Post on 03-Feb-2016
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File: P/Wlkt mkl Bangkok
TB PERSPECTIVE At North Jakarta Municipal Administrationin connection with Global Climate Change
By. M. Effendi Anas
. The accurate prediction of scientist on negative effect of global warming
. The occurrence of uncertain world climate
. Severe flood in Jakarta year 2004 & 2007 inundated 50-65% of Jakarta area …> activities paralyzed
On the field of farming. The farmers have difficulties to predict when the
harvest season is ?. In Indonesia year 2003, 43.000 Ha paddy field was
hit by flood, and the drought as wide as 21.705 Ha
On the field of fishery . The increase temperature of sea water…> coral
reef was damaged. The damage of coral reef ….> plankton
disappears ….> fish food chain was disturbed …..> fish population was decreasing ……> the result of fisherman was decreasing.
North Jakarta Municipal Administration . The increasing of temperature …>ice melted on
the poles ….> The sea level rose ….> threaten coastal area ….> flood
The spread of disease . The increasing of temperature …> incubation of
mosquito growth shortened ….> the increasing of mosquito population ….> the increasing of DHF, malaria
TBC disease . In Indonesia …> 1 -2 sufferer per 1.000 population. The third cause of the death after cardiovascular, upper
respiratory system infection . In Jakarta ….> priority program since 2001. Tend to increase ….>year 2003 (2.589 cases), year 2004
(3.437 cases), year 2005 (4.169 cases), year 2006 (4.653 cases).
. Climate change ….> affect to the increasing of TB …..> it was worsened by geographical location of north Jakarta ….> many slum areas, prone to flood, many people resided in unhealthy housing residence.
. Topography of North Jakarta ….> lower land area 0 – 2 M from the sea level …..> as estuary 13 rivers
. Climate change ….> prone to flood as the sea level rises .…> Can increase humidity ….> the appropriate
temperature for the growth of TB Bacteria. ….> prolonged dry season ..> increase air
pollution (dust) ..> Bacteria grow on the dust …> prone to
the transmission of the disease
NORTH JAKARTA NORTH JAKARTA NORTH JAKARTA BORDER• NORTH : KEP.SERIBU (THOUSAND ISLAND)• WEST : WEST JAKARTA BARAT AND TANGERANG• SOUTH : CENTRAL JAKARTA , EAST JAKARTA & WEST
JAKARTA • EAST : EAST JAKARTA AND BEKASI
SUB DISTRICTS : 6VILLAGES : 31HAMLETS : 414NEIGHBORHOODS :
4.746
HOSPITALS : 16SUB DISTRICT PHC : 6VILLAGE PHC : 42
THE POPULATION OF NORTH JAKARTA 2006 :
1.173.935 PEOPLE , THE WIDTH 142.3 Km2
. Topography of North Jakarta ….> lower land area 0 – 2 M from the sea level …..> as estuary 13 rivers
. Climate change ….> prone to flood as the sea level rises .…> Can increase humidity ….> the appropriate
temperature for the growth of TB Bacteria. ….> prolonged dry season ..> increase air pollution
(dust) ..> Bacteria grow on the dust …> prone to the
transmission of the disease . Climate change worsens the quality of environment
…….>bacteria grow……>the case is increasing.
INDICATOR OF ENVIRONMENTAL HEALTH
Aspects Result standard
1. Permanent house : 70.4 % : 95.0 %2. House and occupancy rate : 34.6 % : 5.0 %3. House and ventilation : 68.1 % : 95.0 %4. House and the light : 74.4 % : 95.0 %5. House and plantation : 62.3 % : 75.0 % Survey .2003)
. Prevention approach ….> Host intervention - Agent ….> CDR …> searching of sufferer …> in Jakarta target up to 2006 is 70%, North Jakarta has
reached the target .…> DOTS …> short term medication by inspection ….> Indicator is CR /cure rate ….> In north jakarta ….> CR 2006 was 63.9 % >> still under target which was 85% .…> DOTS evaluation (year 2006) ..> CR was 63.9
%, complete medication 17.5% ….> 10.4%
neglected /DO ..> 7 % migrate ..> 0.9% died ..>0.2% fail
THE DATA OF HEALTH FASILITIES IN
NORTH JAKARTA MUNICIPAL ADM.
NO SUB DISTRICTS
INTEG
RA
TED
HEA
LTH
PO
ST
HEALTH FASCILITIES
Expl
PH
C
clinics
hosp
itals
pra
ctitioners
mid
wife
Priv
ate
mate
rnity
hosp
.
HOSPITAL
1 PENJARINGAN 73 7 0 4 220 7 5 4
2 PADEMANGAN 33 5 0 0 60 35 4 0
3 TG. PRIOK 132 14 1 7 222 45 4 7
4 K O J A 85 8 8 2 120 47 7 2
5 KLP. GADING 29 4 1 2 160 12 1 2
6 CILINCING 164 10 2 1 70 6 2 1
TOTAL 516 48 12 16 852 152 23 16
. DOTS APPROACH …> supported by all Health Facilities in North Jakarta
….> Networking …> medicating and reporting on the same place
.…> Internal networking …> all units from Health service division.
handle TB sufferer by DOTS .…> External networking …> all units from Health
Service division coordinate with Public Health Division.
. DOTS …> supported by LABORATORY…> as referral for recovered sufferer, fail …> Verify germ Resistance against drugs.
. IDEALLY …> TBC Prevention should be comprehensive ….> consider environmental aspect. …..> the theory of Biology law (John Gardon) and the theory of - Health Status (HL. Blum)
. Climate change …> can change strengths and weaknesses of environmental factors effecting the growth of TB bacteria …> the significant influence is the increasing of case prevalence
. Harmonization …> TB prevention approach by Jakarta Province Health Dept. / Public Health Sub Division from North Jakarta Municipal Administration
- with, . Infrastructural development …> physical aspect ..> Long term : Infrastructure; realization of BKT (East canal flood
project), Healthy storey house (Rusunawa 1000 towers), slum area management , re plantation at RTH (Green space management), Reclamation & management of coastal area by planting mangrove
..> Mid term : build secondary and tertiary networking, prepare urban drainage system, relocate slum housing under toll road.
build Voder (water canal) & provide water pump, consistent space management, etc
…> short term : residential area managemen, renovation TB suferrer’s house, Put TB suferrer into storey house, etc
. Climate change …> can hamper the objective of TB prevention program either in the environmental perspective or the approach of TB prevention prgram by Jakarta Province Health Dept or North Jakarta Municipal Administration.
. Climate change …> can hamper the achievement of MDG’S commitment declared by 180 countries which is reduce poverty and world retardation
. Climate change brings into bad effects on Health Program
. The effects on health program : …>hamper the succes of Communicable disease control program.
. We supprot the action of efforts to curb green house effect. …>reduce the use of chemical substances effecting the depletion of ozone layer.
. We are ready to cooperate in responding the effects of global warming.
POPULATION PER SUB DISTRICT
PENJARINGAN : 176.586 PEOPLE PADEMANGAN : 121.839 PEOPLE TANJUNG PRIOK : 311.440PEOPLE K O J A : 221.631 PEOPLE KLP. GADING : 105.699 PEOPLE CILINCING : 236.740PEOPLE
---------------------------North JAKARTA 1.173.935 PEOPLE
1.952
2.355
2.639
1809
1.111
1.485
1.814
2.014
1472
1.478
0 1.000 2.000 3.000 4.000 5.000
TH 2003
2.004
2.005
2.006
2007
MALE FEMALE
THE NUMBER OF TB SUFERRERS BY GENDERNORTH JAKARTA
YEAR 2003 UP TO SEPT 2007
910
1.159
1.242
896
1.026
1.205
1.351
1.463
997
523
879
1134
1326
936
43
63
5615
594
92
37
6
8
13
19
0 500 1.000 1.500 2.000 2.500 3.000 3.500 4.000 4.500
TH 2003
TH 2004
TH 2005
TH 2006
TH 2007
BTA POS BTA NEG CHILDREN RECURE EXTRA PARU
THE NUMBER OF TB SUFERRER IN NORTH JAKARTA YEAR 2003 UP TO Sept 2007
92.6 87.572.6
31.516.5
92.0105.6
0.0
20.0
40.0
60.0
80.0
100.0
120.0
PADEMANGAN
CILINCING
KOJA
TG PRIOK
PENJARINGANKLP GADING
JAK UTR
CDR OF TB SUFERRERS (+ SPUTUM SMEAR) IN NORTH JAKARTA
YEAR 2006
Target 70%
79.4
57.6 55.7
37.117.7
64.1
102.0
0.0
20.0
40.0
60.0
80.0
100.0
120.0
PADEMANGAN
CILINCINGTG PRIOK
KOJA
PENJARINGANKLP GADING
JAK UTR
CDR OF PULMONARY TB SUFERRERS (+ SPUTUM SMEAR) IN NORTH JAKARTA
JANUARY - SEPTEMBER 2007
Target 70%
26.9 29.2 34.3
67.2
91.5 92.0
64.1
26.2
0
10
20
30
40
50
60
70
80
90
100
TH2000 TH2001 TH2002 TH2003 TH2004 TH2005 TH2006 TH2007
CDR OF PULMONARY TB SUFERRERS (+ SPUTUM SMEAR) IN NORTH JAKARTA
YEAR 2000 UP TO SEPT 2007
Target 70%
80.074.5 73.4 72.7 70.3 68.1 68.1
56.8
7.4
70
83.8
0.0
20.0
40.0
60.0
80.0
100.0
KOJA TG PRIOKPENJARINGANPADEMANGANKLP GADINGYSA CILINCINGHOPE
RSI
SUKAPURARSU KOJAJU
PULMONARY TB SUFERRERS (+ SPUTUM SMEAR) 2OO6EXPERIENCING CONVERSION IN NORTH JAKARTA
Target 80%
82.0 84.975.2
64.2 68.5 70.078.6
0
10
20
30
40
50
60
70
80
90
TH 2000 TH 2001 TH 2002 TH 2003 TH 2004 TH 2005 TH 2006
CONVERSION OF TB (+SPUTUM SMEAR)IN NORTH JAKARTA
YEAR 2000 UP TO 2006
Target 80%
RECOVERED TB SUFERRERS (+ SPUTUM SMEAR)RECOVERED TB SUFERRERS (+ SPUTUM SMEAR)IN NORTH JAKARTA IN NORTH JAKARTA
73.3 70.064.6 66.7
73.8 76.3
52.243.3
0.0
63.9
77.4
0.0
20.0
40.0
60.0
80.0
100.0
KOJA TG. PRIOKCILINCINGHOPE YSA PENJARINGANPADEMANGANKLP GADING
RSI
SUKAPURARS KOJAJAK UTR
Target 85%
72.1
57.7
70.3
59.7 63.967.2
0
10
20
30
40
50
60
70
80
TH 2000 TH 2001 TH 2002 TH 2003 TH 2004 TH 2006
CR OF PULMONARY TB (+SPUTUM SMEAR) IN NORTH JAKARTA
YEAR 2000 - 2006
Target 85%
2.589
3.437 3.594 3.281
4.653
1.888
0
500
1.000
1.500
2.000
2.500
3.000
3.500
4.000
4.500
5.000
YEAR 2002YEAR 2003YEAR 2004YEAR 2005YEAR 2006YEAR 2007
TB CASES FOUND AND MEDICATED AT PUBLIC HEALTH CENTERIN NORTH JAKARTA
YEAR 2002 - SEPT 2007
17,5
10,4 7,0 0,9 0,2
63,9
0,0
10,0
20,0
30,0
40,0
50,0
60,0
70,0
RECOVERED COMPL MED NEGLECTED MIGRATE DIED FAILED
EVALUATION OF TB SUFERRERS (+SPUTUM SMEAR)IN NORTH JAKARTA
YEAR 2006
The flow of diagnose of TB patient in hospital
Microbilology Lab.General clinic
Patient
Pharmacy
DOTS Unit Hospital
Other HealthService units
Specialist clinic
Emergency unit Patology clinic
Radiology
Medical Record
Promotion services
Treatment
The flow of implementation
Patients
Anamnesis,PF,Sputum 3x,Ro,Lab
TB Diagnose Therapy Kat.I,II,III
Follow up every 2 weeks
Control Control late 2 days
Hospital call supervisor
Supervisor call PHCOn the same day
House visitThe following day
Feedback
THE REFERRAL SYSTEM FOR TB PATIENTS
HospitalPublic Health
Center
coordinator HDL at Sub
district
Patient, Anti TB drug , TB.01, referral letter
(TB.09)
TB Supervisor Sub district
informconfirm
(TB.09)