor Regency was an endemic filariasis area with the discovery of clinical filariasis patients continuing to grow from year to year since 2004 until now. Until the end of 2018, there were 117 people with clinical filariasis in Bogor Regency. The control of filariasis in Bogor Regency has focused on administering drugs to patients and preventing and limiting disability. Attention to mosquitoes as vektors was still minimal, entomological studies based on mosquito bioecology have not been carried out, so that this control effort still leaves problems in the field. In addition, data and information about the factors that influence filariasis are not widely known. In connection with this, to control filariasis, Bogor Regency must pay attention to all aspects that can affect the incidence of filariasis, including vektors, the environment, humans, agents, and the role factors of health institutions. Based on these problems, it is necessary to research filariasis both on an agent, environmental, vektor, human factors, and the role of health institutions as primary data that can be used to develop an integrated filariasis control strategy in Bogor District. The study was carried out for 10 (ten) months, namely June-July 2019, September 2019-February 2020 and August-September 2021. Collection of adult mosquitoes, observation of mosquito larvae habitats and measurements of community behaviour were carried out in two villages, namely Tamansari Village and Cimanggis Village. Epidemiological studies, program evaluations and the role of health institutions were carried out in 46 Puskesmas in Bogor Regency and the Bogor District Health Office. Adult mosquitoes are collected every two weeks for six months using the human landing collection (HLC) and resting collection methods for 12 hours of observation (18.00-06.00). Mosquito larvae were collected in various habitat types every month for six months. Dissection technique and polymerase chain reaction (PCR) carried out the detection of filarial in the mosquito body. They were measuring community behaviour using interview questionnaires with a sample size of 157 respondents in Tamansari Village and 369 in Cimanggis Village. Epidemiological studies and evaluation of the filariasis program were carried out by analyzing secondary data from the Bogor District Health Office. Study of the role of health institutions using a monitoring and evaluation questionnaire at the health centre level and in-depth interviews with key informants at the Bogor District Health Office level. Distribution of filariasis in Bogor District with dominant sufferers in women (59.8%) and productive age (36-45 years). The chi-square test results showed a significant difference between the age groups with the incidence of filariasis from year to year (p<0.05). In contrast, the relationship between gender and theincidence of filariasis from year to year did not show a significant difference (p>0.05). Sub-districts with filariasis sufferers increased from 55% in 2015 to 77,5% in 2018. The implementation of POPM includes treatment achievement rates (> 65%) and treatment success rates (> 85%) from 2015 to 2018 has exceeded the national target. There were six species of mosquitoes in Cimanggis Village, namely Culex quinquifasciatus, Cx. visnhui, Cx. tritaeniorhynchus, Aedes aegypti, Armigeres kesseli, Ar. subalbatus. In Tamansari Village, eight mosquito species were found, six species were the same as in Cimanggis Village, and two additional species were Ae. albopictus and Mansonia annulata. The highest dominance was found in Cx. quinquefasciatus both in Tamansari Village (90.46) and in Cimanggis Village (95.67). The mosquito diversity index was low in Tamansari Village (H'=0.444) and Cimanggis Village (H'=0.238). In general, mosquito-biting behaviour prefers to suck blood inside the house (endophagic) with a peak density of 23.00-04.00. Cx. quinquefasciatus is very dominant due to very supportive environmental and habitat conditions. The potential habitat in Cimanggis Village consists of ribs, ditches/gullies and used tires, while in Cimanggis Village, the most potential habitats are ditches/gullies. The mosquito density per person per night (man biting rate-MBR) in Tamansari and Cimanggis villages mostly had no significant correlation with rainfall, temperature and humidity. The parity rate of mosquitoes collected in Tamansari and Cimanggis villages was very high (>80%). The microscopic observation didn’t detect the presence of worm larvae, as well, the Ssp I PCR test didn’t detect the presence of Wuchereria bancrofti larvae in the thorax and heads of mosquitoes. The knowledge of respondents in Tamansari Village, in general, is low (52.8%), and in Cimanggis Village, they have moderate knowledge (55.3%). The attitude of respondents in Tamansari Village and Cimanggis Village, in general, has neutral attitude while the general practice is good. Education has a significant relationship with knowledge and attitudes in Cimanggis Village, meaning that the better the education of the respondents, the better their knowledge and attitudes. Practices do not have a significant relationship with the characteristics of respondents in Tamansari and Cimanggis villages, meaning that the characteristics of gender, age, education and occupation do not influence the practices carried out by the community. Spearman's correlation test between knowledge, attitude and practice found only attitudes and practices that had a significant relationship in Cimanggis Village, meaning that the better respondent’s attitude, the better their practice. There are significant differences knowledge, attitudes and practices in rural (Tamansari Village) and urban (Cimanggis Village) areas about filariasis. The role of health institutions in controlling filariasis was quite good in several aspects, and there were still shortcomings in other aspects. There were (8.7%) health center that do not have a filariasis treatment program. The mass prevention mass drug administration program (MDA), clinical management and establishment of medicine man have been quite good but the formation of cadres and vector control was still low. There were adequate health personnel at the health center involved in the filariasis program, but the presence of entomology personnel was very low at only 13% of all health center. The healt center have very well carried out the patient survey and counseling activities while the activities that were still very low were knowledge, attitude, and pratice (KAP)surveys, mosquito larvae habitat surveys, evaluation surveys for filariasis transmission, and microfilaria evaluation surveys after MDA. The health center have received quite good supervision, guidance, monitoring, and health department evaluation. The health center have also received infrastructure support, but it was still lacking from the support of Non Goerment Organiations (NGOs). Assessment of the health department level shows that policy, budget, cooperation, and human resources were still very lacking. The budget given was minimal and cross-sectoral cooperation was not yet running. Human resources owned were very low both in quantity and quality. Facilities and infrastructure were considered sufficient to support filariasis prevention programs and activities. Based on the results of the strengths, weakness, opportunities, and threats (SWOT) analysis of the data and information obtained, the selected strategies and steps that can be developed for filariasis control strategies based on entomological studies and evaluation of the role of health institutions are as follows: increasing understanding and comprehensive vector control, empowering communities and personnel health in the scope of the health center, comprehensively increasing public information and knowledge about filariasis, and support for strengthening regulations and cooperation in controlling filariasis.