Kali Angke Final Report Health Study · 2011-11-20 · as possible about the condition of water at Kali Angke river and its inhabitants on the riverbanks. Therefore research areas

Kali Angke Final Report Health Study


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CHAPTER I INTRODUCTION

RIVERS FLOW IN JAKARTA

Jakarta is a city that is build upon a swamp with 13 rivers cut the city and end in

Teluk Jakarta (DaAi TV Indonesia, 2006). In the east Jakarta, there are Cakung, Jati

Kramat, Buaran, Sunter and Cipinang river; in the central there are Ciliwung, Cideng,

and Krukut river; and in the the west there are Grogol, Sekretaris, Pesanggrahan,

Mookervaart and Angke river. Beside that, the Jakarta’s topography is indeed lower

than the sea level so that flood is a common problem to this city.

But topography is not the only factor that causes flood in Jakarta. The hight of

rainfall, the clearing of the forest that vanishes the water reservoir, the population

growth follows with the pile up of garbage that clog the waterflow, the building and

housing that are build upon the waterflow area; those are the factors that cause the

flood in Jakarta. This city also records some big flood in 1621, 1654, 1918, 1976, 1996

and 2002.

KALI ANGKE HISTORY

This river is called “Angke” or “Ang” which means “red” in the Chinese

language. It refers to Angke tragedy, a sad history of the butchering of 10.000 Chinese

people by VOC in Kali Besar Barat, Batavia. The blood of the victims flew all over from

the Kali Besar to java river through Angke river. While “kali” in Javanese denotes ”river”

in English.

Actually, in 1960 it was noted that Angke river was a clear and see-through river

with 25 metres width and a lot of creatures lived there: shrimp, gabus fish, lele (catfish),

and betook fish.The river was surrounded by plantfields and ponds. People that lived in

Kapuk Muara use the land owned by the government as rice- and vegetables fields.

This situation changed in 1970 when Kapuk Muara was filled with soil and a

convection factory was built, then followed by other industries. The opening of the

factory invited many urban from the villages and they claimed the empty area as their

possession. The more industries were established, the more people came. By the end

of the 1980’s, there were thousands of people lived in the dike of Angke river.


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When the local government constructed the Cengkareng Floodway System and

Cengkareng drain, the flow of angke river, Mookervaart canal, Pesanggrahan and

Grogol rivers was discharged to the Cengkareng drain. As the consequences of this

system, the waterflow from Angke river through Kapuk Muara stopped flowing. In a

month, the water turned black and dark, and it was not able to revive the oxygen. The

lack of oxygen killed the bactery that used to destroy the litter and waste. On the other

side, the still water invited more people to build houses upon river. The home littering,

industrial waste, and the houses reduced both the quality and the quantity of the dead

river; it reduced to 10m width and 1 m deep (used to be 25m width and 12 m deep).

Consequently, when the flooding was drawn, the people in Kapuk Muara that own

fragile houses upon the Angke river faced the new problem: they lost their houses and

belongings.

THE RIVER CLEANING PROGRAM

After big flood in 2002, the Tzu Chi Indonesia established a “Jakarta Flood

Relief Program” through 5 P, that are:

• Pengeringan (draining)

• Pembersihan (cleaning)

• Penyemprotan (fogging)

• Pengobatan (medical help)

• Perumahan (housing)

As a pilot project, Kali Angke was choosen due to its historical background.

Considering the impossibility to revive the river without relocating the

inhabitants that lived upon the river, Tzu Chi foundation built houses for relocated

inhabitants. After some steps of socialization and selection, finally on July 2003 Tzu

Chi Foundation dan Jakarta Government relocate residents of Kapuk Muara and

Pejagalan to Great Love Village of Tzu Chi in Cengkareng. Through same phases as

the first Great Love Village, 393 families from kali Adem were moved to Great Love

Village II in Muara Angke on June 26, 2005. Some facilities are prepared to people

including housing, educational services and health services.


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MULTIDISCIPLINARY STUDY

Characteristics of river reflect the environmental condition of the surrounding

landscape. Healthy river ecosystems are balanced systems where input, output and

chemical transformation maintain nutrient concentrations within ranges appropriate for

organisms living in the river (Naiman et al., 1998). In response to the high nutrient

levels and the associated high concentration of organic matter, autotrophic and

heterotrophic microbial communities bloom and natural species composition are

severely disrupted. The consequences of these effects to water quality may be severe

that human health is directly threatened, especially the presence of toxin in these

effluents (Naiman et al., 1998). On that condition, access to safe drinking water is a

basic need for maintaining healthy life.

Water quality is most commonly thought of as representing water’s chemical

character. Generally physical, chemical and biological constituents affect river water

quality. Water quality includes physical, chemical, and biological constituents affecting

a stream’s physical condition and chemical constituents and the total of these

characteristics may be accurately thought of as stream quality.

Faculty of Medicine University of Indonesia organized an extensive program to

assess the quality of Kali Angke and how it affects the inhabitants or reciprocally. In

latter scheme, it is designed for local community to provide intensive technical

assistance for them in empowering local community and improving their health status

in a sustainable period. Still they need an intensive and extensive empowerment

program in order to maintain environmental program and improve their health based on

local capacity. So that they could continue the river cleaning program independently

from Tzu Chi or other NGO or government programs. To capture the magnitude of the real problem in society firstly we are

conducting a multidisciplinary research to evaluate Kali Angke river and the people

living in river banks area holistically.


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CHAPTER II OBJECTIVES

As the first step of a larger work, it is necessary to collect informations as much

as possible about the condition of water at Kali Angke river and its inhabitants on the

riverbanks. Therefore research areas include assessment on water quality from

physical, chemical and microbiological aspect and health status of the inhabitants in

relation with waterborne diseases.

The main objectives of the study are:

1. To evaluate Kali Angke water quality

2. To obtain prevalence rate of water-borne disease at Kali Angke river area

3. To assess health status of 2-5 year old children inhabited at Kali Angke river

4. To identify variables for water quality and Kali Angke residents’ living quality

improvement

Therefore team was divided into two big groups, The first group is water team,

with main task to assess water quality in Kali Angke; and the second one is human

team to assess health status of 2-5 year old children inhabited at Kali Angke.


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CHAPTER III PROCESS AND ACTIVITIES

WATER TEAM ACTIVITIES

Water team which is responsible in assessing the water quality of Kali Angke

river, has sucessfully collected samples from 8 different locations of Kali Angke

representing the mid stream area, ex relocation area and Kali Angke bay, using

randomized duplicate sampling method. The locations are:

1. Kembangan/Duri Kosambi

2. Pesing Poglar

3. Teluk Gong

4. Pantai Indah Kapuk

5. River Mouth

6. Left Side of River Mouth

7. Right Side of River Mouth,

8. Outer Side of River Mouth

The sampling was done on April 15, 2007. Prior to the sampling, survey to

location was conducted once on March 25, 2007. It aimed to choose appropriate

locations.

Water quality in situ measured by WQC Horiba U 10 and data Logger YSI 6000,

while the other parameters analyzed in laboratory (Table 1). Government Role, (PP

82, 2001), is used to evaluate the water condition. The investigators did a

comprehensive evaluation on the water samples based on:

1. physical parameter

2. chemical parameter

3. biological parameter

Table 1. Methods/instruments for physical parameters

No. Parameter Instruments (unit) (Methods)

1 Temperature (°C) WQC Horiba U 10, Data Logger YSI 6000 2 Turbidity (NTU) WQC Horiba U 10 3 Conductivity (mS/cm) WQC Horiba U 10, Data Logger YSI 6000 4 Suspended solid (mg/l) Gravimetric 5 Light (m) Secchi dish


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6 Current Current meter 7 Grain size analysis

Table 2. Methods/instruments for chemical parameters

No. Parameter Instruments 1 pH WQC Horiba U 10, Data Logger YSI 6000 2 Dissolved oxygen (mg/l) Data Logger YSI 6000/ titrimetri 3 NO3 Spectrophotometer 4 NO2 Spectrophotometer 5 NH4 Spectrophotometer 6 TN Spectrophotometer 7 TP Spectrophotometer 8 Orthophosphate. Spectrophotometer 9 COD Titrimetric

10 H2S Spectrophotometer 11 TSS Gravimetric 12 TOM Titrimetric

13 Heavy metals (Cd,Cu,Hg, As) in sediment and biota and water

Atomic Absorption Spectrophotometry (AAS)

14 Acute toxicity analysis (LC50) Table 3. Methods/instruments for biological parameters


1 Phytoplankton Plankton net and Water Bottle Sampler 2 Harmful Algal Bloom Plankton net and Water Bottle Sampler 3 Microbiology (E.coli) Double Tube Method

Membrane Filter Method 4 Ascaris lumbricoides egg Sedimentation method (Suzuki, 1977)

Entamoeba histolytica cyst Sedimentation method (Suzuki, 1977) 5 Benthic organism Ekman Grab & Peterson Grab

Laboratories used for analysis are:

1. hydrochemistry laboratory, Limnology Research Centre, LIPI, category: Good

Laboratory Practice

2. affiliation laboratory department of chemistry, FMIPA UI

3. marine biology laboratory, departement of biology, FMIPA UI

4. microbiology laboratory, FKUI

5. parasitology laboratory, FKUI


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Picture 1. Activity in parasytology laboratory

HUMAN TEAM ACTIVITIES

Intensive surveys has been performed in period of April-May 2007 to inspect

the location, obtain permission from local authorities and coordination with local trained

community volunteers as well as other Non Governmental Organization (NGO).

Data was collected crosssectionally. Human team executed data collection for

two days on June 9-10, 2007 at RW 04, Kapuk Muara district, North Jakarta. Specific

district was choosed according to relocation area. The sampling method is stratified

cluster sampling. The total sample of children aged 2-5 years old inhabited at RW 04 is

included in this study.

Picture 2. Team of doctors from University of Indonesia conducted a complete

examinations on children


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Collection of baseline data includes:

1. Diarrhea morbidity

2. Parasite morbidity

3. Nutritional status

4. Developmental status

5. Dental health status

6. Skin health status

7. Oxidant and antioxidant status

8. Health behaviour

Laboratories used for analysis are:

1. gastroenterology laboratory, department of child health, FKUI; for faecal analysis

2. prodia laboratory; for blood analysis

3. biochemistry laboratory, FKUI; for oxidant and antioxidant status

4. dermatology laboratory, FKUI; for KOH examination

5. parasitology laboratory, FKUI for parasit analysis

As regards this study, we closely cooperate with local authority and local trained

community volunteers. During data collection, team was also fully supported by Tzu

Chi foundation for man power and medicine supplies.

This study has been granted ethical clearance from Ethical Committee, Faculty

of Medicine University of Indonesia on May 2007.

Picture 3. Tzu Chi volunteers in registration table


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CHAPTER IV WATER QUALITY

PHYSICAL PARAMETERS

A. TEMPERATURE Physiological processes like metabolism, respiration, photosynthesis, and

activity pattern and behavior are very dependent on temperature. Physiological

reaction velocity is decided by enzyme system which depends on temperature and has

optimal temperature. So, temperature is an important factor.

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Figure 1. The average value of temperature

Water temperature in Kali Angke is between 26,7oC- 29,6oC, while in estuary

region is between 30oC – 31 oC (Figure 1). According to Government Roule, (PP82,

2001), temperature deviation is not more than 3 oC for water Class I-III, while for water

class IV not more than 5 oC.

B. CONDUCTIVITY Conductivity is a measure of waters ability to carry an electrical current, varies

both with the number and types of ions that waters contains. Conductivity provides

baseline information against which changes in water quality can be detected and also

is used to trace the movement of substances discharge to the water body (Naiman

and Bilby, 1998). The value of conductivity is expressed in µmhos/cm or µSiemens/cm

(Mackereth et al., 1989). Pure water has conductivity value around 1 µmhos/cm, while


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natural inland waters is around 20 – 1500 µmhos/cm (Boyd, 1988). Sea waters has

high value of conductivity because it contains much dissolved salt. Industrial waste

can reach 10.000 µmhos/cm (APHA, 1976). The value of conductivity is related close

to the total dissolved solids (TDS). K = DHL (S/m)/ TDS (mg/l) where K = constanta of

specific water (0,55 – 0,75 Canadian Water Quality Guidelines, 1987).

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Figure 2. The average value of conductivity

The average value conductivity of Kali Angke is between 0,168-6,980 mS/cm

(168-6.980 µmhos/cm) while in estuary is between 48,93-56,63 mS/cm (48.930-56.630

µmhos/cm) (Figure 2). The lowest value 168 µmhos/cm found in Pantai Indah Kapuk

which indicate that this area is grouped to the natural waters, and the highest 6.980

µmhos/cm found in Pesing Poglar, indicate that this area is not grouped to the natural

waters (maximum value is 1500 µmhos/cm for natural waters). In estuary area, the

lowest value is 48.930 µmhos/cm found in Right Side of River Mouth and the highest

56.630 µmhos/cm found in River Mouth. This high concentration is probably influenced

by sea waters which contains much dissolved salt.


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C. SALINITY

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Figure 3. The average value of salinity

The salinity in estuary region is between 29 – 35 ‰ (Figure 3). The highest

salinity found at the outer side of river mouth, because of saline water influence from

the Jakarta Bay.

D. TURBIDITY Suspended material in water is typically measured as turbidity and expressed in

nephelometric turbidity units (NTU) or as total suspended solids (TSS) which is a

gravimetric determination of the mass solids and expressed in mg/L. Turbidity will

influence the light penetration on water column and then influence the velocity of

photosynthesis reaction, oxygen production, and the survival of the aquatic animal.

The United States EPA in 1986 recommends a maximum turbidity of 25 NTU to protect

designated beneficial uses in fresh waters of US (Welch et al., in Naiman & Bilby,

1998).


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Figure 4. The average value of turbidity

The average value of turbidity in Kali Angke is between 14,94 – 27,33 NTU and

in estuary in between 11,77 – 54,5 NTU (Figure 4). This value is similar to the TSS

which indicate that the highest value in Kali Angke was found in Teluk Gong while in

estuary the highest value found in Right Side of River Mouth.

E. SUSPENDED SOLIDS Suspended solids in freshwaters ecosystem usually comes from precipitation,

shake of water column, or microorganisms found in water column. Suspended solid will

influence the light penetration to the water column so will influence the depth of photic

zone. Elevated levels of TSS may have both lethal and sublethal effect on stream biota

(Welch et al., in Naiman & Bilby 1998).

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Figure 5. The average value of total suspended solids (mg/L)


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The average value of TSS in Kali Angke is between 26,40 – 57,20 mg/L where

the lowest found in Duri Kosambi and the highest in Teluk Gong, while for estuary area

the lowest foud in Outer side of River (21,87 mg/L) and the highest in Right Side of

River Mouth (128,92 mg/L) (Figure 5). Sublethal effects have been observed at levels

as low as a few hundreds mg/L and lethal effects at concentration in excess of 1000

mg/L (Naiman & Bilby,1998).

The highest average value of TSS in estuary was found in Right Side of River

Mouth, this is similar to the highest average value of turbidity which found in Right Side

of River Mouth, while in Kali Angke the highest average value was found in Teluk Gong

similar to the highest average value of turbidity which found in Teluk Gong.

CHEMICAL PARAMETERS

A. pH

pH, which is a measure of the acidity or alkalinity of a solution is one of

important abiotic factor in freshwater ecosystem. Aquatic biota usually live in the range

of normal pH. So, pH is a limiting factor for their life. pH is probably most important in

affecting the toxicity of poisons and within the range 5 – 9, pH probably has little direct

effect (James & Evison, 1979).

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Figure 6. Average value of Kali Angke pH


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The pH value of Kali Angke waters is between 7,13 – 7,38, and in estuary

between 7,26 – 8,25 (Figure 6). This is indicating that the condition of waters is normal

to alkaly. Naturally, there is no organism can live in wide range of pH neither

physiologically or morphologically (Brönmark & Hansson, 1998).

According to Role of Government 82/2001, the recomended pH for water Class

I-III is between 6-9, while for Class IV is between 5-9. Relating to this factor, the

aspect of natural geographic value must be intended.

B. Dissolved Oxygen (DO)

Dissolved oxygen (DO) is related closed to water quality because oxygen is

very important for aquatic organisms, especially animals, microphytes and submerse

macrophytes for their respiration in the evening. Dissolved oxygen also very important

for microorganims which conduct the aerobic decomposition process. Oxygen is, of

course, a necessary requirement for all organisms with aerobic respiration, which

include the majority of freshwater species. If the concentration of dissolved oxygen is

limited, the decomposition process will occur in anaerobic condition. An aerobic

process will release bed smell of gaseous compounds. So, dissolved oxygen is limiting

factor for aquatic organisms. The major in put of oxygen in aquatic ecosystems are

through diffusion from the atmosphere and photosynthesis, and consumed by

organisms with aerobic respiration during the complex biochemical processes of

catabolism where nutrient molecules are broken down.

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DO

Figure 7. Average value of Kali Angke dissolved oxygen (DO)


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The average value of DO in Kali Angke is between 0,4-15,4 mg/L and in estuary

region is between 3,4-5,73 (Figure 7). The range of this value influenced by time

measuring. The lowest DO concentration found in Pesing Poglar, while the highest in

Kembangan/Duri Kosambi. This character contribute by the condition in the field which

indicate by black color of Pesing Poglar waters. It is almost absolutely could not

support the life of aquatic organisms.

C. Total Phosphor (TP) Phosphor is essensial factor for all organisms because phosphor use in

fundamental processes in storing and transfering genetic information (RNA-DNA), cell

metabolism, cell energy system (ATP). In aquatic ecosystem, phosphor may come

from watershed, released from sediment, and atmospheric deposition. In recent 50

years, the phosphor concentration as a result of human act increase cause of the

human activities. Phosphor is limiting factor for growth and primary productivity in a

freshwater ecosystem and its concentration is easier to measured than carbon.

Phosphat

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mg/

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Figure 8. The average value of PO4

Figure 8 shows that the highest concentration of PO-4 is found at Pesing Poglar

(2,54 mg/L) and the lowest at Pantai Indah Kapuk (0,11mg/L). While at estuary region,

the highest found at River Mouth (0,066 mg/L) and the lowest at outer side of River

Mouth (0,037 mg/L).


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Figure 9. The average value of Total Phosphor (TP)

Distribution of total phosphorus is similar with orthophosphate distribution that

observed in Kali Angke River, the highest concentration of total phosphorus was found

at Pesing Poglar (2.65 mg/L) and in estuarine area at Right Side of River Mouth. The

lowest concentration of total phosphorus were found at River Mouth and Outer Side of

River (Figure 9). It supposed phosphorous concentration in estuary region has

significant correlation with suspended solid and turbidity. Based on Government

Regulation, (PP 82, 2001), in estuarine area, due to concentration of total phosphorous

is included in class I-II, but Angke river is included in class III and IV, except Pantai

Indah kapuk is grouped as class I-II. According to the total phosphorous concentration,

the water quality of the estuarine region is better than kali Angke.

D. Total Nitrogen (TN) In aquatic ecosystem, nitrogen originated from nitrogen fixation and rain

deposition. Nitrogen ussually is not limiting factor for aquatic organism, although

nitrogen concentration that has no strong corelation up the trophic level compare to

phosphorus. It indicates oligotrophic lake is not contain low concentration of nitrogen.

Nitrogen is in the form of organic bound, such as molecul N2, nitrite (NO2-), nitrate

(NO32-) and ammonium (NH4

+). Ammonium form is absorbed to cell easily, although

nitrate and nitrate reduced to ammonium form before it is used by organism.

Distribution of nitrate and ammonium in eutrophic lake and oligotrophic lake is different.

Generally, primary productivity is limited by phosphorous concentration but in

eutrophic lake nitrogen also became limiting factor. In lake that there is no human

activities, influence nitrogen concentration is in the range of 100-1500µg/L but in lake


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receiving waste from human activities or animal as bird colony, nitrogen concentration

is higher than 1500 µg/L.

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Figure 10. The average value of Total Nitrogen (TN)

Distribution of total nitrogen in Kali Angke River indicated that the highest

concentration was observed at Teluk Gong (11,60 mg/L) and the lowest at Pantai

Indah Kapuk (4,21 mg/L), in estuarine area the highest was observed at Left Side of

River Mouth (3,22 mg/L) and the lowest at the Outer Side of River (2,94 mg/L) (Figure

10). But the concentration of TN at Left Side of River Mouth (3,22 mg/L) is not

significant different with TN concentration at Right Side of River Mouth (3,21 mg/L).

So, the distribution of TN is similar to phosphorus, TSS, and turbidity.

E. Ammonium (NH4+)

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Figure 11. The average value of ammonium


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Near sampling point of Teluk Gong, there is home industry of “tempe” (soybean

product), their waste use discharged that threw to river probably still contained protein,

after degradation process it will be increasing the nitrogen level will increase. At Teluk

Gong ammonium concentration is the higher than other sampling sites, this high

ammonium concentration probably originated from decomposition of soybean waste

from “tempe” production (Figure 11).

Nitrogen compounds in water quality indicate biologically available nutrient to

plants or exhibit toxicity to humans or aquatic life. In aquatic ecosystem, nitrogen

originates from nitrogen fixation and rain deposition. Nitrogen forms in aquatic

ecosystem consists of organic nitrogen, N2 molecule, nitrite (NO2-), nitrate(NO3

-),

ammonium (NH4+) and ammonia (NH3). Ammonia (NH3) is the first product in oxidative

deceomposition of nitrogenous organic compounds. Further oxidation leads to nitrite

and then to nitrate. Ammonia is naturally present in most surface and wastewaters. Its

further degradation to nitrites and nitrates consumes dissolved oxygen. Fertilisers in

agriculture content cause the increase of oxygen consumption in river water. If excess

of fertilisers flow into river water, generally nitrate level also increase in the ground and

surface waters. Under unfavourable conditions, carcinogenic nitrosamine can be

produced from amines and nitrite.

According to Government Roule (PP82,2001), the concentration ammonia of

ammonium in Kali Angke generally exceed the ambient value of ammonia recomended

concentration 0,5 mg/L.

F. NO2 AND NO3

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side

of

river

mou

th

Riv

er m

outh

Rig

ht s

ide

ofriv

er m

outh

Out

er s

ide

ofriv

er

Location

NO

2 (m

g/L)

Figure 12. The average value of nitrite


19

Nitrate

00,5

11,5

22,5

3

Kem

bang

an/

Dur

iko

sam

bi

Pesi

ngPo

glar

Telu

k G

ong

Pant

ai In

dah

Kapu

k

Left

side

of

river

mou

th

Riv

er m

outh

Rig

ht s

ide

ofR

iver

mou

th

Out

er s

ide

of ri

ver

Location

mg/

L

Figure 13. The average value of nitrate

High concentration of nitrite was observed at Kembangan (0,22 mg/L) and

Pantai Indah Kapuk (0,1 mg/L) (Figure 12). This value is over than the maximum

torelable for class I,II and III (0,06 mg/L) according to Goverment Regulation (PP.82,

2001). High concentration of nitrite is threatened human and organism, nitrite oxidizes

iron in blood hemoglobin from Fe2 to Fe3. The resulting compound, called

methemoglobin, cannot carry oxygen. The resulting oxygen deficiency is called

methemoglobinemia. It is specially dangerous in infants (blue baby syndrome) because

their small total blood volume (Weiner, 2000). Similar condition for nitrate concentration

was observed at Kembangan and Pantai Indah Kapuk, high level of dissolved oxygen

in these sampling points lead to increase nitrate concentration (Figure 13). However

these value are under the maximum tolerable for nitrate for class I and II is 10 mg/L,

according toGoverment Regulation (PP.82, 2001). According to Goverment Regulation

(PP.82, 2001), the maximum tolerable for nitrate for class I and II is 10 mg/L. So, the

concentration of nitrate was tolerable in Kali Angke and estuary region.

G. H2S Anoxic sediment that contained a lot of organic material will release H2S and

bad smell. In aerobic condition H2S will be oxidized to sulfate. Sulfide is formed in

surface water from anaerobic decomposition containing sulfur. Sulfide reacts with water

to form hydrogen Sulfide, H2S, a colorless, highly toxic gas that smells like rotten eggs.

The human nose is very sensitive to the odor of low level of H2S (Weiner, 2000).


20

According to Goverment Regulation (PP82, 2001), the maximum tolerable for H2S, for

Class I and IV is 0,002 mg/L.

0.000.501.001.502.002.503.003.50

Kem

bang

an/D

uri

Kosa

mbi

Pesi

ng P

ogla

r

Telu

k G

ong

Pant

ai In

dah

Kapu

k

Left

side

of

river

mou

th

Riv

er m

outh

Rig

ht s

ide

ofriv

er m

outh

Out

er s

ide

ofriv

er

Location

H2S

(mg/

L)

Figure 14. The average value of H2S

The highest concentration of H2S was observed in Kali Angke River at Duri

Kosambi (3.04 mg/L) and the lowest is Pantai Indah Kapuk (0.45 mg/L) and in

estuarine area the highest concentration was observed at Left Side of River Mouth

(0.65 mg/L) and the lowest at Right Side of River Mouth (0.25 mg/L) (Figure 14).

Concentration of H2S in all location indicated over of maximum tolerable value for

aquatic ecosystem.

H. Chemical Oxygen Demand (COD) Chemical oxygen demand (COD) refers to amount of oxygen consumed when

organic matter in a given volume of water is chemically oxidized to CO2 and H2O by

strong chemical oxidant, such as permanganate or dichromate. COD is sometimes

used as a measure of general pollution. For example, in an industrial area built on fill

dirt, COD in ground water might be used as an indicator of organic materials leached

from the fill material. Leachate from landfills often has high levels of COD (Weiner,

2000).


21

0

10

20

30

40

50

Kem

bang

an/D

uri

Kosa

mbi

Pesi

ng P

ogla

r

Telu

k G

ong

Pant

ai In

dah

Kapu

k

Left

side

of

river

mou

th

Riv

er m

outh

Rig

ht s

ide

ofriv

er m

outh

Out

er s

ide

ofriv

er

Location

CO

D (m

g/L)

Figure 15. The average value of COD

The highest value of COD was observed at Teluk Gong (Figure 15) .The COD

value is over than maximum tolerable value for class II. It indicated amount of organic

matter in this site too much and potential to become depleted in oxygen. The average

concentration of TOM in Kali Angke was higher than estuary region.

I. Total Organic Matter (TOM) Total organic matter (TOM) in aquatic ecosystem ranges from dissolved organic

compound to large aggregates of particulate organic matter and from living to dead

material. Most of the organic matter, whether dissolved or particulate is detritus

(organic matter from dead organisms. TOM will utilized by organisms for metabolism.

In estuarine area TOM is more available for metabolism of organisms compare to the

river sites.

0102030405060708090

100

Kem

bang

an

Pesi

ngPo

lgar

Telu

k G

ong

Pant

aiin

dah

Kapu

k

Left

side

of

river

mou

th

Riv

er m

outh

Rig

ht s

ide

of ri

ver

mou

thO

uter

sid

eof

rive

rm

outh

Location

TOM

mg/

L

Figure 16. The average concentration of total organic matter


22

The highest concentration of TOM in Kali Angke was found at Pesing Poglar

(20,64 mg/L) and the lowest at Teluk Gong (13,48 mg/L). In estuary region, the highest

concentration found at Outer Side of River ( 92,76 mg/L) and the lowest at Right Side

of River Mouth (48,72 mg/L). Compare between Kali Angke and estuary region, the

concentration of TOM was higher in estuary region (Figure 16).

J. Heavy Metals

J.1. In water The results from qualitative and quantitative analysis of Hg, Pb, Cd, and As in

each river water sample from 8 different locations were shown in Table 4.

Table 4. Quantitative analysis of Hg, Pb, As, and Cd in Kali Angke river's water samples

Quantitative Result No.

Sample Location

SampleCode Hg (µg/L) Pb

(µg/L) As

(µg/L) Cd

(µg/L) 1 Duri Kosambi / Kembangan 1 1.59 x 10-3 30.09 16.27 16.81

2 Pesing Poglar 2 1.55 x 10-3 1.06 2.45 3.08

3 Teluk Gong 3 0.9 x 10-3 0.81 <1.00 4.05

4 Pantai Indah Kapuk 4 1.56 x 10-3 0.29 5.91 2.44

5 Left side of the river side (IV) 5 0.49 x 10-3 42.02 <1.00 114.02

6 River mouth (III) 7 1.57 x 10-3 0.09 <1.00 16.09

7 Right side of the river side (II) 6 0.58 x 10-3 <0.09 5.91 16.17

8 Outer side (I) 8 0.32 x 10-3 0.50 4.18 <1.00


23

Figure 17. Concentration of Pb, As and Cd (µg/L) based on sampling location

0.00

4.00

8.00

12.00

16.00

20.00

24.00

28.00

32.00

36.00

40.00

Dur

i Kos

ambi

/ Kem

bang

a

Pes

ing Pog

lar

Telu

k Gon

g

Pan

tai In

dah K

apuk

Left

side

of th

e rive

r side

(IV)

Rive

r mou

th (II

I)

Righ

t side

of th

e rive

r side

(II)

Oute

r side

(I)

Sampling location

Con

c. H

eavy

met

als

(µg/

ML)

Pb (µg/L)

As (µg/L)

Cd (µg/L)

Figure 18. Concentration of Hg (µg/L) based on sampling location

0.00

0.50

1.00

1.50

2.00

Duri K

osam

bi

Pes

ing Pog

lar

Telu

k Gon

g

Pan

tai In

dah K

apuk

Left

side

of th

e rive

r side

(IV)

Rive

r mou

th (II

I)

Righ

t side

of th

e rive

r side

(II

Oute

r side

(I)

Sampling Location

Hg

Con

c. (n

g/m

L)

Hg (ng/L)


24

From the data obtained, all the river water sample gave the positive qualitative

result for all the heavy metal being tested (Hg, Pb, Cd and As). However the

concentration of those heavy metals in each location were slightly different.

In the up-stream (Duri Kosambi area) the concentration of Pb in the sample

relatively high ( 30.09 µg/L) compare to As and Cd (16.27 and 16.81µg/L) , and Hg

(1.59 x 10-3 µg /L);

In the mid-stream (Pesing Poglar, Teluk Gong/Pasar Gembira and Pantai

Indah Kapuk area) the concentration of all the heavy metals being tested were smaller

than the up-stream area, that was bellow than 6.0 ng/L for Pb, As, and Cd, and 1.55 x

10-3 µg /L for Hg.

In the down-stream (4 locations in Muara Angke area) the Cd concentration

were high especially in the left side of the Muara Angke (Cd concentration up to

114.02 µg/L); the concentration also high in the river mouth and right of the Muara

Angke, but not in the outer side of the river. For Pb, the concentration was also higher

in left side of the Muara Angke (Pb concentration was 42.02 µg/L) compare to other

heavy metal (lower than 1.0 µg/L).

The results from acute toxicity (LC50) study for 48 hours of each river water

sample from 8 different locations were shown in Table 5.

Table 5. Acute toxicity (LC50) 48 hours of Kali Angke river's water samples

No.

Sample Location

SampleCode

LC50 (%)

95% Lower Limit

95% Upper Limit

1 Duri Kosambi / Kembangan 1 - - -

2 Pesing Poglar 2 18.61 11.49 30.14

3 Teluk Gong 3 20.73 11.51 31.83

4 Pantai Indah Kapuk 4 44.90 13.58 148.49

5 Left side of the river side (IV) 5 12.68 8.95 17.95

6 River mouth (III) 7 16.35 11.76 22.73

7 Right side of the river side (II) 6 16.12 9.95 26.10

8 Outer side (I) 8 10.68 4.91 17.76


25

Figure 19. Acute toxicity (LC50) 48 hours of Kali Angke river's water samples

LC50 of The River Water

0.00

10.00

20.00

30.00

40.00

50.00

PesingPoglar

TelukGong

PantaiIndahKapuk

Leftside ofthe riverside (IV)

Rivermouth (III)

Rightside of

the riverside (II)

Outerside (I)

Sampling Location

LC50

(%)

J.2. In sediment Based on heavy metal analysis using Atomic Absorption Spectrophotometer, as

it is shown in table 6 and figure 20 that lead (Pb) content in Angke River sediment

range from 13,732 in Pantai Indah Kapuk and 56,098 µg/g dry wt (ppm) in Right side of

Rivermouth. Most of these values were above the Canadian Standard which for Pb is

25 ppm. Sources of lead (Pb) usually is from leaded gasoline, smelting, paint and

galvanizing, also electroplating factories.

Cadmium (Cd) content in Angke river ranges from 8,917 µg/g dry wt (ppm) in

Pesing Poglar - 124,332 µg/g dry wt (ppm) in Rivermouth. These values exceed the

Canadian Standard for contaminated sediment which for Cd is 0.006 ppm. Cadmium is

used extensively in electroplating, paints, batteries, and phosphate fertilizers.

The concentration of Arsenic (As) in sediments of Angke river and its estuary

ranges from 3,552 - 34,281 µg/g dry wt. Probable Effect Level (PEL) is the

concentration above which adverse effects are expected to occur frequently. The PEL

for arsenic is 17 micrograms per gram (µg/g) dry weight, for bulk (un-sieved)

sediments. Arsenic occurs naturally in soil and minerals and it therefore may enter the

air, water, and land from wind-blown dust and may get into water from runoff and

leaching. Beside that, arsenic is used in various agricultural insecticides, termination

and poisons.

http://en.wikipedia.org/wiki/Agriculture�


26

Mercury (Hg) content in sediments of Angke river and its estuary varied between

<0.2 - 28.11µg/g dry wt (ppm). Some of these values are below the detection limit. Only

at River mouth is high. This is probably due to water discharge directly from river that is

carried by the currents. Canadian Standard for Mercury in sediments is 0.5 ppm.

Mercury is naturally occurring and exists in several forms. High mercury exposure

results in permanent nervous system and kidney damage. Exposure is most likely to

occur during mining, production, and transportation of mercury, as well as mining and

refining of gold and silver ores. Mercury is commonly found in thermometers,

manometers, barometers, gauges, valves, switches, batteries, and high-intensity

discharge (HID) lamps. It is also used in amalgams for dentistry, preservatives, heat

transfer technology, pigments, catalysts, and lubricating oils.

Table 6. Heavy metals (Pb, Cd, As, and Hg) content in sediments of Angke River and

its estuary

Heavy metals Pb Cd As Hg

Locations

(µg/g dry wt) (µg/g dry wt) (µg/g dry wt) (µg/g dry wt)Kembangan 38,282 18,936 4,411 <0.2

Pesing Poglar 29,491 8,917 34,281 <0.2

Pasar Gembira 54,378 16,157 3,552 <0.2

Small industrial villages 13,732 14,110 5,669 <0.2

Left side of river mouth 15,722 15,157 5,660 1.282

River mouth 40,456 124,332 13,076 <0.2

Right side of river mouth 56,098 75,586 3,910 28.11

Outerside of river mouth 32,065 32,571 30,294 <0.2


27

Figure 20. Heavy metals content of sediment samples in Angke River and its estuary

It can be seen from the graph that in most locations, the percentage of coarser

particles (< 425 µ) is higher (almost 90 %) than the finer particles (< 16 µ) (Figure 21).

This is because their rock origin came from upstream of Ciliwung River which contains

boulders and gravels. Some of them are carried away to the river and settled in several

locations, and the rests are suspended as particulates in downstream. Heavy metals

here tend to be bound at finer particles. The finer the particles, the more heavy metals

will be. In this case, not many fine particles (< 63 µ) were found in locations, except on

location in right side of river mouth. This is because the flow of the current that bring

suspended particulate sediment tends to move in the right direction. It is also the

reason why heavy metals were hardly found in many locations.


28

Figure 21. Grain size distribution in Angke River and its estuary

J.3. In benthic organism

In general, concentration of heavy metals in benthic organisms Kali Angke is

dominated by Arsenic (Figure 22). Arsenic occurs naturally in the environment as an

element of the earth's crust. Arsenic is combined with other elements such as oxygen,

chlorine, and sulfur to form inorganic arsenic compounds. Exposure to higher-than-

average levels of arsenic occurs mainly in workplaces, near or in hazardous waste

sites, and areas with high levels naturally occurring in soil, rocks, and water. Exposure

to high levels of arsenic can cause death. Chronic exposure to arsenic can lead to

dermatitis, mild pigmentation keratosis of the skin, vasospasticity, gross pigmentation

with hyperkeratinization of exposed areas, wart formation, decreased nerve conduction

velocity, and lung cancer.

In this research, the highest concentration is on Duri Kosambi which is 60 mg/L

(ppm), followed by Pesing Poglar and left side of river mouth, which were 18 and 17

mg/L, respectively. These concentration were above the threshold limit value. The

Threshold Limit Value for As is 0.01 mg/L.

The second highest of metal that were observed was lead (Pb). The

concentration of Pb was highest at Duri Kosambi; which is 20 mg/L. The theshold limit

value is 1 mg/L. Probably because in Duri Kosambi, there is a human waste discharge

in the river, so the metal that accumulated in human body were excreted. Lead


29

overexposure is one of the most common overexposures found in the industry and is a

leading cause of workplace illness. Therefore, OSHA has established the reduction of

lead exposure to be a high strategic priority. OSHA's five year strategic plan sets a

performance goal of a 15% reduction in the average severity of lead exposure or

employee blood lead levels in selected industries and workplaces.

Lead is also a major potential public health risk. In general populations, it may be

present in hazardous concentrations in food, water, and air. Sources include paint,

urban dust, and folk remedies. Lead poisoning is the leading environmentally induced

illness in children. At greatest risk are children under the age of six because they are

undergoing rapid neurological and physical development.

Lead adversely affects numerous body systems and causes forms of health

impairment and disease that arise after periods of exposure as short as days (acute

exposure) or as long as several years (chronic exposure). The frequency and severity

of medical symptoms increase with the concentration of lead in the blood. Common

symptoms of acute lead poisoning are loss of appetite, nausea, vomiting, stomach

cramps, constipation, difficulty in sleeping, fatigue, moodiness, headache, joint or

muscle aches, anemia, and decreased sexual drive. Acute health poisoning from

uncontrolled occupational exposures has resulted in fatalities. Long term (chronic)

overexposure to lead may result in severe damage to the blood-forming, nervous,

urinary, and reproductive systems.

Tabel 7. Heavy metals (Pb, Cd, As, and Hg) content in benthic organisms (Mollusca

and Polychaeta of Angke River and its estuary

Benthic Animal samples (Mollusca* and Polychaeta)

Pb Cd As Hg

No.

Locations

(µg/g dry wt) (µg/g dry wt) (µg/g dry wt) (µg/g dry wt)

1 Duri Kosambi

Mollusca*

0.2185 0.0186 4.5260 1.4560

2 Duri Kosambi 5.9452 0.5420 60.2256 0.0252

3 Pesing Poglar 0.2072 0.0115 0.8460 0.0065

4 Pantai Indah

Kapuk

0.8403 0.0352 17.8939 0.0006

5 Left side of river

mouth

0.1083 0.0217 1.2683 0.0036

6 River mouth 3.1902 0.3652 16.8632 0.0614


30

Benthic Animal samples (Mollusca* and Polychaeta)

Pb Cd As Hg

No.

Locations

(µg/g dry wt) (µg/g dry wt) (µg/g dry wt) (µg/g dry wt)

7 Right side of river

mouth

0.5269 0.0729 6.0524 0.0075

8 Outer side of river

mouth

0.0857 0.0064 0.6878 0.0015

Figure 22. Heavy metals content of benthic animals samples in Angke River and its estuary


31

BIOLOGICAL PARAMETERS

A. Phytoplankton In Kali Angke, at four location of sampling site was found high abundance of

Oscillatoria tenuis and low abundance of Microcystis aeruginosa (Table 8) .

Tabel 8. Composition of phytoplankton

No. Divisi KembanganPesing Poglar Teluk Gong

Pantai Indah Kapuk

(Ind/L) (Ind/L) (Ind/L) (Ind/L) Cyanophyta

1 Anabaena afinis 0 0 0 0

2 Anabaena aphanizomenoides 0 0 23.333 0

3 Anabaena menderi 20.000 0 0 04 Coleasphaerium dubium 0 300.000 0 0

5 Coleasphaerium kuitzigianium 0 0 853.333 0

6 Dactylococcopis smuhil 0 0 40.000 07 Dactylococcus infusianium 0 0 0 08 Lyngbya sp. 23.333 80.000 0 80.0009 Microcystis aeruginosa 106.667 20.000 50.000 0

10 Oscillatoria tenuis 0 1.000.000 2.800.000 160.00011 Spirulina laxissima 0 160.000 33.333 40.000

Bacillariophyta 1 Chaetoceros copense 0 0 0 02 Closterium acerosum 700.000 0 100.000 03 Closterium gracile 500.000 0 0 04 Closterium sp. 0 160.000 0 23.3335 Coscinodiscus rothi 0 0 0 06 Diatoma longissima 0 0 0 07 Melosira granulata 0 0 6.667 08 Melosira sp. 0 0 0 09 Navicula elegans 0 0 100.000 0

10 Nitszia sigma 0 0 0 011 Skoletenema costatum 0 0 0 012 Synedra ulna 200.000 0 13.333 0

Chlorophyta 1 Actinesatrum hantzchi 0 0 0 02 Ankistrodesmus falcatus 0 300.000 0 800.0003 Ankistrodesmus fractus 0 0 3.000.000 0


32

No. Divisi KembanganPesing Poglar Teluk Gong

Pantai Indah Kapuk

(Ind/L) (Ind/L) (Ind/L) (Ind/L) 4 Closteriopsis longissima 0 0 05 Coelastrum sp. 0 0 1.000.000 06 Cosmarium magnificum 0 0 43.333 07 Kirchneriella sp. 0 0 13.333 08 Pediastrum biradiatum 20.000 0 0 09 Scenedesmus abundans 20.000 0 6.667 0

10 Scenedesmus bijuga 0 0 53.333 0 Dinophyta

1 Ceratium sp. 0 160.000 0 160.0002 Peridinium sp. 0 200.000 0 40.0003 Protoperidinium sp. 0 0 0 0

Total 1590001 2380002 8136668 1303337

Phytoplankton Diversity Index

00,20,40,60,8

11,21,41,6

Kem

bang

an/

Dur

iko

sam

bi

Pesi

ngPo

glar

Telu

k G

ong

Pant

ai In

dah

Kapu

k

Left

side

of

river

mou

th

Riv

er m

outh

Rig

ht s

ide

ofR

iver

mou

th

Out

er s

ide

of ri

ver

Location

Div

ersi

ty In

dex

Figure 23. The diversity index of phytoplankton

The highest diversity index of phytoplankton was found at Pesing Poglar even

this area is heavy polluted by phosphorous and organic material (Figure 23). Pantai

Indah Kapuk which tends to have lowest concentration of the analysis parameters, has

the lowest diversity index. This condition may be influenced by toxic substance like H2S

and NO2=. At Pesing Poglar and Teluk Gong, the abundance species is from Divisio

Cyannophyta. The majority of Cyannophyta are filamentous including many well known

nuisance algae dominant in eutrophic lakes. Low oxygen concentration, creating


33

optimal condition for nitrogen fixation (Brönmark & Hanson, 1998). According to trophic

status in lakes and ponds this indicate that the water quality grouped to eutrophic. In

estuary region, the abundance species is from Divisio Bacillariophyta and Dinophyta.

According to trophic status in lakes and ponds, this indicate that the water quality

grouped to oligotrophic and mesotrophic.

The observation on sea-water sample taken from four stations showed 47 (forty

seven) phytoplankton species which are belonging into groups of dinoflagellates,

diatoms, and cyanobacterias. Table 9 showed 3 (three) species which predominating

other species in all station, that could be seen from the high amount of cells density

compared to other species (> 10.000 cells/litre). The three species are Ceratium furca,

Chaetoceros spp., and Skeletonema costatum, with cells density almost distributed

evenly in every sampling depth.

Table 9. Phytoplankton Cells Density at station 5 (left side of Kali Angke river mouth)

Cells/ liter Divisio Species Name 1 m 2 m 3 m Dinoflagellata/ Dinophyta Protoperidinium spp. 5144 5726 1715 Ceratium furca 36347 15362 857 Protoperidinium conicum 2640 5521 171 Protoperidinium oceanicum 480 2092 103 Gymnodinium sp. 1 309 652 0 Protoperidinium divergens 171 617 0 Protoperidinium venustum 823 2949 240 Ceratium fusus 103 34 0 Ceratium trichoceros 69 34 0 Gonyaulax sp. 1 1680 274 103 Gymnodinium sp. 2 206 240 0 Prorocentrum micans 103 103 0 Ceratium tripos 0 34 0 Dinophysis caudata 0 69 0 Gonyaulax spinifera 0 69 0 Pyrophacus steinii 0 103 0Diatom/ Bacillariophyta Chaetoceros sp. 1 12790 25271 20231 Pleurosigma sp. 1063 12859 44371 Nitszchia seriata 206 823 1989 Rhizosolenia setigera 137 69 2572 Thallasiothrix sp. 0 0 343 Asterionella japonica 0 617 309 Lauderia annulata 0 549 754 Rhizosolenia styliformis 0 0 103 Coscinodiscus spp. 103 0 69 Skeletonema costatum 158080 300380 249290 Chaetoceros sp. 2 206 1577 891


34

Cells/ liter Divisio Species Name 1 m 2 m 3 m Thallasiossira mala 34 137 0 Odontella sp. 0 34 0 Rhizosolenia sp. 1 0 0 240Cyanophyta Trichodesmium sp. 0 690 7200

Table 10. Phytoplankton Cells Density at station 6 (in front of Kali Angke river mouth)

Cells/ liter Divisio Species Name

1 m 2 m 3 m Dinoflagellata/ Dinophyta Protoperidinium spp. 3551 3711 8597 Ceratium furca 94171 9372 11935 Protoperidinium conicum 6408 1789 3364 Protoperidinium oceanicum 988 320 507 Gymnodinium sp. 1 267 27 53 Protoperidinium divergens 27 0 267 Protoperidinium venustum 3124 294 347 Ceratium fusus 27 721 0 Gonyaulax sp. 1 39650 107 0 Gymnodinium sp. 2 107 0 0 Prorocentrum micans 187 27 0 Ceratium tripos 53 0 0 Dinophysis caudata 53 27 0 Oxytoxum sp. 27 0 0 Pyrophacus steinii 53 0 0 Gonyaulax sp. 2 53 0 0 Gymnonidium sp. 3 27 0 0 Podolampas sp. 27 0 0 Chaetoceros sp. 1 0 28756 64107Diatom/ Bacillariophyta Pleurosigma sp. 1015 5073 22855 Nitszchia seriata 401 347 2083 Rhizosolenia setigera 107 587 1228 Thallasiothrix sp. 0 0 320 Bacteriastrum varians 774 935 481 Asterionella japonica 1148 240 2590 Lauderia annulata 347 427 935 Rhizosolenia alata 0 0 27 Rhizosolenia styliformis 0 53 107 Coscinodiscus spp. 53 134 134 Thallassiossira sp. 27 0 0 Skeletonema costatum 110270 284890 669100 Chaetoceros sp. 2 454 2403 107 Thallasiossira mala 0 53 27 Odontella sp. 0 0 0 Climacodinium sp. 0 53 0Cyanophyta Trichodesmium sp. 530 0 0


35

Table 11. Phytoplankton Cells Density at station 7 (right side of Kali Angke river mouth)

Cells/liter Divisio Species Name 1 m 2 m 3 m Dinoflagellata/ Dinophyta Protoperidinium spp. 309 446 103 Protoperidinium conicum 34 1234 34 Protoperidinium oceanicum 103 274 0 Ceratium furca 857 13990 583 Protoperidinium venustum 309 0 34 Ceratium fusus 0 69 0 Ceratium trichoceros 34 103 0 Gonyaulax sp. 1 137 206 34 Prorocentrum micans 34 0 0 Dinophysis caudata 137 69 0 Pyrophacus steinii 0 34 0 Gonyaulax sp. 2 0 34 0 Podolampas sp. 34 0 0 Ceratium deflexum 0 34 0 Diatom/ Bacillariophyta Chaetoceros sp. 1 27398 22220 0 Pleurosigma sp. 480 2880 12893 Nitszchia seriata 1577 652 446 Rhizosolenia setigera 377 411 171 Thallasiothrix sp. 0 34 0 Bacteriastrum varians 1715 2606 0 Lauderia annulata 274 137 0 Rhizosolenia styliformis 34 891 0 Coscinodiscus spp. 0 34 0 Skeletonema sp. 404280 207450 68920 Odontella sp. 0 0 34 Diploneis sp. 0 0 34 Cyanophyta Trichodesmium sp. 0 1710 3090


36

Table 12. Phytoplankton Cells Density at station 8 (outer side of Kali Angke river mouth)

Cells/liter Divisio Species Name 1 m 2 m 3 m Dinoflagellata/ Dinophyta Protoperidinium spp. 2709 6721 69 Ceratium furca 8813 3223 4389 Protoperidinium conicum 1063 1303 103 Protoperidinium oceanicum 0 343 137 Gymnodinium sp. 1 34 0 0 Protoperidinium divergens 754 34 34 Protoperidinium venustum 1577 1440 686 Ceratium fusus 69 0 34 Ceratium macroceros 103 0 0 Gonyaulax sp. 1 0 34 171 Prorocentrum micans 103 34 69 Dinophysis caudata 34 34 0 Gonyaulax spinifera 0 69 0 Prorocentrum sp. 1 0 69 34 Dinophysis tripos 34 0 0 Diatom/ Bacillariophyta Chaetoceros sp. 1 8127 22391 22220 Pleurosigma sp. 137 549 1234 Nitszchia seriata 137 1169 1200 Rhizosolenia setigera 0 137 446 Thallasiothrix sp. 0 309 0 Bacteriastrum varians 137 994 3189 Asterionella japonica 0 686 2160 Lauderia annulata 0 343 480 Rhizosolenia styliformis 0 0 0 Coscinodiscus spp. 34 69 137 Thallassiossira sp. 0 0 137 Skeletonema costatum 121040 194420 185170 Chaetoceros sp. 2 69 0 4526 Thallasiossira mala 0 69 0 Hemiaulus indicus 0 171 0 Rhizosolenia calcar-avis 0 34 0 Bidulphia sp. 34 0 0 Nitszchia longissima 34 0 0


37

The domination of these three species of phytoplankton has already caused the

low level of diversity index in every sampling location at fourth station, which is range

from 0,34076 until 1,37557 (Table 13). A community is defined to have a high level of

diversity index when the community is compiled by species with the same or almost the

same abundance. On the contrary, the community will have a low level of diversity

index when compiled by less species or only a few dominant species. (Soegianto 994:

111). The low level of diversity index at station 7 with 1 meter depth ( H = 0,34076) is

caused by the abundance of Skeletonema costatum cells at the location which is reach

four times fold from other sampling location.

Table 13. Diversity index of phytoplankton at four sampling stations

B. Harmful Algal Bloom Species

The observation on sea-water sample taken from four stations (Station 5, 6, 7,

and 8) showed 13 (thirteen) phytoplankton species belonging into groups of

dinoflagellates, diatoms, and cyanobacterias that already categorized as Harmful Algal

Blooms, which are Ceratium furca, Chaetoceros spp. (2 species), Dinophysis caudata,

Dinophysis tripos, Gymnodinium spp. (3 species), Gonyaulax spp. (3 species),

Prorocentrum micans, and Skeletonema costatum (table 14). The commonly public

impacts which are caused by these species are to: human health (Dinophysis caudata,

Dinophysis tripos, and Gymnodinium spp.), fishery resources (Gymnodinium spp.,

Gonyaulax spp., Prorocentrum micans, Ceratium furca, and Chaetoceros spp.), and

also recreation and tourism activities (Skeletonema costatum, and Gymnodinium spp.)

(table 15).

Diversity Index Depth

Station 5 Station 6 Station 7 Station 8

1m 0.99218 1.37557 0.34076 0.71856

2m 0.91472 0.71646 0.78426 0.73496

3m 0.91542 0.65856 0.67990 0.78191


38

Table 14. List of phytoplankton observed and their category according to GEOHAB2001

No. Species name Category 1 Asterionella japonica Non-HAB 2 Bacteriastrum varians Non-HAB 3 Bidulphia sp. Non-HAB 5 Ceratium deflexum Non-HAB 6 Ceratium fusus Non-HAB 7 Ceratium macroceros Non-HAB 8 Ceratium trichoceros Non-HAB 9 Ceratium tripos Non-HAB

10 Coscinodiscus spp. Non-HAB 11 Diploneis sp. Non-HAB 12 Dinophysis caudata HAB (responsible for DSP) 13 Dinophysis tripos HAB (responsible for DSP) 14 Gonyaulax spinifera HAB (potentially harmful by oxygen depletion) 16 Gonyaulax spp. HAB (potentially harmful by oxygen depletion) 17 Gymnodinium spp. HAB (some species are harmful, responsible for

fish mass mortality) 18 Hemiaulus indicus Non-HAB 19 Lauderia annulata Non-HAB 20 Nitszchia longissima Non-HAB 21 Nitszchia seriata Non-HAB 22 Odontella sp. Non-HAB 23 Protoperidinium spp. Non-HAB 24 Pleurosigma sp. Non-HAB 25 Podolampas sp. Non-HAB 26 Protoperidinium conicum Non-HAB 27 Protoperidinium

divergens Non-HAB

28 Protoperidinium oceanicum

Non-HAB

29 Protoperidinium venustum

Non-HAB

30 Prorocentrum micans HAB (potentially harmful by oxygen depletion) 31 Prorocentrum sp. 1 Non-HAB 32 Pyrophacus steinii Non-HAB 33 Rhizosolenia calcar-avis Non-HAB 34 Rhizosolenia setigera Non-HAB 35 Rhizosolenia styliformis Non-HAB 36 Rhizosolenia sp. 1 Non-HAB 37 Thallasiossira mala HAB (potentially harmful by oxygen depletion) 38 Thallassiossira sp. Non-HAB 39 Thallasiothrix sp. Non-HAB 40 Trichodesmium sp. HAB (potentially harmful by oxygen depletion)


39

Table 15. Effect of HAB and causative organisms (GEOHAB, 2001)


40

Figure 24-26 showed 3 (three) species which dominating other species in all

station, which could be seen from the high amount of cells density (> 10.000 cells/litre).

The three species are Ceratium furca, Chaetoceros spp., and Skeletonema costatum).

Ceratium furca and Skeletonema costatum (Figure 25 a-c )had already categorized as

a Harmful Algal Blooms (HAB) causing microorganisms, as they could make red tide in

which mass mortality of marine organisms due to oxygen depletion (GEOHAB, 2001).

The hypoxia or anoxia condition which occurred in the waters could affect the natural

and cultures marine resources. Chaetoceros spp. has also categorized as a HAB

species, since it could caused mechanical damage such as clogging the gills of farmed

fishes whenever the cells found abundant in the waters.

Ceratium furca

0

20000

40000

60000

80000

100000

Stasiun 5 Stasiun 6 Stasiun 7 Stasiun 8

1 m

2 m

3 m

Figure 24. Ceratium furca cells abundance (cells/litre) at four stations

Chaetoceros spp.

0

10000

20000

30000

40000

50000

60000

70000


1 m

2 m

3 m

Figure 25. Chaetoceros spp. cells abundance (cells/litre) at four stations


41

Skeletonema costatum

0100000200000300000400000500000600000700000800000


1 m

2 m

3 m

Figure 26. Skeletonema costatum cells abundance (cells/litre) at four stations

Notes : Station 5 located at the left side of river mouth of kali Angke, station 6 located

at river mouth, station 7 located at the right side of river mouth, and station 8 located at the outerside of river mouth

Picture 4. a. Left: Chaetoceros spp.; b. Middle: Ceratium furca; c. Right: Skeletonema costatum (Photomicrograph by : Riani Widiarti & Yudha Fariska)

Chaetoceros spp. and Skeletonema costatum is a group of phytoplankton

included in diatoms which is commonly found in the water condition of decreasing

salinity and increasing nutrient level (Praseno, 1980). The condition of river mouth

waters in Jakarta Bay with low salinity (<35‰) and high level of nutrient input, is an

appropriate place for both species to grow. Ceratium furca is a heterotrophic

dinoflagellate which is capable on conducting vertical migration from surface to water

below and on the contrary (Okaichi, 2003). The specific characteristic made Ceratium

furca could compete with other phytoplankton species, especially in the case of

nutrient, sunlight, and other supporting factors. These made Ceratium furca could

dominate other species and often found in an abundance number.


42

In general, it could be seen that river mouth of Kali Angke estuary is an

appropriate place for several HAB causing phytoplankton species to grow and

conducted blooming. The high values of nitrate (0,41 - 1,07 mg/l) and phosphate (0,026

- 0,107 mg/l) during sampling showed the high of nutrient rate in the river mouth of Kali

Angke waters (Figure 25 a-f). The high values of nutrient in the waters could be

considered as an indicator of high eutrophication level. Besides that, the condition of

water speed which is very low (0,01 - 0,03 m/second), especially at stations in front of

the river mouth (stations 5, 6, and 7), showed relatively slow movement of water

current. These conditions, could cause nutrient accumulation and phytoplankton

concentration in one location, so that can the phytoplankton could dominate, even

conduct a blooming in the waters.

Temperature

29,429,629,8

3030,230,430,630,8

3131,2

Left side ofriver mouth

River mouth Right side ofRiver mouth

Outer side ofriver

Location

ºCel

cius 1m

2 m3 m

Figure 27. Temperature profile of Kali Angke river mouth at different depth

Salinity

05

10152025303540



Outer side ofriver

Location

Par

t per

thou

sand

1m2 m3 m

Figure 28. Salinity profile of Kali Angke river mouth at different depth


43

Dissolved oxygen

0

1

2

3

4

5

6

7

8



Outer side ofriver

Location

Par

t per

mill

ion

1m2 m3 m

Figure 29. Dissolved Oxygen profile of Kali Angke river mouth at different depth

Water current

0

0,005

0,01

0,015

0,02

0,025

0,03

0,035



Outer side ofriver

Location

m/s 1m

2 m3 m

Figure 30. Water Current profile of Kali Angke river mouth at different depth

Nitrate

0

0,2

0,4

0,6

0,8

1

1,2



Outer side ofriver

Location

mg/

L 1m2 m3 m

Figure 31. Nitrate profile of Kali Angke river mouth at different depth


44

Phosphate

0

0,02

0,04

0,06

0,08

0,1

0,12


Rivermouth

Right sideof Rivermouth

Outer sideof river

Location

mg/

L 1m2 m3 m

Figure 32. Phosphate profile of Kali Angke river mouth at different depth

C. Microorganisms (Escherichia coli) In term of microbiological test, Escherichia coli (E. coli) is used as the indicator

for testing the quality of drinking water. Escherichia coli are an opportunistic organism

which found in human intestinal or mammals as normal flora. The presence of E.coli in

the water, indicate that water is contaminated by human/mammals feces.

The parameters of microbiology examination of water quality are: - Total Coliform

- Fecal Coliform

Bacteriological analyzing can be done by two methods:

a. Double Tube Method

The three basic tests to detect coliform bacteria in water are presumptive,

confirmed and completed. The tests are performed sequentially on each sample.

They detect the presence of coliform bacteria (indicators of fecal contamination), the

gram-negative, nonspore-forming bacilli that ferment lactose with the production of acid

and gas that is detectable following a 24-hours incubation period at 37oC.

b. Membrane Filter Method

A water sample is passed through a sterile membrane filter that is housed in a

special filter apparatus contained in a suction flask. Following filtration, the filter disc

that contains the trapped microorganisms is aseptically transferred to a sterile Petri

dish containing an absorbent pad saturated with a selective, differential liquid medium.

After incubation, the bacterial colonies are counted. To detect Total Coliform and Fecal


45

Coliform in 100 ml water, we used Most Probably Number (MPN) method, which was

done in 2 steps:

1. Presumptive Test (picture 2)

• Inoculation on Lactose Broth medium

• If there is bubbles formation, continue to Confirmed Test

2. Confirmed Test (picture 3)

• Inoculation on Brilliant Green Bile Lactose Broth (BGLB)

• To examine the Total Coliform, the inoculated BGLB tubes are incubated in to

35 ± 0,5 °C for 48 hours, while to examine the Fecal Coliform, the inoculated

BGLB tubes are incubated in to 44,5 ± 0,2 °C for 48 hours

• Calculate most probable number (MPN) of coliforms based on proportion of

confirmed gassing BGLB tubes for 5 consecutive dilutions.

Picture 5. Presumptive test

Picture 6. Confirmed test


46

Picture 7. Escherichia coli on Eosin Methylene Blue Agar and biochemical test

(Completed test)

To ensure the presence of E. coli in water, Completed test (picture 4) have

been conducted using selective medium and biochemical test. The study was

completed within 2 weeks. The interpretation is based on the Ministry of Health

Recommendation (Keputusan Mentri Kesehatan RI 907/MENKES/SK/VII/2002, July

29, 2002). The requirements of good quality of drinking water are:

1. Total Coliform = 0

2. Fecal Coliform = 0

3. E. coli not found

Another interpretation based on Government Regulation: Peraturan Pemerintah

Republik Indonesia no. 82, 2001 about water quality handling and water pollution

control (table 16).


47

Table 16. Water quality of several different locations at Angke River No. Location Test Result Standard Interpretation

1. Duri Kosambi

1. MPN Total Coliform = 2400 2. MPN Fecal Coliform = 0 3. E. coli, K. oxytoca, P. mirabilis, P. aeruginosa

Did not meet with drinking water requirements, but can be used as clean water (2nd class water quality)

2. Pesing Poglar

1.MPN Total Coliform = 2400 2. MPN Fecal Coliform = 0 3. E. coli,K. pneumoniae


3. Teluk Gong

1. MPN Total Coliform = 2400 2. MPN Fecal Coliform = 0 3. E. coli, K. oxytoca, P. mirabilis


4. Pantai Indah Kapuk

1. MPN Total Coliform = 81 2. MPN Fecal Coliform = 0 3. E. coli, E. aerogenes, P. aeruginosa

Did not meet with drinking water requirements (A), but can be used as clean water (2nd class water quality)

5. Muara (left side of river mouth)

1. MPN Total Coliform = 2400 2. MPN Fecal Coliform = 0 3. E.coli, P. mirabilis

A. Drinking water requirements * 1. MPN Total Coliform = 0 2. MPN Fecal Coliform = 0 3. E. coli not found B. Drinking water quality

requirements ** 1. MPN Total Coliform = 1000 2. MPN Fecal Coliform = 100



48

No. Location Test Result Standard Interpretation

6. Muara (river mouth)

1. MPN Total Coliform = 2400 2. MPN Fecal Coliform = 0 3. E. coli, E. aerogenes


7. Muara (right side of river mouth)

1. MPN Total Coliform = 2400 2. MPN Fecal Coliform = 0 3. E. coli,K. pneumoniae


8. Muara (outer side of river mouth)

1. MPN Total Coliform = 430 2. MPN Fecal Coliform = 0 3. E. coli, P.aeruginosa

A. Drinking water requirements * 1. MPN Total Coliform = 0 2. MPN Fecal Coliform = 0 3. E. coli not found B. Drinking water quality

requirements ** 1. MPN Total Coliform = 1000 2. MPN Fecal Coliform = 100


• Ministry of Health Recommendation: Drinking Water Quality Requirements and Control SK Menkes RI No. 907/MENKES/SK/VII/2002 July 29th, 2002 ** Government regulation: Water quality handling and water contamination control. Peraturan Pemerintah Republik Indonesia No. 82/Tahun 2001


49

Escherichia coli were found at all points under study in Angke River. At Duri

Kosambi we found that the MPN Total Coliform = 2400, MPN Fecal Coliform = 0 and

E.coli (Table 16). Beside E. coli, we also found Klebsiella oxytoca (K. oxytoca),

Proteus mirabilis (P. mirabilis) and Pseudomonas aeruginosa (P. aeruginosa). Water

examination from Pesing Poglar and Teluk Gong showed almost the same result with

Duri Kosambi (Table 16). Microorganisms isolated from Pesing Poglar were E. coli, K.

pneumoniae and from Teluk Gong were K. oxytoca and P. mirabilis. At Pantai Indah

Kapuk the results were: MPN Total Coliform = 81, MPN Fecal Coliform = 0, not only E.

coli but we also found other pathogens such as Enterobacter aerogenes and

Pseudomonas aeruginosa (Table 16). On 3 points at estuary (Muara), the result was

similar, except at the outer side of river mouth whereas MPN Total Coliform = 430

(table 16). Pathogenic organisms isolated other than E. coli were P. mirabilis, E.

aerogenes, K. pneumoniae and P. aeruginosa.

The result at Duri Kosambi showed that this location was contaminated with E.

coli origin from the environment, but not from human/animal feces. Other

microorganisms observed such as K. oxytoca, P. mirabilis and P. aeruginosa are

human pathogens/opportunistic pathogens. At Pesing Poglar and Teluk Gong we found

microorganisms that generally cause gastrointestinal and urinary tract infection in

human (K. oxytoca,K. pneumoniae, and P. mirabilis . Even though the MPN Total

Coliform of water from Pantai Indah Kapuk and outer side of river mouth were the

lowest, based on Ministry of Health Recommendation (SK Menkes RI No. 907/

MENKES/SK/VII/2002 July 29, 2002), the water could not fulfill the requirements for

drinking water. In general, the water at Angke River is not recommended to be used as

drinking water. However, the result using microbiology parameters showed that the

water can be used as clean water according to the government regulation which

categorized the river as 2nd class water quality. People live in Pantai Indah Kapuk, have

a higher economic level than other area. So, it can be assumed that they are more

educated and have more knowledge and insight in hygiene and. sanitation. At the

estuary, the water has a higher salt concentration; so that coliform bacterial growth is

inhibited.


50

D. Parasites and Worms Table 17. Number of Ascaris lumbricoides eggs and Entamoeba histolytica cysts in water of Kali Angke

No Part of river Sampling locations Number of A. lumbricoides eggs

Entamoeba histolytica

cysts 1 Upper reaches of

river (Hulu)

Kembangan/

Duri Kosambi

8 (8/60, 13.3%) +

2 Lower reaches of

river (Hilir)

Pesing Polgar 0 (0/60, 0.0%) +

3 Lower reaches of

river (Hilir)

Teluk Gong 3 (3/60, 5.0%) -

4 Estuary Pantai Indah Kapuk 48 (48/60, 80.0%) -

5 River mouth River Mouth 0 (0/60, 0.0%) -

6 River mouth Left side river mouth 1 (1/60, 1.7%) -

7 River mouth Right side river mouth 0 (0/60, 0.0%) -

8 Outer side of

river mouth

Outer side of river mouth 0 (0/60, 0.0%) -

Total 60 2(+)

A. lumbricoides eggs were found in Kembangan/Duri Kosambi (8, 13.33%),

Teluk Gong (3, 5.0%), Pantai Indah Kapuk (48, 80.0%) and left side of river mouth (1,

1.7%). In addition, there were no A. Lumbricoides eggs found in Pesing Polgar (0,

0.0%), in river mouth (0, 0.0%), right side of river mouth (0, 0.0%) and outer side of

river mouth (0, 0.0%) (Table 17).

Cysts of Entamoeba histolytica were found in Kembangan/Duri Kosambi (+) and

Pesing Polgar (+). In addition, cysts of Entamoeba histolytica were not found in Teluk

Gong (-), Pantai Indah Kapuk (-), river mouth (-), left side of river mouth (-), right side of

river mouth (-) and outer side of river mouth (-) (Table 11).

In Kembangan/Duri Kosambi and Teluk Gong A. lumbricoides eggs were found

because inhabitants living around it defecatefeces in traditional toilets located at either

left or right sides Kali Angke. In addition, Pantai Indah Kapuk A. lumbricoides eggs

was found because Pantai Indah Kapuk is an estuary area of Kali Angke and has

several traditional toilets. In contrast, in Pesing Polgar there was no A. lumbridoides

eggs. In Pesing Polgar, there was no traditional toilets and it has a lot of trash in water

of river. A. lumbricoides eggs are difficut to find because a lot of trash in the water.


51

A. lumbricoides egg that has been found in left side of river mouth showed that river

mouth highly contaminated with human feces. Therefore, A. lumbricoides eggs found in

river of Kali Angke indicated that river of Kali Angke has been contaminated with

human feces that are discharged by inhabitans living around Kali Angke.

Picture 8. Ascaris lumbricoides’ egg under microscope


52

CHAPTER V HEALTH STATUS

Population of this study is family living at river banks of kali Angke (relocation

area); while the subject is children aged 2-5 years old inhabited in Kali Angke area.

Performing as respondent is their mother which is responsible to the child in daily life.

In total there are 117 respondents were being questioned, but due to the

missing variable not all respondents were analyzed.

DESCRIPTIVE DATA OF DETERMINANTS

Table 18. Descriptive data of children’s determinants (n=116)

The distribution of sex among children is almost equal with slightly higher

frequency in male. Ninety-four percent (94%) are moslems, in accordance with

Indonesia’s demographic data which stated that moslem is the majority. Most children

are aged between 37-48 months (37.9%) with small difference among other two groups

of age.

Most of children (80.2%) were breastfed. It is quite a high number and gives a

positive perspective in line with breastfeeding program promoted lately by WHO and

ministry of health.

Variables Frequencies Percent Sex Male 62 53.4 Female 52 44.8 Missing 2 1.7 Religion Moslem 109 94 Christian 2 1.7 Buddhist 5 4.3 Age (months) 24-36 33 28.4 37-48 44 37.9 49-60 36 31 Missing 3 2.6 Breastfeeding 93 80.2


53

Table 19. Descriptive data of mother’s determinants (n=116)

Family is the first place for children’s education; and due to close interaction

between an under five-year old child with their mother, mother’s educational

background is presumed to be important. Elementary school graduated holds the

highest number, while diploma and bachelor degree are held each by one person only

of total 116 respondents.

Mean of family income is 820000 rupiahs (± 420000) which is below minimum

regional salary (more than 900000 rupiahs/months). The lowest rank is 100000 rupiahs

and the highest one is 1.8 million rupiahs/months. Only 44.8% respondents have

higher salary than minimum regional salary. This quite large discrepancy is actually

acptured the true condition of Indonesian citizens’ economic status. It relies from very

poor until extremely rich.

A high number of people (79.7%) go to doctor when they get sick. It is also

supported by the fact that 51.7% respondents have access to health information

sufficiently.

Variables Frequencies Percent Education illiterate 3 2.4 elementary school 51 41.5 junior school 34 27.6 High school 23 18.7 Diploma 1 0.8 Under Graduate 1 0.8 Missing 2 1.7 Occupation House wife 82 66.7 Government employee 2 1.6 Private 21 17.1 entrepreneurship 11 8.9 Family income* (Rp) 820000 420000 Access to health information 60 51.7 Access to health service doctor/clinic/distric health centre 98 79.7 nurse/paramedic 1 0.8 self treatment 11 8.9 others 14 10.6


54

WATER-BORNE DISEASE PREVALENCE

Table 20. Diarrhea morbidity

Disease Frequencies Percent

Diarrhea N=70

Acute 58 82.9 %

Prolonged 10 14.3 %

Chronic 2 2.9 %

Of 116 respondents, 70 people (60.3%) claimed to be sufferred from diarrhea in

the last 3 months and 31 respondents experienced more than once. Diarrhea was

defined as loose stool, more than 3 times a day, with/without mucous and/or blood. It

was denoted by self-reporting by the respondents during interviews. Acute diarrhea

lasts less than 7 days, while prolonged and chronic diarrhea last 7-14 days and more

than 14 days, respectively.

Diarrhea is an infectious disease transmitted from contaminated food or water.

In the developing country, high prevalence of diarrhea due to combination of

contaminated drinking water and poor nutrional status.

More than 30% cases of acute diarrhea is caused by virus, while E.Coli and

Salmonella hold around 20-30% and 5-18% of the remaining cases (Sunoto, 1986).

Microbiological analysis has confirmed the existence of E.Coli in water. So that Kali

Angke river is not suitable for drinking water source.

Parasites do not affect the occurrence of acute diarrhea but more often in

chronic cases. Without a proper management of disease, nutrition and environment, 1-

5% acute diarrhea will develop to prolonged and chronic diarrhea (Sunoto, 1986).

Those might be the cause of prolonged and chronic cases in this study. In this sudy,

parasites has been found both in water and human feses.

NUTRITIONAL STATUS

Appropriate nutritional status for the whole family is needed for preventing

nutritional related diseases and maintaining health. The high number of people with

low socio-economics condition in the Great Love Tzu Chi Housing may create

problems. Low nutrients intake is commonly found in poor environmental condition. The


55

people who live in low socio economic condition are usually unable to provide healthy

food.

Table 21. Average of children’s weight based on age group

Age group Weight (in kgs)

25-36 months 13.53 (± 2.41)

37-48 months 13.73 (± 2.55)

49-60 months 13.84 (± 2.76)

Values are expressed by mean and SD

Children’s means of weight based on age group (25-36 months old, 37-48

months old, 49-60 months old) are 13.53 kgs, 13.73 kgs and 13.84 kg, respectively.

Eventhough there is slight increase between age group, however it does not differ

significantly. It could raise failure to thrive in children. As underfive is known as golden

period for development of the brain, this condition later on could effect the kognitif and

quality of entire growth and development in children.

Two major causes for nutritional status of underfive children are food intake and

infectious diseases. An inadequate food intake is one of the main factors that

contribute to under nutrition of underfive children.

Picture 9. Anthropometric measurement on children


56

Table 22. Description of percentage nutrients intake of children compare to the

Indonesian Daily Allowance

Variables FFQ Semi Quantitative 24 hour recall

Energy %RDA

3 y 124.85 (52.3-259.7) 136.0 (53.4-344.3)

4-5 y 89.0 (31.0-307.8) 93.1 (33.8-151.2)

Protein %RDA

3 y 165.8 (66.4-344.0) 179.4 (68.4-473.2)

4-5 y 103.8 (35.9-366.2) 152.8 (39.6-369.6)

Table 23. Classification of children nutrients intake by FFQ semi quantitative and 24-

hour recall

Variables FFQ Semi Quantitative 24 hour recall

Frequency (n=117) Percent Frequency

(n=117) Percent

Energy

High 34 29.1 43 36.8

Normal 54 46.2 42 35.9

Low 29 24.8 32 27.4

Protein

High 62 53.0 83 70.9

Normal 35 29.9 21 17.9

Low 20 17.1 13 11.1

Fat

High 84 71.8 88 75.2

Normal 23 19.7 20 17.1

Low 10 8.5 9 7.7

Carbohydrate

High 40 34.2 37 31.6

Normal 59 50.4 51 43.6

Low 18 15.4 29 24.8


57

Most of children consume high protein (53%), high fat (71.8%) and normal in

carbohydrate intake (50.4%). The high fat intake might be caused by consumption of

fried meals (gorengan) available in street vendors.

DEVELOPMENTAL STATUS

Growth is defined as the increase in the size of the body and development as

an increase in function of process related to body and mind. Growth is assessed by

plotting accurate measurement on growth chart and comparing them with previous

measurement.

Table 24. Results of developmental screening using Kuesioner Pra Skrining

Perkembangan

Developmental status Frequencies (N=117)

Percent

consistent with developmental stage 80 68,4

possible of developmental delays 37 31,6

Table 24 showed that 31.6% of children at Kali Angke river side were possible

of having developmental delays. This result is similar to early developmental detection

in USA which was performed to before school age children, about 20-30%.

Table 25. Developmental delay based on sex (n=117)

Developmental status Boys Girls

consistent with developmental stage 41 39

possible of developmental delays 20 17

Results of developmental status were similar to those boys and girls. All

children with possible of developmental delays should be screened and assessed for

more specific developmental status.


58

DENTAL HEALTH STATUS Picture 10. Dental examination

Prevalence dental caries of the underfive chidren in Muara Kapuk region

Jakarta Utara is quiet high (89%) with average decay 6.93 teeth per child. This

condition is in accordance with a high number of them (90%) (table 26) has a habit of

eating refined carbohidrat and 81% of them eat it every day. The ignorance of mothers

on the cause of dental caries and 21% of the children who never brush their teeth are

also one of the reason (table 27). A number of 85% of the subjects (98 persons) brush

their teeth using tooth paste, and all of them never used water from the river while they

brush their teeth.

Table 26. Number of subjects according to their habit in taking sweet snacks

Taking sweet snack N %

Yes 104 89.7

No 12 10.3

Total 116 100

Table 27. Number of subjects according to habit in brushing their teeth

Brushing every day N %

Yes 91 78.4

No 24 20.7

Others 1 0.9

Total 116 100


59

In the contrary with 30% of the mothers statement that she always searched

for medical services in the health centre for every dental problems among the familly,

the average of filled teeth of the children are less than 1% and only 1 tooth filled

among 797 caries teeth. The reason for this may also be due to their social economic

problem.

Gingivitis prevalence among the children is 40% where 60% of them have light

gingivitis and only one child has moderate gingivitis. Mother’s educational background

and pH plaque were known to be statistically significant as factors related with

gingivitis.

Prevalence of email hypoplasia among the children is 36%. There are 2

children which each has 14 dental hypoplasia and other 4 children with 11 dental

hypoplasia each. The average of dental hypoplasia among the children is 1.04 teeth

per child ( SD = 1.75). Statistically significant, pH plaque correlates with the incidents of

enamel hypoplasia.

Nearly 21% of the children which did not brush their teeth every day (table 27)

may also be the reason for the high prevalence (40%) of gingivitis among the children.

And a quite number of email hipoplasia (35.65%) among the subjects under

investigation showed that they might have problems during their primary teeth

development. A low social economic background which may cause an inadequat intake

of nutrition may be one of the reason.

SKIN HEALTH STATUS

Skin infection due to environmental organisms especially water are very few

and some times has specific mapping, for example; infection of Vibrio species are

common in United States coastal area especially Gulf of Mexico in the warmer months

of April through October. Chromobacterium violaceum is a saprophyte of soil and water

in the tropics and subtropics and only rarely causes human infection. This organism is

considered a potential etiologic agent in wound infections of patients exposed to

environmental sources of stagnant water (i.e., drainage ditches or ponds). Aeromonas

species is a gram-negative organism that is found in water and soil.

Infections by fungus, parasites, and viruses are not usually contracted through

water contact, but rather person to person contact. However such infections maybe

predisposed by factors related to the use of water (i.e., bathing, washing and changing

clothes, etc)


60

Table 28. Type and frequency of dermatoses among subjects

TYPE OF DERMATOSES Numbers (person)

Miliaria 28 Infections 13 Vesicobullous impetigo 1 Furunculosis 1 Furuncle 2 Foliculitis 4 Tinea corporis 3 Scabies 2 Insect bite hypersensitivity 10 Pigmentary Disorders 10 Post-inflammatory Hyperpigmentation 6 Post-inflammatory Hypopigmentation 3 Hypopigmentation 1 Dermatitis 9 Atopic dermatitis 3 Allergic contact dermatitis 1 Irritant contact dermatitis 1 Nummular eczema 1 Seborrhoeic dermatitis 1 Non-specific dermatitis 1 Dyshidrosis 1 Prurigo Hebra 3 Trauma 1 Ulcer (heat-induced) 1 Alopecia areata 1

The lower the income of the family, the easier the subjects have skin infections;

this finding is statistically significant. The number of children with skin infection was

comparable to those without, in both health information access groups. There was only

one family that used river for bathing. Interestingly, skin infection only occurred in those

subjects that did not use river for bathing. Probably the infections come from other

sources but river. Skin infection tend to take place in the families who used river water

for laundry, although this finding is not statistically significant. Frequency of changing

clothes did not affect the occurrence of skin nfection. Interestingly also, our study did

not observe skin infection in subjects who did not use towel separately. This might be


61

explained partially, by the fact that skin infection among subjects in our study occurred

independently, unrelated to the presence of similar condition among other family

members.

Our study found correlation between skin infection and household income, and

also parent’s educational background; however, the latter is statistically not significant.

Similarly, we found that there was a tendency for skin infection in families using river

water for laundry, retiring, and recreation, but not bathing. There was only one family

using the river water for bathing and did not have any skin infection. It is not possible to

make any conclusion with such a small sample. Interestingly, skin infection was not

observed in subjects with low frequency of changing clothes and sharing a bath towel.

Several factors influence the prevalence of skin infections, such as using soap for

bathing, using detergent for washing the towels, ironing the clothes and towels. All of

these factors were not evaluated in this study. The other possibility of the insignificant

statistics is a low prevalence of skin infection in the population.

STATUS OF PARASITE INFECTION

Several species of parasitic protozoa are transmitted through water, with

Giardia lamblia and Entamoeba histolytica/dispar being among the most important

intestinal parasites worldwide. Morbidity, and particularly mortality, rates for

E.histolytica/dispar are high, especially in nonindustrialized countries. The

concentration of oocysts of Cryptosporidium and cysts of Giardia is related to the level

of faecal pollution or human use of the water. The cysts are very persistent in water

and extremely resistant to the disinfectants commonly used in drinking-water treatment.

These characteristics, coupled with the low numbers of (oo)cysts required for an

infection, place these organisms among the most critical pathogens in the production of

safe drinking-water from surface water.

A total of 105 faecal specimen from children aged 2-5 years old were collected

and transported to parasitology laboratory, Faculty of Medicine, University of Indonesia.

All samples were examined by direct and concentrated techniques using lugol and

trichrome stain.


62

Table 29. Prevalence of intestinal parasites in children living at Kapuk Muara

Intestinal parasites Total (%)

Protozoa Giardia lamblia

Blastocystis hominis

Entamoeba histolytica + Entamoeba coli

Blastocystis hominis + Giardia lamblia

Blastocystis hhominis + Entamoeba coli

Helminth Ascaris lumbricoides

Trichuris trichiura

Negative

20 (19.0)

3 (2.9)

1 (1.0)

5 (4.8)

1 (1.0)

2 (1.9)

1 (1.0)

72 (68.6)

Total 105 (100)

Tabel 30. Faecal microscopy according to age group (n=104)

Fecal results (%) Age group

(months) Gl Bh Eh + Ec Bh + Gl Bh + Ec Al Tt Negative

Total

24 to 35 4 (16.0)

1 (4.0)

1 (4.0)

1 (4.0)

22 (72)

29 (27.6)

36 to 47 9 (22.0)

3 (7.3)

1 (2.4)

27 (68.3)

40 (38.1)

48 to 60 7 (18.4)

4 (10.5)

1 (2.6)

1 (2.6)

22 (65.8)

35 (33.3)

Total 20 (19)

3 (2.9)

1 (1.0)

5 (4.8)

1 (1.0)

2 (1.9)

1 (1.0)

71 (68.3)

104

Note: Gl = Giardia lamblia; Bh = Blastocystis hominis; Eh = Entamoeba histolytica; Ec = Entamoeba coli; Al = Ascaris lumbricoides; Tt = Trichuris trichiura

Of 105 faecal samples examined, 33 (31.4%) were positive for intestinal

protozoa or helminthes. Six species of parasites (Giardia lamblia, Blastocystis hominis,

Entamoeba histolytica, Entamoeba coli, Ascaris lumbricoides or Trichuris trichiura)

were identified in the stool specimens examined in this study. Giardia lamblia was the

most prevalent parasite in children with multiple infection as well as in monoparatized

individuals , the most prevalent species was Giardia lamblia (19.0%) (Table 29).


63

Of 104 children, 29 (27.6%) aged 24-35, 40 (38.1%) aged 36-47; 35 (33.3%)

aged 48-60. The difference in prevalence between this age range was not statistically

significant (p > 0.05) and that of 36 to 47 months was more frequent (Table 30). The

intestinal parasites were more frequent in children above 3 years old. It may be caused

by the children aged above 3 years old often put their fingers or something into the

mouth. According to gender, the results showed that G. lamblia in males was the same

in females. Giardia lamblia infection was more frequent in children drinking boiling

water and it was significantly significant (p= .000). It was possible that the water

containers were not clean. The children using public water supply was more frequent

harboring Giardia lamblia in their stool. It may be caused by contamination of water but

it was not statistically significant (p = 0.987).

STATUS OF OXIDANT AND ANTIOXIDANT

Some of diseases are probably of caused by oxidative stress. For example,

many of the biological concequences of excess radiation exposure are due to oxidative

damage. The symptoms by chronic dietary deficiencies of selenium or of tocopherols

might also be mediated by oxidative stress. However, in most diseases, oxidative

stress is consequence and not a cause of the disease. Tissue damage leads to

formations of increased amount of putative ‘injury mediators’, such as prostaglandins,

leukotriens, cytokines, and, of course reactive species (RS). All of these have, at

various times, been suggested to play important roles in tissue injury. (Halliwell and

Gutteridge, 2007). Cell have a number of mechanism to protect themselves against

damage from the naturally occuring continues generations of Reactive Oxygen Species

(ROS).

MDA appears in the blood and urine is used as an indicator of radical damage.

Glutathione peroxidase is one of the body’s principal means of protecting against

oxidative damage. It catalyzes the reduction of hydrogen peroxide and lipid peroxides

by glutathione (GSH) serve as electron donors, and are oxidized to the disulfide form

(GSSG) during the reactions.

The samples of 112 children aged 2-5 years old were taken from venous blood.

The plasma MDA level was measured by Wills ED method (Wills, 1987). The plasma

GSH level was measured by Ellman method (Ellman, 1959).

This study stated the levels of plasma MDA are ranging from 0,050 – 0,628

nmol/mL, while the levels of plasma GSH range from 0,488 – 2,594 μg/m. The mean of


64

the plasma MDA level is 0,264 nmol/mL and the mean of the plasma GSH level is

1,423 µg/mL. The distribution pattern of plasma MDA and GSH levels are shown in

graphic below (Fig 33 and 34).

Figure 33. Distribution pattern of MDA level

MDA level (nmol/mL)

,70,65,60,55,50,45,40,35,30,25,20,15,10,05

Normal curve of MDA levels

Freq

uenc

y

20191817161514131211109876543210

Figure 34. Distribution pattern of plasma GSH level

GSH level (ug/mL)

2,762,61

2,462,31

2,162,01

1,861,71

1,561,41

1,261,11

,96,81

,66,51

Normal curve of GSH levels

Fre

quen

cy

30

20

10

0


65

The data show an increase in plasma MDA level in children with chronic

diarrhea (diarrhea more than 14 days) (Table 31). The plasma MDA level of children

with chronic diarrhea is 0,314 nmol/mL, while of children with no diarrhea and acute

diarrhea children are only 0,257 nmol/mL and 0,252 nmol/mL. The plasma GSH level is

also decrease in chronic diarrhea in line with the plasma MDA level increase. The

plasma GSH level in chronic diarrheal children is 1,152 ug/mL compared to children

with no and acute diarrheal both are 1,385 ug/mL and 1,486 ug/mL.

Table 31. Average plasma MDA and GSH level in children with/without diarrhea acute chronic

No diarhea

(< 14 days) (> 14 days) MDA (nmol/mL) 0.257 0.252 0.314

GSH (ug/mL) 1.385 1.486 1.152

The study conducted by Nieto et al. (2000) suggested that early chronic

diarrhea and severe protein-energy malnutrition impair the antioxidant defense system

in both the small and large intestine, which may have a role in the pathogenesis and

maintenance of the vicious circle of malabsorption-diarrhea-malnutrition in infancy. This

is appropriate with our study which found that there is a significant GSH level decrease

in chronic diarrhea compared with no and acute diarrhea. The decrease in GSH as an

antioxidant might caused by the using of antioxidant to oxidized the free radicals

generated in diarrhea.

Data from the study also show a slightly increase in plasma MDA level in

children whose found parasites in their faeces (table 32). The difference in plasma

MDA level between the groups with and no parasites is not significant statistically

(p=0,19). The plasma GSH level is also increase in line with the plasma MDA level

increase. The difference in plasma GSH level between the groups with and no

parasites is also statistically insignificant (p=0,17).

Table 32. Plasma MDA and GSH level in children according parasites in their faeces

Parasites

negatif positive

MDA level (nmol/mL) 0.256 (± 0.121) 0,291 (± 0.137)

GSH level (ug/mL) 1,405 (± 0.340) 1,504 (± 0.333)

Values are expressed by mean and SD


66

The present data support that plasma MDA may be a potential biomarker for

oxidative stress (Nielsen F et al., 1997). Nevertheless, many studies found that there

are no significant different in MDA level between cases and control groups.

The most prevalence parasites found are Giardia lamblia. There is an increase

in plasma MDA level in children infected with Giardia lamblia (0,318 nmol/mL)

compared to children not infected with parasites (0,257 nmol/mL) and infected with

parasite other than Giardia lamblia (0,202 nmol/mL). The plasma GSH level in children

infected with Giardia lamblia is not different with children uninfected with Giardia

lamblia.

Figure 35. Diagram of the plasma MDA level in children infected with Giardia lamblia

Plasma MDA level in children with Giardia lamblia

0.000

0.050

0.100

0.150

0.200

0.250

0.300

0.350

0.400

no parasites parasites positive, noGiardia lamblia

Giardia lamblia

types of parasites

Plas

ma

MD

A le

vel (

nmol

/mL)

There was no significant difference between malondialdehyde levels of patients

with Blastocystis and none group, which is in accordance with other study (Kýlýç,

2003). The same insignificant result of malondialdehyde levels is also found in neither

female and male patients with tapeworm and no tapeworms, although malondialdehyde

levels were clearly increased in the patients infected with human tapeworm (Yazar et

al., 2005).

HEALTHY BEHAVIOUR

Family by social perspective is the primer agency to socialization, social control

and values transmission for individuals within family. It is the first place for someone to

know the practice of healthy behavior. The health status of the family is influenced by


67

individual’s habits in fulfilling their basic needs. Family should get priority to have

primary attention in improving responsibility for living healthy. Therefore, family

empowerment should apply as efforts to make the relocated people can sustain the

healthy behavior.

Health behaviour scale questioner used to collect information on individual

household and community. The instrument was developed to identify the perception of

child, school age, teenage, adult and elderly who were relocated as well as who were

still live close to the river, about healthy behavior practices, such as elimination,

hygiene, etc. and identify the healthy behavior practices of child, school age, teenage,

adult and elderly who were relocated as well as who were still live close to the river. It

also extended to collect self report to measure individual and family’s health behaviour

practice in house and in river environment; various aspect of health behaviour practice:

personal hygiene (bathing, bowel elimination and toileting, hand washing), laundering,

food handling, cooking, eating, drinking, food storage, house environment, river

environment, house and river environment, recreation, money generating, reunion to

river community, and disposal.

Picture 11. Household wastes at Kali Angke river


68

Table 33. Respondents’ distribution based on water resources and the use of the

water from river

Variable Frequencies Percentage (%)

Water resources • Well • Public water supply • Buy clean water • Others

7

90 6

20

5.7

73.2 4.9

16.2 The use of river: Drinking water

• Yes • No

Public toilet • Yes • No

Wash dishes • Yes • No

Cooking • Yes • No

Bathing and shampooing • Yes • No

Wash clothes • Yes • No

Wash fruits and vegetables • Yes • No

Brushing teeth • Yes • No

Earning money • Yes • No

Recreation place • Yes • No

0 116

8

108

1 115

0

116

1 115

4 112

0

116

0 116

3

113

9 107

0 100

6.9

93.1

0.9 99.1

0

100

0.9 115

3.4 96.6

0

100

0 100

2.4

97.4

7.8 92.2

At table 33, it is showed clearly that the respondents did not use water from the

river as a drinking water, to brush the teeth and cooking even only to wash the food

(fruits and vegetables). However, some of them sometime use the river as public toilet

and use the water to wash clothes.


69

Picture 12. Sources of drinking water from street vendors

Table 34. Respondents’ knowledge, behavior and habit in personal hygiene


Behavior and habit

o Washing hand before eat o Yes o No

o Washing hand after passing stools o Yes o No

o Changing clothes o Every day o Not every day o Others

o Bath towels for every family member o Yes o No o Others

o Brushing teeth every day o Yes o No o Others

o Drink boiled water o Yes o No

97 16

108

8

102 1

13

101 14 1

91 24 8

107 16

83.6 13.8

93.1 6.9

82.9 0.8

10.6

87.1 12.1 0.8

74 19.5 0.65

87 13

Table 34 shows variables that used as indicators to measure healthy behavior.

It is clear that there are only 13.8% of respondents who do not have a good habit in


70

personal hygiene which represented by the number of respondents who do not

washing hand before eating. It can be concluded that only 30% of respondents who

show good healthy behavior.

Table 35. Distribution of healthy behavior


Healthy Behavior • Good • Poor

80 34

70.18 % 29.82 %

Table 35 indicated clearly that most of respondents have good habits in

maintain their health. It shows that 70% of them have a good habit in healthy behavior

and the rests are categorized as poor behavior.

Table 36. The relationship between healthy behaviors with diarrhea incidence

Diarrhea incidence Healthy behaviors No Yes

OR

p value

Good 49 (61.35%) 31(38.8%)

Poor 20 (58.8%) 14 (41.2%)

0.488 0.808

Table 36 showed the relationship between the population healthy behavior

habits with the diarrhea incidence. The population with poor healthy behavior habits

experience diarrhea incidence about 41.2 %, while the population with good habits

reached 38.8%, with OR equals to 0.488. Eventhough it statistically is not significant, it

shows that good healthy behaviour has a protector effect of diarrhea.


71

CHAPTER VI CONCLUSION

WATER QUALITY

In Kali Angke, Kembangan/Duri Kosambi has the highest concentration for

nitrate (NO3=) nitrite (NO2

=), and hydrogen sulphide (H2S), Pesing Poglar has the

highest concentration for orthophosphate (PO4=), total phosphorous (TP), TOM, and

conductivity, while Teluk Gong has the highest concentration for total nitrogen (TN),

ammonium (NH4+), COD, chlorophyll-a, turbidity, and total suspended solids (TSS).

Pantai Indah Kapuk tend to have the lowest concentration for PO4=, TP, TN, NH4

+, H2S,

chlorophyll-a and conductivity.

In estuary region, Left Side of River Mouth has the highest concentration for

H2S, River Mouth has the highest concentration for chlorophyll-a, salinity and

conductivity, but relatively has low concentration for others parameters. Right Side of

River Mouth has the highest concentration for PO4=, TP, TN, NH4

+, NO2=, COD, TSS,

and turbidity, while the Outer Side of River has the highest concentration for NO3=,,

TOM but relatively has low concentration for others parameters.

According to Government Role (PP82,2001), all sampling sites exceed from

H2S and NH4+ recommended concentration, except River Mouth and Outer Side of

River for parameter NH4+. Generally, estuary region has lower concentration for all

parameters nutrient compare to Kali Angke, while for DO concentrations, estuary

region has higher than Kali Angke. The phytoplankton abundance and diversity Index is

also higher in estuary region. So, estuary region water quality was better than Kali

Angke.

From heavy metals measurement, it seems that most of heavy metals (As,Cd,

and Pb), except Hg, observed in Angke River and its estuary tend to be distributed

equally. Only at River Mouth and Right side of River Mouth, the high concentration of

the two metals (Cd and Pb) were found. Most of those concentration exceed the

Canadian Standard for Contaminated Sediment.

It seems that the currents brought finer sediment to river mouth and to the right

side of river mouth. Here, metals tend to be bound in finer particles (< 63 µ). In these

locations there were relatively high percentage of this fraction.


72

In the river mouth of Kali Angke waters, thirteen species of phytoplankton which

had potency in causing the HAB phenomenon were found. Of them, three species of

HAB causing phytoplankton were found in a great number of cells (>10.000 cells/litre),

namely Ceratium furca, Chaetoceros spp., and Skeletonema costatum. Ceratium furca

and Skeletonema costatum could make red tide in which mass mortality of marine

organisms due to oxygen depletion, whereas Chaetoceros spp. could caused

mechanical damage such as clogging the gills of farmed fishes whenever the cells

found abundant in the waters. Some environmental parameters in the river mouth of

Kali Angke are the supporting factors for the abundances of HAB causing species, for

example the high level of nutrients (phosphate and nitrate) and the low value of water

current.

Based on parasitological analysis, A. lumbricoides eggs found in river of Kali

Angke indicated that river of Kali Angke has been contaminated with human feces that

are discharged by inhabitans living around Kali Angke.

HEALTH STATUS

In total there are 117 respondents were being questioned, but due to the

missing variable not all respondents were analyzed. The distribution of sex among

children is almost equal with slightly higher frequency in male. Ninety-four percent

(94%) are moslems, and most children are aged between 37-48 months (37.9%).

Elementary school graduated holds the highest number for the mother, while

diploma and bachelor degree are held each by one person only of total 116

respondents. Mean of family income is 820000 rupiahs (± 420000) which is below

minimum regional salary (more than 900000 rupiahs/months). Only 44.8% respondents

have higher salary than minimum regional salary.

Of 116 respondents, 70 people (60.3%) claimed to be sufferred from diarrhea in

the last 3 months and 31 respondents experienced more than once. The public health

care center is the most preferable health care that had been visited by the respondents

and only 10.6% respondents who did the alternative treatment when their family

members get sick.

Children’s means of weight based on age group (25-36 months old, 37-48

months old, 49-60 months old) are 13.53 kgs, 13.73 kgs and 13.84 kg, respectively.

Eventhough there is slight increase between age group, however it does not differ


73

significantly. Nevertheless, the consumption of fat and protein among children was

relatively high (71.8% and 53%, respectively).

There were about 31.6% of children inhabited at Kali Angke riverside had

possibility of having developmental delay based on Kuesioner Pra Skrining

Perkembangan. Areas of developmental delays varied in those 4 major developmental

areas; gross motor, fine motor skills, language and personal social and self help skill.

Only a number of 13 ( 11% ) subjects have free dental caries. The rest of them

(89%) have dental caries with mean def-t score was 6.93. It is higher than def-t score

of 3-5 years children in Jakarta in 2001. Statistically, frequency of refined carbohydrate

consumption and pH plaque are the determinants affecting dental caries. Prevalence of

gingivitis and enamel hypoplasia was 40% and 36%, respectively. There was

significant relationship between mother’s education, pH plaque and gingivitis. Not only

caries and gingivitis, pH plaque also plays important role in enamel hypoplasia.

Our study found correlation between skin infection and household income, and

also parent’s educational background; however, the latter is statistically not significant.

Similarly, we found that there was a tendency for skin infection in families using river

water for laundry, retiring, and recreation, but not bathing. The other possibility of the

insignificant statistics is a low prevalence of skin infection in the study population.

Parasitological examination in children at Kali Angke river showed that there

were six species parasites (Giardia lamblia, Blastocystis hominis, Entamoeba

histolytica, Entamoeba coli, Ascaris lumbricoides or Trichuris trichiura ). The most

prevalence parasite was Giardia lamblia and it was more frequent in children were

aged 36 to 47 months.

The study from 112 children aged 1-5 years old at Rw 4, Kapuk Muara district,

North Jakarta have found the levels of plasma MDA range from 0,050 – 0,628

nmol/mL, while the levels of plasma GSH range from 0,488 – 2,594 μg/m. The mean of

the plasma MDA level is 0,264 nmol/mL. The mean of the plasma GSH level is 1,423

µg/mL.

There is an increase in plasma MDA level of children with chronic diarrhea

(0,314 nmol/mL) compared to the children with no and acute diarrhea (0,257 nmol/mL

and 0,252 nmol/mL). There is a decrease in plasma GSH level in chronic diarrheal

children (1,152 ug/mL) compared to children with no and acute diarrheal (1,385 ug/mL

and 1,486 ug/mL). The plasma MDA level in children with parasites in their faeces is

higher (0,29 nmol/mL ± 0,138 nmol/mL) compared to the plasma MDA level in children

with no parasites in their faeces (0,257 nmol/mL ±0,121 nmol/mL). The plasma GSH


74

level in children with parasites in their faeces is higher (1 ,508 µg/mL ± 0,333 µg/mL)

compared to the plasma GSH level in children with no parasites in their faeces (1,403

µg/mL ± 0,34 µg/mL).

Most of the respondents already practice the healthy behavior such as do not

use water from the river for drink, cooking, and washing the food (fruits and

vegetables). However there are some respondents who have not practiced the healthy

behavior. They used the river as public toilet (6.9%); and as water resources for

washing clothes (3.4%) and shampooing (0.9%). It was also identified that 13.8% of

respondent sometimes do not wash their hand before eat and after finish bowel

elimination (6.9%). Moreover, 78% of respondents do nothing to keep the river clean,

only 8.9% who take out the garbage from the river. Therefore, the river looks black and

a lot of trashes on it.

RECOMMENDATION

For the investigator: Further study :

1. to compare between the data obtained (Hg. Pb, As, and Cd concentrations and

LC50) from the Kali Angke river’s water with the standard river’s water value for

Hg. Pb, As, and Cd concentrations and LC50 from the literature

2. to see whether the seasonal changes impact the data obtained, it is better to do

the investigation for water quality in dry season and rainy/wet season.

3. to conduct a research on the process of purifying the Kali Angke water

4. to know mother’s knowledge of nutrition for children

5. to examine the nutrient deficiencies more specifically, e.g. vitamins and

minerals

6. developmental assessment for the children with possible developmental delay

7. examination for several patients should be performed such as skin

histopathology and/ or bacterial culture to ensure the definite diagnosis

8. number of subjects should be increased for better accurate result of study in

determining the relationship between several factors and skin health

9. relationship between intestinal parasites and water intake with the larger

sample

10. to get plasma malondialdehyde (MDA) and plasma glutathione (GSH) value in

healthy children population aged 1-5 years old.


75

11. research using quantitative method which will explore healthy behavior

12. research using qualitative method, especially action research is needed to

improve the family practice of healthy behavior and empower family role to

influence healthy behavior practice in the community

For the residents of Kali Angke: 1. The subjects are suggested to arrange their meals according to their

requirement

2. A further developmental stimulation should be implemented continuously to all

the children while those with possible developmental delays should be

assessed for further developmental status and should receive early intervention

3. Promotion program on proper teeth brushing and how to prevent dental disease

4. Because the prevalence of Giardia lamblia infection was rather high (19%) so it

was important to give treatment to infected children for controlling transmission

5. Together with NGO or other related institution: perform a health promotion

program to increase healthy behaviour among residents

6. Empowerment program of local volunteer by means of Posyandu and

sustainable educational program

7. Public participation in maintaining the cleanliness of the river to prevent further

water pollution/contamination

For local government or other organizations: 1. To continue river cleaning program

2. To conduct an intensive and simultaneously disease prevention program. For

the sustainability of the program, it is sugested that NGO or other local

organization (for instance: Posyandu) also cooperate with local

authority/government (Kelurahan and Puskesmas).

3. Local government or authorized institution should arrange a regulation to

prohibit people from using Kali Angke water for drinking, cooking, washing

dishes, clothes or foods. This rule should be socialized in accordance with

health promotion program.


76

ACKNOWLEDGEMENT

This research was conducted under the sponsorship of University of Indonesia,

Tzu Chi foundation, Indonesia and Tzu Chi university, Taiwan. The authors wish to

thank Mrs. Dwi and Ms. Siti from Tzu Chi, head of Kapuk Muara district for their

assistance in obtaining the demographic data. And also to drg. Linda from Tzu Chi

foundation, Indonesia for providing medical supplies.

Documents

Kali Angke Final Report Health Study · 2011-11-20 · as possible about the condition of water at Kali Angke river and its inhabitants on the riverbanks. Therefore research areas