HEALTH EDUCATION FOR PRIVATE TEACHERS IN NORTH …

EFFECTIVENESS OF HEALTH EDUCATION ON FIRST AID

OF DENGUE HAEMORRHAGIC FEVER ON PRIVATE TEACHERS

IN NORTH JAKARTA, 2011.

Gladys, Saleha Sungkar Faculty of Medicine, Universitas Indonesia

ABSTRAK Jakarta Utara merupakan daerah dengan insidens demam berdarah dengue (DBD)

tinggi di Provinsi DKI Jakarta.Untuk mengurangi mortalitas dan morbiditas akibat

DBD masyarakat khususnya guru sekolah perlu diberikan pengetahuan mengenai

pertolongan pertama pada DBD. Tujuan penelitian ini adalah mengetahui efektivitas

penyuluhan mengenai pertolongan pertama DBD pada guru swasta di Jakarta

Utara.Desain penelitian ini adalah pre-post study dan data diambil pada tanggal 22

September 2011. Semua guru yang hadir saat penyuluhan dijadikan subyek penelitian.

Data diambil dengan kuesioner yang berisi lima pertanyaan mengenai pertolongan

pertama sebelum dan sesudah penyuluhan. Data diproses dengan SPSS versi 11,5 dan

diuji dengan marginal homogeneity. Hasilnya menunjukkan dari 82 responden, guru

perempuan 34 orang (41,5%) dan laki-laki 48 orang (58,5%). Hasil pre-test, guru

yang memiliki tingkat pengetahuan baik adalah 3 orang (3,7%), cukup 13 orang

(15,9%), dan kurang 66 orang (80,5%). Pada post-testjumlah guru dengan

pengetahuan baik menjadi 5 orang (6,1% ), cukup 26 orang (31,7%), dan kurang 51

orang (62,2%). Uji marginal homogeneity menunjukkan perbedaan bermakna pada

tingkat pengetahuan sebelum dan sesudah penyuluhan (p<0,01). Disimpulkan

penyuluhan efektif meningkatkan pengetahuan guru mengenai pertolongan pertama

DBD.

Kata kunci: pengetahuan, guru, penyuluhan, DBD, pertolongan pertama.

ABSTRACT North Jakarta has high incidence of dengue haemorrhagic fever (DHF) in DKI

Jakarta. To reduce mortality and morbidity of DHF, people especially teachers need

to be educated on first aid of DHF. Purpose of this research is to know the

effectiveness of health education on first aid of DHF on private teachers in North

Jakarta. The design of the research is pre-post study and data was taken on September

22nd

, 2011. Teachers who came were all subjects. Data was taken by questionnaires of

5 questions about first aid of DHF before and after the education. Data was processed

with SPSS version 11.5 and tested with marginal homogeneity. The result shows that

from 82 respondents, female teachers were 34 people (41.5%) and 48 people (58.5%)

male teachers. Pretest results show that teachers who had good, moderate, and poor

knowledge were 3 people (3.7%), 13 people (15.9%), and 66 people (80.5%). In the

post-test, it was found that teachers with good, moderate, and poor knowledge were 5

people (6,1%), 26 people (31.7%), 51 people (62.2%). Marginal homogeneity showed

significant difference on knowledge before and after the education (p<0.01). To

conclude, health education is effective to increase the knowledge first aid of DHF.

Keywords: knowledge, teacher, health education, DHF, first aid.

Effectiveness pf healt..., Gladys Saleha Sungkar, FK UI, 2013

BACKGROUND

Dengue haemorrhagic fever (DHF) is one of the major health problems in

Indonesia, especially in major cities. Indonesia has one of the highest incidence of

DHF in South East Asia (SEA). In fact, WHO has declared that DHF is the main

cause of mortality and morbidity of children in SEA.1 It was estimated that in 2007,

there were 50-100 million cases and 500 000 were hospitalized. In SEA, there was

15% increase of mortality due to DHF compared to the previous year including

Indonesia. The number of DHF cases in SEA occurred in Indonesia was 57%, in 2005

was 95270 cases and 1298 deaths occured with the CFR of 1.4%. The number

decreased as it reached 27964 cases in 2009 with 32 deaths.1,2

By 2008, the incidence of DHF in Indonesia is 60 per 100000 people with the

case fatality rate (CFR) 0,86%.DKI Jakarta is one of the capital cities in Indonesia

with the highest incidence of DHF.3 By 2009, the third highest region of dengue

hemmorhagic fever in Jakarta is North Jakarta with the number of cases was 5571

which was mostly found on the age group of 15-55.4

DHF can decrease the productivity, increase the number of absentees, and

cause higher cost of health care. Thus, we have to be prepared on dealing with DHF

by knowing its clinical symptoms so that we can do early detection and the right first

aid. So, it is very important to educate people on DHF especially teachers, because

teachers can deliver the knowledge to the students and it is expected that the students

will transfer the knowledge to their families at home. Health education given was

about DHF’s clinical symptoms, first aid, its vector, prevention and promotion. Due

to the limitation of the study, this research focused on the knowledge of first aid of

DHF. By knowing the first aid of DHF, it is expected that people will manage DHF

with the proper first aid. Thus, we may reduce the mortality and morbidity of DHF.

To know the effectiveness of the health education, survey was conducted before

and after the intervention.

LITERATURE REVIEW

Etiology

The etiology of DHF is dengue virus. The virus itself is included in the

aarthropod-borne viruses (Arboviruses) group now known as Flavirus genus, family

of Flaviridae. It has four serotypes which are DEN - 1 through DEN - 4. DEN-3 is the

mostly found serotype. Contact with one of the strains will only guarantee someone to


be immune with that specific strain only for a lifetime.5,6

The virus itself is a positive - stranded encapsulated RNA virus. It consists of

three structural protein genes, which will later be translated to the nucleocapsid or

core (C) protein, a membrane - associated (M) protein, an enveloped (E) glycoprotein,

and seven non - structural (NS) proteins. Immune response to NS1 of dengue virus

may cause complement - mediated lysis of DV - infected cells. However, other

reactions include activation of endothelial cells and expression of cytokine chemokine

and adhesion molecules causing cell damage. NS3 will induce the activation of DV -

reactive CD4+ and CD8+ T cells which results in increasing level of interferon

gamma as well as TNF - α, TNF - β, and chemokines. One of the chemokines is

macrophage inhibitory protein - 1β which will interact with DV - infected antigen

presenting cells and will play role in the lysis of DV - infected cells.7

Stages of infection may include undifferentiated febrile illness, classic DF,

and DHF, and dengue shock syndrome (DSS). It was proven that a person who has

developed immunity of one of the serotypes might get infected by other serotypes and

it will cause more severe clinical manifestation (DHF/DSS).7

Vector

The vector for the spread of dengue virus is a species of mosquitoes namely

Aedes aegypti. It prefers warmer climate to live. It also loves to stay in places near

humans, especially in containers like vases, water storage containers, and roof gutters.

The females of this species usually travel approximately 50 meters. They usually stay

in the place where they were hatched and continue the life cycle there.6

Figure 1. Aedes aegypti

Ae. aegypti is known for its capacity to spread dengue virus by its ability to

take incomplete blood meals from multiple individuals, daytime feeding behavior,

highly anthropophilic, and it is highly susceptible of DV infection.6


Sign and Clinical Symptoms

During the early stages, patient may show signs and symptoms like myalgia,

arthralgia, general febrile illness, lethargy, rash, low platelet and WBC count.

However, as it progresses, it may show signs and symptoms like haemorrhagic

complications, thrombocytopenia, plasma leakage due to vascular permeability, and

liver damage. In more severe cases it may manifest as disturbance in circulatory

system, even failure of the circulatory system, and death. 6

The clinical manifestation will begin with high fever (39 - 40˚C) accompanied

with headache, retro - orbital pain, malaise, nausea, vomiting, and myalgia. The

duration of this acute febrile stage is approximately 2 - 7 days. Patients may feel

weakness afterwards. When the fever decreases, patient may be complaining of

bleeding nose, mild petechial hemorrhage, gastrointestinal bleeding, and bleeding of

the gum. In the physical examination soft and tender liver, also hepatomegaly might

be found. These may require health care in which lasts for approximately 3 - 10 days.

It may even require hospitalization and may debilitate patients and cause social, not to

mention financial, burdens.6,7

Figure 2. Timeline of dengue infection

Pathology and Pathogenesis

Other than the mentioned clinical manifestations, DHF may cause

histopathological changes. The changes will mostly occur on these three places, the

lymphocytic tissue, the liver, and the vascular system. Changes in the liver include

fatty metamorphosis, the formation of councilman bodies, and degeneration of liver

cells, and kupffer cells. Other changes might be due to secondary to circulatory

failure, for example perisinusoidal oedema, congestion, and hemorrhage. Increase


proliferation of lymphoblastoid cells and lymphocytic phagocytosis may be found in

the lymphocytic tissue. Damaged endothelium due to cellular necrosis might be able

to be observed. In the vascular system, swelling of endothelial cells and diapedesis of

erythrocytes through vessel walls with pervascular infiltration by lymphocytes and

mononuclear cells.8

In the cases of DHF, the immunopathologic process will play big role in

creating the clinical manifestations. The known immune process which play role in

DHF’s pathogenesis are:5

1. Antibody Dependent Enhancement (ADE)

It is the formation of antibody which will help in neutralizing the virus and

cytolytic process which will be mediated complement, and cytotoxicity which

will be mediated by antibody.

2. T lymphocytes

Both T helper (CD4) and T cytotoxic (CD8) will help in immune response

towards the dengue virus. T helper 1 as the differentiated form of the T helper

cells will produce IFN - γ, IL - 2, and lymphokines. The other differentiated

form of T helper cells, which is T helper 2 will produce IL - 4, IL - 5, IL - 6,

and IL - 10.

3. Monocytes and macrophages

They will phagocyte the virus through antibody opsonization process.

However, the phagocytosis process will increase the virus replication and

cytokines released by macrophages.

4. Complement Activation

Complement activation by immune complex will trigger the formation of C3a

and C5a.

All of these processes will contribute to the clinical manifestation of DHF.

Secondary heterologous infection hypothesis stated that when person is re - infected

by different serotype of dengue virus will cause greater damage due to higher

concentration of immune complex. Infection by the dengue virus will cause activation

of the macrophage which will then phagocyte the virus - antibody complex resulting

in the replication of the virus inside the macrophage. Activation of the T cells will

also lead to the production of lymphokines and interferon gamma. Interferon gamma

will activate the monocytes which will produce other inflammation mediator. Thus,


the dysfunction of endothelium cells and plasma leakage happen.

The cause of thrombocytopenia in dengue infection is due to bone marrow

suppression and thrombocytes’ destruction and shortening of thrombocytes’ lifetime.

Reaction towards thrombocytopenia is increase in the production of thrombocytes or

thrombopoiesis. Dysfunction of the endothelial cells is due to the coagulopathy

caused by the virus interaction with the endothelial cells. It happens through the tissue

factor pathway and kalikrein C1 - inhibitor complex.

Diagnosis

According to World Health Organization (WHO) in 2011, criteria of DHF

clinical diagnosis are:2

Clinical manifestations:

1. Acute, high and continuous fever lasts for 2 – 7 days

2. Any of the mentioned haemorrhagic tendency: positive tourniquet test,

purpura, epistaxis, gum bleeding, haematemesis, melena, petechiae.

3. In 90%-98% of DHF in children, enlargement of the liver (hepatomegaly) can

be found.

4. Signs of shock, characterized by tachycardia, poor tissue perfusion with weak

pulse and lower pulse pressure (20 mmHg or less) or hypotension with the

presence of cold, clammy skin, and/or restlessness

Laboratory findings:

1. Thrombocytopenia ( ≤100 000 cells per mm3)

2. Signs of increased haemoconcentration; incline in haematocrit level of 20% or

more from the baseline of patient or population of the same age.

The diagnosis can be made from the two first clinical manifestations and the

laboratory findings.

Grading of DHF according to WHO in 2011:2

1. Grade I: Fever along with haemorrhagic tendency (positive tourniquet test)

and evidence of plasma leakage. Laboratory findings: thrombocytopenia <100

000 cells/mm3 and increase in HCT for 20% or more.

2. Grade II: manifestations of grade I along with spontaneous bleeding.

Laboratory findings are the same with grade I.


3. Grade III: manifestations of grade I or II along with circulatory failure marked

with weak pulse, narrow pulse pressure of 20 mmHg or less, hypotension and

restlessness. Laboratory findings are the same with grade I and II.

4. Grade IV: manifestations of grade III along with profound shock with

undetectable BP and pulse. Laboratory findings are the same with grade I, II,

and III.

5. Grade III and IV of DHF are classified as DSS.

Treatment

Patients with mild dengue infections may be given oral hydration and antipyretics.

It is recommended to give paracetamol compared to aspirin to reduce the risk of

Reye’s syndrome and hemorrhage. Patient needs to be monitored for 24h after the

defervescence. When the patient has reached the stage of DSS, fluid replacement

therapy to replace the loss of plasma is needed. WHO suggests immediate volume

replacement with ringer’s lactate, ringer’s acetate, or 5% glucose diluted in

physiological saline, followed by plasma or colloid solutions. Other drugs such as

corticosteroids may help in prolonged thrombocytopenia. However, the usage of

others need to be confirmed by large trial before be given to the patients.

In patients without shock, patients need to drink a lot to prevent shock. Patient

needs to drink approximately 1,5 - 2 liters in 24 hours. Liquid may include water,

sweet tea, syrup, milk, or oralit. Antipyretic also needs to be given to prevent seizures.

Liquid administration may be through intravenous line if the patient keeps vomiting

to prevent dehydration and acidosis. Intravenous administration of the fluid

replacement may also be given if in the examination it is found that the hematocrit

increases over time.

When the patient is in shock condition, fluid replacement is given which is ringer

lactate. If the patient is in condition of heavy shock, the fluid replacement therapy

needs to be given as soon as possible with the velocity of 20 ml/kgBW/hour.

Afterwards, it may be reduced to 10 ml/kgBW/hour when the patient’s condition got

better. In determining the velocity and the fluid replacement therapy, constant

monitoring of the hematocrit level is needed.

Proper management is needed to prevent the profound shock condition in which

the patient may die in the 12 - 24 hour duration. If the management is done properly,

then the patient may recover soon, approximately 2 - 3 days.9


Prevention and Promotion

DHF control is the effort to prevent and to deal with incidents of DHF include

measures to limit the spread. Dengue control emphasizes more on the preventive

action, for example mass spraying. Community is also asked to involve with the

programme pemberantasan sarang nyamuk (mosquitoes breeding control). Its purpose

is to reduce the incidence of DHF and also CFR. The principal activities are:

1. Observation and Management of Patients

Patients suspected or diagnosed with DHF will be reported to the Ministry of

Health of district and blood tests will be conducted.

2. Vector Control

There are two types of vector control. The first one is done before the season.

Before the season, what we can do is to protect the individual and also to

control the mosquito breeding place. Protecting individual can be done by

applying mosquito repellent, spray inside the house with mosquito repellent,

and also using mosquito nets.

North Jakarta

As the capital city and the biggest city in Indonesia, DKI Jakarta is divided

into 6 regions namely: Central Jakarta, North Jakarta, East Jakarta, West Jakarta,

South Jakarta, and Kepulauan Seribu. It was found that North Jakarta was one of the

regions with high incidence of DHF. Filled with industrial areas, offices, residential

buildings, and houses definitely make North Jakarta as one of the busiest region in

Jakarta. With the population of 1 181 096 people, North Jakarta is prone to the

transmission of DHF.

RESEARCH METHOD

This research used pre - post study design with health education as the interventionto

try to find out the improvement of knowledge level about DHF’s first aid. Research

was done from September 2011 to February 2013. Data collection was conducted in

North Jakarta at 22 September 2011. In this research, private teachers in North Jakarta

are the target population. Furthermore, the accessible population was private teachers


in North Jakarta who came to the health education at 22 September 2011, fulfilled the

inclusion criteria, and did not meet the exclusion criteria. Sample size of the research

was measured by total population method, which makes all of the teachers came to

the health education as the research subjects. In this research, the dependent variable

is defined as the level of knowledge on first aid of DHF before and after the health

education was delivered. Meanwhile, the independent variable is health education on

first aid of DHF. The dependent variables include the gender, education, occupation,

and history of dengue infection. In the health education, researcher asked for

informed consent by explaining to the subjects about the research. Subjects have the

right to refuse if they do not want to be involved in the research. If the subject

agreed, the researcher would give the questionnaires before and after the health

education. The health education was given by two resource persons who were

professor of parasitology and doctor from community medicine department for 1

hour. While the subjects were filling the questionnaires, they were accompanied by

researcher to ensure that they had filled in the questionnaires correctly.

Confidentiality would be ensured upon the data obtained from the questionnaires.

Souvenirs would be given after the data collection as a token of gratitude.

Data of the subjects from the questionnaire would be kept confidential. In the end

of the event, souvenirs were given for each subject. Data verification was done after

the subjects finished completing the questionnaires given to assure that the questions

were filled correctly and completely. Data obtained was processed using SPSS

version 11.5. Data analysis was done using marginal homogeneity test as well as

descriptive methods and analytic methods for significant relationship between two

variables using Kolmogorov-Smirnov. The level of knowledge was scored through

questionnaires previously validated. It consisted 5 questions regarding first aid of

DHF with maximum score of 5 for each questions. Total of the scores will be

classified into good knowledge if it is 80% more, moderate if it is between 60%-79%,

and poor knowledge if the score is less than 60%. Education is the last formal study of

the respondent. Occupation is the level of teaching of the respondents. History of

dengue infection is whether or not the respondent had exposed to dengue infection

before.


RESULTS

Health education is important to be given to teachers as it is expected that teachers

will transfer the knowledge to the students as well as other people. The result of the

study shows from 82 teachers joined the study, 48 of them was male (58.5%) and 34

of them was female (41.5%). The education level varies among these teachers. Most

of them graduated from undergraduate program, followed by postgraduate, diploma,

and high school. Most of these teachers were junior high school teachers and never

had dengue infection before (Table 4.1).

Tabel 4.1 Demographic Characteristic of Teachers in North Jakarta, 2011

Variable Category Frequency Percentages

Gender Male 448 48 58.5

Female 34 41.5

Education Level

Teaching Level

History

High School

Diploma

S1

S2

Kindergarten

Elementary School

Junior High School

High School

Yes

No

4

7

62

9

3

22

39

18

27

55

4.9

8.5

75.6

11

3.7

26.8

47.6

22

32.9

67.1

The table 4.2 represents the respondent’s pretest level of knowledge first aid

of DHF with other influence factors. According to the education level, S1 graduates

got most of the good scores. However, most of the respondents got the poor level of

knowledge. It was found that both gender mostly got poor results. On teacher’s

occupation, it was found that more of the high school teachers got average results,

followed by junior high school teachers, elementary school teachers, and kindergarten

teachers. Kolmogorov-Smirnov test proves that education level, gender, teacher’s

occupation, and history of the exposure of DHF do not have relations to the level of

knowledge about pathophysiology and first aid of DHF.


Table 4.2 Respondent Pretest Level of Knowledge on First Aid of DHF with other

Influence Factors

As it is presented in table 4.3, there was significant difference between the

knowledge about first aid of DHF before and after the health education. Thus, in this study

the health education is proven to be effective.

Table 4.3 Knowledge on First Aid of DHF Before and After the Health

Education

Variables

Level of Knowledge

Test Good Moderate Poor

Pre-test 3 (3.7%) 13 (15.9%) 66 (80.5%) Marginal

homogeneity

Post-test 5 (6.1%) 26 (31.7%) 51 (62.2%) p<0,01

Based on table 4.4, it was found that before the health education, the question

which was mostly understood by the respondent was the question on what is the most

proper first aid to be done to DHF patients in which 85.4% respondents answered

Variables

Category Knowledge p

Poor Moderate Good

Education

Level

High School 4 0 0 0,999

Diploma 6 1 0

S1 49 10 3

S2 7 2 0

Gender Male 41 5 2 0,941

Female 25 8 1

Teaching

Level

Kindergarten 3 0 0 0,987

Elementary School

19 2 1

Junior High School 30 8 1

High School

14 3 1

History Yes 23 4 0 1,000

No 43 9 3


correctly. The question that was mostly misunderstood by the patient was the question

on when to refer DHF patients to the doctor or hospital in which none of the

respondents got full score of the question. After given the health education, more

respondents answered the question on the proper first aid to be done to DHF patient

correctly as 97.6% of the respondents got full score. However, the question on when

to refer DHF patients to doctor or hospital was still the least understood question but

the scores of the respondents were improved as 1,2% of the respondent finally got full

score.

Table 4.4 Proportion of Question Answered to the Question Regarding the

Knowledge on First Aid of DHF

No Pretest

Score Total

Posttest

Score Total

1 0 12 (14.6%) 0 2 (2.4%)

5 70 (85.4%) 5 80 (97.6%)

2 0 57 (69.5%) 0 58 (70.7%)

5 25 (30.5%) 5 24 (29.3%)

3 0 27 (32.9%) 0 5 (6.1%)

5 55 (67.1%) 5 77 (93.9%)

4 0 0 (0 %) 0 3 (3.7%)

1 5 (6.1%) 1 47 (57.3%)

2 26 (31.7%) 2 24 (29.3%)

3 51 (62.2%) 3 1 (1.2%)

4 6 (7.3%)

5 1 (1.2%)

5 0 75 (91.5%) 0 68 (82.9%)

5 7 (8.5%) 5 14 (17.1%)

DISCUSSION

Indonesia is one of the countries in South East Asia with the high incidence of

DHF. One of the cities with highest incidence of DHF in Indonesia is Jakarta. The

region which is usually affected by DHF is North Jakarta. Thus, health education is

needed to reduce the mortality and morbidity rate of DHF. Important aspect needs to

be delivered is the first aid of DHF. In this research, we gave questionairres that

needed to be filled by the private teachers in North Jakarta.


Association between Knowledge on First Aid of DHF and Demographic

Characteristic of the Respondents

From 82 respondents, 58,5% of the respondents were male and 34% of the

respondents were female. Both gender mostly got poor results in pre-test. It was found

that there was no relationship between gender and level of knowledge. This is

probably due to gender equality in which everyone has the same rights to obtain their

rights no matter what the gender is. This includes knowledge regarding first aid of

DHF in which gender does not determine the exposure of someone to the information.

Previous study done by Setiawan10

supports this finding as it was also found that there

was no association between gender and level of knowledge on first aid of DHF.

Education is an important stage throughout a person’s life and it will certainly

be a qualification in the employment process. Being a teacher requires people to pass

certain stage of education. If he or she fails to do so, he or she will not be recruited as

teachers.

Most of the respondents graduated from undergraduate program with the

percentage of 75,6%. The rest of the respondents came from various education level

which includes high school, diploma and postgraduate study. In the pre-test, it was

found out that only S1 graduates had good level of knowledge on first aid of DHF.

It was found that there was no relationship between education and level of

knowledge on first aid of DHF. However, several studies suggest otherwise. A study

suggests that with higher education, people will more likely to have more knowledge

on first aid as well as prevention and behavior.11

Higher educational level was also

proven to associate with level of knowledge of dengue in Jamaica.12

Previous study

by Syed et al13

also proves significant relationship is found between knowledge and

education.

This can be due to many reasons. First, the respondents had never been

exposed to knowledge on first aid of DHF during their education deeply. Most of the

teachers came from the same education level which may also be a reason on why

there was no relationship between education and level of knowledge on first aid of

DHF.

All of our respondents were teachers. However, the level in which they teach

varied from kindergarten to high school. No relationship between occupation and

knowledge on first aid of DHF was found. It may be due to lack of exposure to


information about first aid of DHF. There was no specific topic or field in the level of

education which they taught about this.

Most of the respondents had never had history of dengue infection. Only

32,9% of the respondents had ever encountered dengue infection previously. In fact, 3

respondents who had good knowledge prior to the health education had never had

history of dengue infection. On the contrary, none of the respondents who had history

of dengue infection had good knowledge. It was found that there is no relationship

between history of the infection and the level of knowledge on first aid of DHF.

Respondents who had history of dengue infection might not have applied proper first

aid when they faced dengue infection. Most patients with dengue infection would be

admitted to the hospital and be treated parenterally. Not only that, doctors rarely

explains about the proper first aid needs to be done when the patients re-encounter

dengue infection. Thus, they are lacking of knowledge towards first aid of DHF.

Using the health education, the level of knowledge may be improved and it is

expected that the respondents will transfer the knowledge to others and apply the

knowledge in their daily activities.

The Effectiveness of Health Education on First Aid of DHF

Knowledge is a very important determinant in someone’s behavior towards

certain diseases. DHF is one of the examples of this; studies have shown that higher

level of knowledge towards DHF will lead to better preventive methods towards

DHF.14-16

It was also proven that health education can improve knowledge, attitude,

and behavior towards DHF.17-19 Not only that, study done by Kooenradt et al20

also

supports this theory by stating that there association between knowledge and the

effort of vector control. With proper knowledge on first aid of DHF, mortality and

morbidity caused by DHF can be decreased.

In this research it was found that before the health education, 80,5% of the

respondents had poor level of knowledge and only 3,7% of the respondents had good

level of knowledge. Hence, before the health education, the knowledge on first aid of

DHF was lacking because more than half of the respondents had poor knowledge.

Poor knowledge had by the respondents may be caused by lack of information source

to the respondents. All this time, the government effort emphasizes to control DHF

vector which were given through health education and promotion using various

media. There was lack of information circulating in public as to how we can give


proper first aid to the DHF patients. This is very important to be given because

proper first aid to the DHF patients may reduce the morbidity and mortality of DHF.

Health education on first aid of DHF can be given using various media and

promotion. Newspaper, radio, or television is few of the possible ways in which

knowledge on first aid of DHF can be given to people. Not to mention, health

education and workshops can also be done in effort of doing so. Best ways to educate

people about this topic is using television and health education by doctors. Study by

Khynn et al21

provs that people who are exposed to various mass media, for example

posters, television, newspaper, and journals, will have deeper knowledge of DHF

compared to people who are not exposed. This is also supported by Itrat et al,22

who

stated that the most influential media to transfer the knowledge of DHF is through

television.

In this research, it was found that health education is effective to improve the

knowledge on first aid of DHF. This result is also supported by previous study done

by Setiawan,10

which also proved that health education is effective to improve the

knowledge of DHF. Another study done in Jeddah also proves that health education

can improve knowledge significantly compared to knowledge before the education.23

Effectiveness of the health education itself is affected by multiple factors, some of

them are the resource person of the education and also people who attend.

Resource persons of this health education are undoubtedly experts in their

fields. They are also experienced in giving health education in several occasions

before. The materials of the presentations were given in interactive, simple, and

interesting ways as well as using presentation slides which could emphasize on the

importance of the materials. Not only that, the respondents were teachers, they had

passed several educational stages that need to be fulfilled as teachers. They were also

enthusiastic in listening to the health education and involved actively in question and

answer session of the health education.

Proportion of the Question Answered to the Question regarding the Knowledge

on First Aid of DHF

There were 5 questions about the first aid of DHF. Before the health education

was delivered, questionnaires were distributed as pre-test. After the health education,

questionnaires were distributed as post-test. As it was mentioned above, the level of


knowledge on first aid of DHF before the health education was generally poor.

The first question was regarding the proper first aid of the DHF. Options

given were to drink a lot, to eat a lot, to rest, unknown, or others. The correct answer

is to drink a lot. In this question, 85,4% of the respondents answered correctly in the

pre-test. After the health education was given, the percentage increases to 97,6%.

Nearly all of the respondents answered correctly which indicates that the content of

the health education regarding this question was clearly understood by the

respondents.

The second question was regarding the proper management to lower the fever

in DHF patients. Options given were cold compress, warm compress, alcohol

compress, unknown, or others. The correct answer was warm compress. In the pre-

test, it was found that 30,5% of the respondents answered warm compress. However,

in the post-test it was found that the percentage declined to 29,3%. This may be due

to the beliefs that cold compress should always be given in cases of fever. On the

contrary of the beliefs, warm compress should be given. Other possibility is that the

material of the health education regarding this topic was too difficult to be understood

by the respondents.

The third question was the correct drug to lower the fever in DHF patients.

The choices of answer were paracetamol, aspirin, antibiotic, unknown, or others. In

this question, the correct answer was paracetamol. It was found in the pre-test that

67,1% of the respondents answered correctly. The percentage rose to 93,9%. In this

question, we can say that people have known what drug should be given in case they

face DHF cases. Materials regarding this topic was also clearly understood which can

be seen in the percentage that almost all respondents answered this correctly.

The fourth question was when to refer DHF patients to the doctor or hospital.

In this question, respondents could answer more than one correct answer. Before the

health education, none of the respondents answered this correctly. After the health

education was given, only 1,2% of the respondents answered this using correct

answer. However, improvement could be found as more respondents got higher score

for this question, although not perfect, in the post-test. The correct answers were

persistent high fever, patient feels sleepy and continuously sleeps, and cold sweat.

The answers were signs of shock. We want to prevent the occurrence of shock. This

indicates low knowledge on shock and the danger of it. This may be due to lack of

information regarding shock. Furthermore, difficult question and difficult materials


regarding this can be also the causes.

Last question was about the correct fluid to be administered to DHF patients.

In the pre-test, almost all respondents with the percentage of 91,5% answered

incorrectly. It means that only 8,5% respondents answered it correctly. The

percentage of respondents who answered correctly doubled in post-test to 17,1%.

However, the percentage of respondents who answered this question incorrectly was

still high, 82,9%. The incorrect answers that were chosen were guava juice and

angkak. Angkak is the result of red rice fermentation by mold, Monascus sp. The

correct answer was oralit. It is believed that guava and angkak can increase the level

of thrombocyte. However, this has never been proven scientifically. Guava is

recommended to be given due to its rich electrolyte content. DHF patients should be

given fluid replacement therapy as soon as possible to avoid shock.

CONCLUSION AND SUGGESTIONS

Conclusion

1. Prior to the health education, 3 teachers had good knowledge towards first aid

of DHF, 13 teachers had average, and 66 teachers had poor level of

knowledge. After the health education, the teachers who had good knowledge

increased to 5 teachers and the number of teacherse who had average

increased to 26 people and the number of teachers with poor level of

knowledge decreased to 51 people.

2. The knowledge on first aid of DHF has no association with gender, education

level, occupation, and history DHF exposure.

3. Health education is proven effective to increase the level of knowledge on first

aid of DHF.

Suggestions

1. 1. Health education on first aid of DHF should be given continuously using

public health campaign through mass media.


2. Health education and public health campaign must be given to all teachers

without considering demographic characteristics.

3. Further research is needed to study the behavior of the teacher about their

daily implementations on this knowledge.

REFERENCE:

1. WHO. Dengue status in South East Asia region: an epidemiological perspective.

[internet]. 2008 [cited 2013 January 5]. Available from: http://www.searo.who.

int/LinkFiles/Dengue_dengue-SEAR-2008. pdftm&gt

2. WHO. Comprehensive guidelines for prevention and control of dengue and dengue

haemorrhagic fever. India: World Health Organization;2011.

3. Sungkar S, Widodo AD, Suartanu N. Evaluasi program pemberantasan DBD di

Kecamatan Pademangan Jakarta Utara. Maj Kedokt Indon. 2006;56:108-12.

Indonesian.

4. Sungkar S, Fadli RS, Sukmaningsih A. Trend of dengue haemorrhagic fever in

North Jakarta.J Indon Med Assoc. 2011;61:394-9.

5. Suhendro, Nainggolan L, Chen K, Pohan HT. Demam berdarah dengue. In: Sudoyo

AW, Setiyohadi B, Alwi I, Simadibrata M, Setiati S,editors. Buku Ajar Ilmu Penyakit

Dalam. 4th

ed. Jakarta: Pusat Penerbitan Departemen Ilmu Penyakit Dalam Fakultas

Kedokteran Universitas Indonesia; 2006. p. 1731-9. Indonesian.

6. Bloemer JM. Aedes aegypti, Aedes albopictus, and dengue virus in Harris Country:

an estimate of risk [dissertation]. Texas: School of Public Health University of Texas;

2009.

7. Chaturvedi UC, Nagar R. Dengue and dengue haemorrhagic fever: Indian

perspective. J Biosci. 2008;33:429-41.

8. Mairuhu ATA, Wagenaar J, Brandjes DPM, Van Gorp ECM. Dengue: an

arthropod-borne disease. Eur J Clin Microbiol Dis. 2004;23:425-33.

9. Sumarmo PS. Demam berdarah dengue. Jakarta: Bagian Ilmu Kesehatan Anak

FKUI; 1995. Indonesian.

10. Setiawan DS. Pengetahuan warga Kecamatan Bayah Provinsi Banten mengenai

gejala dan pertolongan pertama DBD. [dissertation]. Jakarta:Universitas

Indonesia;2011.


11. Uskun E, Alptekin F, Ozturk M, Kisioglu AN. The attitudes and behaviors of

house wives in the prevention of domestic accidents and their first aid knowledge

levels. Ulus Travma Acil Cerrahi Derg. 2008 Jan;14(1):46-52.

12. Shuaib F, Todd D, Stenett-Campbell D, Ehiri Jolly PE. Knowledge, attitudes, and

practices regarding dengue infection in Westmoreland, Jamaica. West Indian Med J.

2010;59(2):139-46.

13. Syed M, Saleem T, Syeda UR, Habib M, Zahid R, Bashir A, et al. Knowledge,

attitudes, and practices regarding dengue fever among adults of high and low

socioeconomic groups. JPMA. 2010;60:243.

14. Ahmed N, Taneepanichskul S. Knowledge, attittude, and practice of dengue fever

prevention among the people in Male’, Maldives. J Health Res. 2008;22(suppl):33-7.

15. Sigarlaki HJO. Karakteristik, pengetahuan, dan sikap ibu terhadap penyakit

demam berdarah dengue. Berita Kedokteran Masyarakat. 2007;23(3). Indonesian.

16. Benthem BHB, Khantikul N, Panart K, Kessels PJ, Somboon P, Oskam L.

Knowledge and use of prevention measures related to dengue in northern Thailand.

Trop Med Int Health. 2002;7:993-9.

17. Tram TT, Anh NTN, Lan NT, Cam LT, Chuong NP, Tri L, etal. Impact of health

education on mother’s KAP on DHF. Dengue Bulletin. 2003;27:174-80.

18. Sungkar S, Winita R, Kurniawan A. Pengaruh penyuluhan terhadap tingkat

pengetahuan masyarakat dan kepadatan Aedes aegypti di Kecamatan Bayah, Provinsi

Banten. Makara, Kesehatan. 2010 December;14(2):81-5. Indonesian.

19. Suyanto S, Zahtamal Z, Restuastuti T, Chandra F, Handayani H. Evaluasi

penerapan promosi kesehatan dalam pencegahan penanggulangan penyakit demam

berdarah dengue melalui gerakan 3M plus di Kota Pekanbaru. J of Envi Sci. 2009:3.

Indonesian.

20. Koendraadt CJM, Tuiten W, Sithiprasasna R, Kijchalao U, Jones JW, Scott TW.

Dengue knowledge and practices and their impact on Aedes aegypti populations in

Kamphaneg Phet, Thailand. AM J Trop Med Hyg. 2006;74(4): 692-700.

21. Khynn TW, Sian ZN, Aye M. Community-based assessment of dengue-related

knowledge among caregivers. Dengue Bulletin. 2004; 28:189-95.

22. Itrat A, Khan A, Javaid S, Kamal M, Khan H, Javed S, et al. Knowledge,

awareness and practice regarding dengue fever among the adult population of dengue

hit cosmopolitan. PloS One


1WHO. Dengue status in South East Asia region: an epidemiological perspektive. [internet]. 2008 [cited 2013 January 5]. Available from: http://www.searo.who. int/LinkFiles/Dengue_dengue-SEAR-2008. pdftm&gt 2 . World Health Organization. Comprehensive guidelines for prevention and control

of dengue and dengue haemorrhagic fever. India: World Health Organization;2011.

3 Sungkar S, Widodo AD, Suartanu N. Evaluasi program pemberantasan DBD di Kecamatan

Pademangan Jakarta Utara. Maj Kedokt Indon. 2006;56:108-12. Indonesian.

4 Sungkar S, Fadli RS, Sukmaningsih A. Trend of dengue haemorrhagic fever in

North Jakarta.J Indon Med Assoc. 2011;61:394-9

5 Suhendro, Nainggolan L, Chen K, Pohan HT. Demam Berdarah Dengue. In:Sudoyo AW, Setiyohadi B, Alwi I, Simadibrata M, Setiati S,ed. Buku Ajar Ilmu Penyakit Dalam. 4th ed. Jakarta : Pusat Penerbitan Departemen Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Indonesia; 2006.p,1731-1739. 6 Bloemer JM. Aedes aegypti, Aedes albopictus, and Dengue Virus in Harris Country : an Estimate of Risk. 7[Chaturvedi U C and Nagar R 2008 Dengue and dengue haemorrhagic fever: Indian perspective; J. Biosci. 33 429–441]

8 Dengue an arthropod borne virus

1. 9 Sumarmo PS. Demam Berdarah Dengue (Dengue Hamorrhagic Fever). Jakarta: Bagian Ilmu Kesehatan Anak FKUI; 1995.

10 Riset dimas rahman 11

Uskun E, Alptekin F, Ozturk M,Kisioglu AN. The attitudes and Behaviors of Housewives in the

Prevention of Domestic Accidents and Their First Aid Knowledge Levels. Ulus Travma Acil Cerrahi

Derg. 2008 Jan;14(1):46-52. 12

Shuaib F, Todd D, Stenett-Campbell D, Ehiri Jolly PE. Knowledge, Attitudes, and Practices

regarding Dengue Infection in Westmoreland, Jamaica. West Indian Med J. 2010; 59(2): 139-146. 13 Syed M, Saleem T, Syeda UR, Habib M, Zahid R, Bashir A, et al. Knowledge,

attitudes, and practices regarding dengue fever among adults of high and low

socioeconomic groups. JPMA. 2010;60:243. 14Journal di ipad

1. 20. Constantianus JM Koendraadt, Wieteke Tuiten, Sithiprasasna R,

Kijchalao U, Jones JW, Scott TW. Dengue knowledge and practices and

their impact on aedes aegypti populations in Kamphaneg Phet, Thailand.

AM J Trop Med Hyg 74(4), 2006, 692-700

21. Khynn TW, Sian ZN, Aye M. Community-based assessment of dengue-

related knowledge among caregivers. Dengue Bulletin 2004; 28:189-95

22. Itrat A, Khan A, Javaid S, Kamal M, Khan H, Javed S et al. Knowledge,

awareness and practice regarding dengue fever among the adult population of

dengue hit cosmopolitan. PloS One. 2008; 3:1-6.


23. Ibrahim NKH, Al-Bar A, Kordey M, Al-Fakeeh A. Knowledge, attitudes,

and practices relating to dengue fever among females in Jeddah high school. J.

of Infection and Public Health. 2009; 2:\\\30-40


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