EFFECTIVENESS OF HEALTH EDUCATION ON FIRST AID
OF DENGUE HAEMORRHAGIC FEVER ON PRIVATE TEACHERS
IN NORTH JAKARTA, 2011.
Gladys, Saleha Sungkar Faculty of Medicine, Universitas Indonesia
ABSTRAK Jakarta Utara merupakan daerah dengan insidens demam berdarah dengue (DBD)
tinggi di Provinsi DKI Jakarta.Untuk mengurangi mortalitas dan morbiditas akibat
DBD masyarakat khususnya guru sekolah perlu diberikan pengetahuan mengenai
pertolongan pertama pada DBD. Tujuan penelitian ini adalah mengetahui efektivitas
penyuluhan mengenai pertolongan pertama DBD pada guru swasta di Jakarta
Utara.Desain penelitian ini adalah pre-post study dan data diambil pada tanggal 22
September 2011. Semua guru yang hadir saat penyuluhan dijadikan subyek penelitian.
Data diambil dengan kuesioner yang berisi lima pertanyaan mengenai pertolongan
pertama sebelum dan sesudah penyuluhan. Data diproses dengan SPSS versi 11,5 dan
diuji dengan marginal homogeneity. Hasilnya menunjukkan dari 82 responden, guru
perempuan 34 orang (41,5%) dan laki-laki 48 orang (58,5%). Hasil pre-test, guru
yang memiliki tingkat pengetahuan baik adalah 3 orang (3,7%), cukup 13 orang
(15,9%), dan kurang 66 orang (80,5%). Pada post-testjumlah guru dengan
pengetahuan baik menjadi 5 orang (6,1% ), cukup 26 orang (31,7%), dan kurang 51
orang (62,2%). Uji marginal homogeneity menunjukkan perbedaan bermakna pada
tingkat pengetahuan sebelum dan sesudah penyuluhan (p<0,01). Disimpulkan
penyuluhan efektif meningkatkan pengetahuan guru mengenai pertolongan pertama
DBD.
Kata kunci: pengetahuan, guru, penyuluhan, DBD, pertolongan pertama.
ABSTRACT North Jakarta has high incidence of dengue haemorrhagic fever (DHF) in DKI
Jakarta. To reduce mortality and morbidity of DHF, people especially teachers need
to be educated on first aid of DHF. Purpose of this research is to know the
effectiveness of health education on first aid of DHF on private teachers in North
Jakarta. The design of the research is pre-post study and data was taken on September
22nd
, 2011. Teachers who came were all subjects. Data was taken by questionnaires of
5 questions about first aid of DHF before and after the education. Data was processed
with SPSS version 11.5 and tested with marginal homogeneity. The result shows that
from 82 respondents, female teachers were 34 people (41.5%) and 48 people (58.5%)
male teachers. Pretest results show that teachers who had good, moderate, and poor
knowledge were 3 people (3.7%), 13 people (15.9%), and 66 people (80.5%). In the
post-test, it was found that teachers with good, moderate, and poor knowledge were 5
people (6,1%), 26 people (31.7%), 51 people (62.2%). Marginal homogeneity showed
significant difference on knowledge before and after the education (p<0.01). To
conclude, health education is effective to increase the knowledge first aid of DHF.
Keywords: knowledge, teacher, health education, DHF, first aid.
Effectiveness pf healt..., Gladys Saleha Sungkar, FK UI, 2013
BACKGROUND
Dengue haemorrhagic fever (DHF) is one of the major health problems in
Indonesia, especially in major cities. Indonesia has one of the highest incidence of
DHF in South East Asia (SEA). In fact, WHO has declared that DHF is the main
cause of mortality and morbidity of children in SEA.1 It was estimated that in 2007,
there were 50-100 million cases and 500 000 were hospitalized. In SEA, there was
15% increase of mortality due to DHF compared to the previous year including
Indonesia. The number of DHF cases in SEA occurred in Indonesia was 57%, in 2005
was 95270 cases and 1298 deaths occured with the CFR of 1.4%. The number
decreased as it reached 27964 cases in 2009 with 32 deaths.1,2
By 2008, the incidence of DHF in Indonesia is 60 per 100000 people with the
case fatality rate (CFR) 0,86%.DKI Jakarta is one of the capital cities in Indonesia
with the highest incidence of DHF.3 By 2009, the third highest region of dengue
hemmorhagic fever in Jakarta is North Jakarta with the number of cases was 5571
which was mostly found on the age group of 15-55.4
DHF can decrease the productivity, increase the number of absentees, and
cause higher cost of health care. Thus, we have to be prepared on dealing with DHF
by knowing its clinical symptoms so that we can do early detection and the right first
aid. So, it is very important to educate people on DHF especially teachers, because
teachers can deliver the knowledge to the students and it is expected that the students
will transfer the knowledge to their families at home. Health education given was
about DHF’s clinical symptoms, first aid, its vector, prevention and promotion. Due
to the limitation of the study, this research focused on the knowledge of first aid of
DHF. By knowing the first aid of DHF, it is expected that people will manage DHF
with the proper first aid. Thus, we may reduce the mortality and morbidity of DHF.
To know the effectiveness of the health education, survey was conducted before
and after the intervention.
LITERATURE REVIEW
Etiology
The etiology of DHF is dengue virus. The virus itself is included in the
aarthropod-borne viruses (Arboviruses) group now known as Flavirus genus, family
of Flaviridae. It has four serotypes which are DEN - 1 through DEN - 4. DEN-3 is the
mostly found serotype. Contact with one of the strains will only guarantee someone to
Effectiveness pf healt..., Gladys Saleha Sungkar, FK UI, 2013
be immune with that specific strain only for a lifetime.5,6
The virus itself is a positive - stranded encapsulated RNA virus. It consists of
three structural protein genes, which will later be translated to the nucleocapsid or
core (C) protein, a membrane - associated (M) protein, an enveloped (E) glycoprotein,
and seven non - structural (NS) proteins. Immune response to NS1 of dengue virus
may cause complement - mediated lysis of DV - infected cells. However, other
reactions include activation of endothelial cells and expression of cytokine chemokine
and adhesion molecules causing cell damage. NS3 will induce the activation of DV -
reactive CD4+ and CD8+ T cells which results in increasing level of interferon
gamma as well as TNF - α, TNF - β, and chemokines. One of the chemokines is
macrophage inhibitory protein - 1β which will interact with DV - infected antigen
presenting cells and will play role in the lysis of DV - infected cells.7
Stages of infection may include undifferentiated febrile illness, classic DF,
and DHF, and dengue shock syndrome (DSS). It was proven that a person who has
developed immunity of one of the serotypes might get infected by other serotypes and
it will cause more severe clinical manifestation (DHF/DSS).7
Vector
The vector for the spread of dengue virus is a species of mosquitoes namely
Aedes aegypti. It prefers warmer climate to live. It also loves to stay in places near
humans, especially in containers like vases, water storage containers, and roof gutters.
The females of this species usually travel approximately 50 meters. They usually stay
in the place where they were hatched and continue the life cycle there.6
Figure 1. Aedes aegypti
Ae. aegypti is known for its capacity to spread dengue virus by its ability to
take incomplete blood meals from multiple individuals, daytime feeding behavior,
highly anthropophilic, and it is highly susceptible of DV infection.6
Effectiveness pf healt..., Gladys Saleha Sungkar, FK UI, 2013
Sign and Clinical Symptoms
During the early stages, patient may show signs and symptoms like myalgia,
arthralgia, general febrile illness, lethargy, rash, low platelet and WBC count.
However, as it progresses, it may show signs and symptoms like haemorrhagic
complications, thrombocytopenia, plasma leakage due to vascular permeability, and
liver damage. In more severe cases it may manifest as disturbance in circulatory
system, even failure of the circulatory system, and death. 6
The clinical manifestation will begin with high fever (39 - 40˚C) accompanied
with headache, retro - orbital pain, malaise, nausea, vomiting, and myalgia. The
duration of this acute febrile stage is approximately 2 - 7 days. Patients may feel
weakness afterwards. When the fever decreases, patient may be complaining of
bleeding nose, mild petechial hemorrhage, gastrointestinal bleeding, and bleeding of
the gum. In the physical examination soft and tender liver, also hepatomegaly might
be found. These may require health care in which lasts for approximately 3 - 10 days.
It may even require hospitalization and may debilitate patients and cause social, not to
mention financial, burdens.6,7
Figure 2. Timeline of dengue infection
Pathology and Pathogenesis
Other than the mentioned clinical manifestations, DHF may cause
histopathological changes. The changes will mostly occur on these three places, the
lymphocytic tissue, the liver, and the vascular system. Changes in the liver include
fatty metamorphosis, the formation of councilman bodies, and degeneration of liver
cells, and kupffer cells. Other changes might be due to secondary to circulatory
failure, for example perisinusoidal oedema, congestion, and hemorrhage. Increase
Effectiveness pf healt..., Gladys Saleha Sungkar, FK UI, 2013
proliferation of lymphoblastoid cells and lymphocytic phagocytosis may be found in
the lymphocytic tissue. Damaged endothelium due to cellular necrosis might be able
to be observed. In the vascular system, swelling of endothelial cells and diapedesis of
erythrocytes through vessel walls with pervascular infiltration by lymphocytes and
mononuclear cells.8
In the cases of DHF, the immunopathologic process will play big role in
creating the clinical manifestations. The known immune process which play role in
DHF’s pathogenesis are:5
1. Antibody Dependent Enhancement (ADE)
It is the formation of antibody which will help in neutralizing the virus and
cytolytic process which will be mediated complement, and cytotoxicity which
will be mediated by antibody.
2. T lymphocytes
Both T helper (CD4) and T cytotoxic (CD8) will help in immune response
towards the dengue virus. T helper 1 as the differentiated form of the T helper
cells will produce IFN - γ, IL - 2, and lymphokines. The other differentiated
form of T helper cells, which is T helper 2 will produce IL - 4, IL - 5, IL - 6,
and IL - 10.
3. Monocytes and macrophages
They will phagocyte the virus through antibody opsonization process.
However, the phagocytosis process will increase the virus replication and
cytokines released by macrophages.
4. Complement Activation
Complement activation by immune complex will trigger the formation of C3a
and C5a.
All of these processes will contribute to the clinical manifestation of DHF.
Secondary heterologous infection hypothesis stated that when person is re - infected
by different serotype of dengue virus will cause greater damage due to higher
concentration of immune complex. Infection by the dengue virus will cause activation
of the macrophage which will then phagocyte the virus - antibody complex resulting
in the replication of the virus inside the macrophage. Activation of the T cells will
also lead to the production of lymphokines and interferon gamma. Interferon gamma
will activate the monocytes which will produce other inflammation mediator. Thus,
Effectiveness pf healt..., Gladys Saleha Sungkar, FK UI, 2013
the dysfunction of endothelium cells and plasma leakage happen.
The cause of thrombocytopenia in dengue infection is due to bone marrow
suppression and thrombocytes’ destruction and shortening of thrombocytes’ lifetime.
Reaction towards thrombocytopenia is increase in the production of thrombocytes or
thrombopoiesis. Dysfunction of the endothelial cells is due to the coagulopathy
caused by the virus interaction with the endothelial cells. It happens through the tissue
factor pathway and kalikrein C1 - inhibitor complex.
Diagnosis
According to World Health Organization (WHO) in 2011, criteria of DHF
clinical diagnosis are:2
Clinical manifestations:
1. Acute, high and continuous fever lasts for 2 – 7 days
2. Any of the mentioned haemorrhagic tendency: positive tourniquet test,
purpura, epistaxis, gum bleeding, haematemesis, melena, petechiae.
3. In 90%-98% of DHF in children, enlargement of the liver (hepatomegaly) can
be found.
4. Signs of shock, characterized by tachycardia, poor tissue perfusion with weak
pulse and lower pulse pressure (20 mmHg or less) or hypotension with the
presence of cold, clammy skin, and/or restlessness
Laboratory findings:
1. Thrombocytopenia ( ≤100 000 cells per mm3)
2. Signs of increased haemoconcentration; incline in haematocrit level of 20% or
more from the baseline of patient or population of the same age.
The diagnosis can be made from the two first clinical manifestations and the
laboratory findings.
Grading of DHF according to WHO in 2011:2
1. Grade I: Fever along with haemorrhagic tendency (positive tourniquet test)
and evidence of plasma leakage. Laboratory findings: thrombocytopenia <100
000 cells/mm3 and increase in HCT for 20% or more.
2. Grade II: manifestations of grade I along with spontaneous bleeding.
Laboratory findings are the same with grade I.
Effectiveness pf healt..., Gladys Saleha Sungkar, FK UI, 2013
3. Grade III: manifestations of grade I or II along with circulatory failure marked
with weak pulse, narrow pulse pressure of 20 mmHg or less, hypotension and
restlessness. Laboratory findings are the same with grade I and II.
4. Grade IV: manifestations of grade III along with profound shock with
undetectable BP and pulse. Laboratory findings are the same with grade I, II,
and III.
5. Grade III and IV of DHF are classified as DSS.
Treatment
Patients with mild dengue infections may be given oral hydration and antipyretics.
It is recommended to give paracetamol compared to aspirin to reduce the risk of
Reye’s syndrome and hemorrhage. Patient needs to be monitored for 24h after the
defervescence. When the patient has reached the stage of DSS, fluid replacement
therapy to replace the loss of plasma is needed. WHO suggests immediate volume
replacement with ringer’s lactate, ringer’s acetate, or 5% glucose diluted in
physiological saline, followed by plasma or colloid solutions. Other drugs such as
corticosteroids may help in prolonged thrombocytopenia. However, the usage of
others need to be confirmed by large trial before be given to the patients.
In patients without shock, patients need to drink a lot to prevent shock. Patient
needs to drink approximately 1,5 - 2 liters in 24 hours. Liquid may include water,
sweet tea, syrup, milk, or oralit. Antipyretic also needs to be given to prevent seizures.
Liquid administration may be through intravenous line if the patient keeps vomiting
to prevent dehydration and acidosis. Intravenous administration of the fluid
replacement may also be given if in the examination it is found that the hematocrit
increases over time.
When the patient is in shock condition, fluid replacement is given which is ringer
lactate. If the patient is in condition of heavy shock, the fluid replacement therapy
needs to be given as soon as possible with the velocity of 20 ml/kgBW/hour.
Afterwards, it may be reduced to 10 ml/kgBW/hour when the patient’s condition got
better. In determining the velocity and the fluid replacement therapy, constant
monitoring of the hematocrit level is needed.
Proper management is needed to prevent the profound shock condition in which
the patient may die in the 12 - 24 hour duration. If the management is done properly,
then the patient may recover soon, approximately 2 - 3 days.9
Effectiveness pf healt..., Gladys Saleha Sungkar, FK UI, 2013
Prevention and Promotion
DHF control is the effort to prevent and to deal with incidents of DHF include
measures to limit the spread. Dengue control emphasizes more on the preventive
action, for example mass spraying. Community is also asked to involve with the
programme pemberantasan sarang nyamuk (mosquitoes breeding control). Its purpose
is to reduce the incidence of DHF and also CFR. The principal activities are:
1. Observation and Management of Patients
Patients suspected or diagnosed with DHF will be reported to the Ministry of
Health of district and blood tests will be conducted.
2. Vector Control
There are two types of vector control. The first one is done before the season.
Before the season, what we can do is to protect the individual and also to
control the mosquito breeding place. Protecting individual can be done by
applying mosquito repellent, spray inside the house with mosquito repellent,
and also using mosquito nets.
North Jakarta
As the capital city and the biggest city in Indonesia, DKI Jakarta is divided
into 6 regions namely: Central Jakarta, North Jakarta, East Jakarta, West Jakarta,
South Jakarta, and Kepulauan Seribu. It was found that North Jakarta was one of the
regions with high incidence of DHF. Filled with industrial areas, offices, residential
buildings, and houses definitely make North Jakarta as one of the busiest region in
Jakarta. With the population of 1 181 096 people, North Jakarta is prone to the
transmission of DHF.
RESEARCH METHOD
This research used pre - post study design with health education as the interventionto
try to find out the improvement of knowledge level about DHF’s first aid. Research
was done from September 2011 to February 2013. Data collection was conducted in
North Jakarta at 22 September 2011. In this research, private teachers in North Jakarta
are the target population. Furthermore, the accessible population was private teachers
Effectiveness pf healt..., Gladys Saleha Sungkar, FK UI, 2013
in North Jakarta who came to the health education at 22 September 2011, fulfilled the
inclusion criteria, and did not meet the exclusion criteria. Sample size of the research
was measured by total population method, which makes all of the teachers came to
the health education as the research subjects. In this research, the dependent variable
is defined as the level of knowledge on first aid of DHF before and after the health
education was delivered. Meanwhile, the independent variable is health education on
first aid of DHF. The dependent variables include the gender, education, occupation,
and history of dengue infection. In the health education, researcher asked for
informed consent by explaining to the subjects about the research. Subjects have the
right to refuse if they do not want to be involved in the research. If the subject
agreed, the researcher would give the questionnaires before and after the health
education. The health education was given by two resource persons who were
professor of parasitology and doctor from community medicine department for 1
hour. While the subjects were filling the questionnaires, they were accompanied by
researcher to ensure that they had filled in the questionnaires correctly.
Confidentiality would be ensured upon the data obtained from the questionnaires.
Souvenirs would be given after the data collection as a token of gratitude.
Data of the subjects from the questionnaire would be kept confidential. In the end
of the event, souvenirs were given for each subject. Data verification was done after
the subjects finished completing the questionnaires given to assure that the questions
were filled correctly and completely. Data obtained was processed using SPSS
version 11.5. Data analysis was done using marginal homogeneity test as well as
descriptive methods and analytic methods for significant relationship between two
variables using Kolmogorov-Smirnov. The level of knowledge was scored through
questionnaires previously validated. It consisted 5 questions regarding first aid of
DHF with maximum score of 5 for each questions. Total of the scores will be
classified into good knowledge if it is 80% more, moderate if it is between 60%-79%,
and poor knowledge if the score is less than 60%. Education is the last formal study of
the respondent. Occupation is the level of teaching of the respondents. History of
dengue infection is whether or not the respondent had exposed to dengue infection
before.
Effectiveness pf healt..., Gladys Saleha Sungkar, FK UI, 2013
RESULTS
Health education is important to be given to teachers as it is expected that teachers
will transfer the knowledge to the students as well as other people. The result of the
study shows from 82 teachers joined the study, 48 of them was male (58.5%) and 34
of them was female (41.5%). The education level varies among these teachers. Most
of them graduated from undergraduate program, followed by postgraduate, diploma,
and high school. Most of these teachers were junior high school teachers and never
had dengue infection before (Table 4.1).
Tabel 4.1 Demographic Characteristic of Teachers in North Jakarta, 2011
Variable Category Frequency Percentages
Gender Male 448 48 58.5
Female 34 41.5
Education Level
Teaching Level
History
High School
Diploma
S1
S2
Kindergarten
Elementary School
Junior High School
High School
Yes
No
4
7
62
9
3
22
39
18
27
55
4.9
8.5
75.6
11
3.7
26.8
47.6
22
32.9
67.1
The table 4.2 represents the respondent’s pretest level of knowledge first aid
of DHF with other influence factors. According to the education level, S1 graduates
got most of the good scores. However, most of the respondents got the poor level of
knowledge. It was found that both gender mostly got poor results. On teacher’s
occupation, it was found that more of the high school teachers got average results,
followed by junior high school teachers, elementary school teachers, and kindergarten
teachers. Kolmogorov-Smirnov test proves that education level, gender, teacher’s
occupation, and history of the exposure of DHF do not have relations to the level of
knowledge about pathophysiology and first aid of DHF.
Effectiveness pf healt..., Gladys Saleha Sungkar, FK UI, 2013
Table 4.2 Respondent Pretest Level of Knowledge on First Aid of DHF with other
Influence Factors
As it is presented in table 4.3, there was significant difference between the
knowledge about first aid of DHF before and after the health education. Thus, in this study
the health education is proven to be effective.
Table 4.3 Knowledge on First Aid of DHF Before and After the Health
Education
Variables
Level of Knowledge
Test Good Moderate Poor
Pre-test 3 (3.7%) 13 (15.9%) 66 (80.5%) Marginal
homogeneity
Post-test 5 (6.1%) 26 (31.7%) 51 (62.2%) p<0,01
Based on table 4.4, it was found that before the health education, the question
which was mostly understood by the respondent was the question on what is the most
proper first aid to be done to DHF patients in which 85.4% respondents answered
Variables
Category Knowledge p
Poor Moderate Good
Education
Level
High School 4 0 0 0,999
Diploma 6 1 0
S1 49 10 3
S2 7 2 0
Gender Male 41 5 2 0,941
Female 25 8 1
Teaching
Level
Kindergarten 3 0 0 0,987
Elementary School
19 2 1
Junior High School 30 8 1
High School
14 3 1
History Yes 23 4 0 1,000
No 43 9 3
Effectiveness pf healt..., Gladys Saleha Sungkar, FK UI, 2013
correctly. The question that was mostly misunderstood by the patient was the question
on when to refer DHF patients to the doctor or hospital in which none of the
respondents got full score of the question. After given the health education, more
respondents answered the question on the proper first aid to be done to DHF patient
correctly as 97.6% of the respondents got full score. However, the question on when
to refer DHF patients to doctor or hospital was still the least understood question but
the scores of the respondents were improved as 1,2% of the respondent finally got full
score.
Table 4.4 Proportion of Question Answered to the Question Regarding the
Knowledge on First Aid of DHF
No Pretest
Score Total
Posttest
Score Total
1 0 12 (14.6%) 0 2 (2.4%)
5 70 (85.4%) 5 80 (97.6%)
2 0 57 (69.5%) 0 58 (70.7%)
5 25 (30.5%) 5 24 (29.3%)
3 0 27 (32.9%) 0 5 (6.1%)
5 55 (67.1%) 5 77 (93.9%)
4 0 0 (0 %) 0 3 (3.7%)
1 5 (6.1%) 1 47 (57.3%)
2 26 (31.7%) 2 24 (29.3%)
3 51 (62.2%) 3 1 (1.2%)
4 6 (7.3%)
5 1 (1.2%)
5 0 75 (91.5%) 0 68 (82.9%)
5 7 (8.5%) 5 14 (17.1%)
DISCUSSION
Indonesia is one of the countries in South East Asia with the high incidence of
DHF. One of the cities with highest incidence of DHF in Indonesia is Jakarta. The
region which is usually affected by DHF is North Jakarta. Thus, health education is
needed to reduce the mortality and morbidity rate of DHF. Important aspect needs to
be delivered is the first aid of DHF. In this research, we gave questionairres that
needed to be filled by the private teachers in North Jakarta.
Effectiveness pf healt..., Gladys Saleha Sungkar, FK UI, 2013
Association between Knowledge on First Aid of DHF and Demographic
Characteristic of the Respondents
From 82 respondents, 58,5% of the respondents were male and 34% of the
respondents were female. Both gender mostly got poor results in pre-test. It was found
that there was no relationship between gender and level of knowledge. This is
probably due to gender equality in which everyone has the same rights to obtain their
rights no matter what the gender is. This includes knowledge regarding first aid of
DHF in which gender does not determine the exposure of someone to the information.
Previous study done by Setiawan10
supports this finding as it was also found that there
was no association between gender and level of knowledge on first aid of DHF.
Education is an important stage throughout a person’s life and it will certainly
be a qualification in the employment process. Being a teacher requires people to pass
certain stage of education. If he or she fails to do so, he or she will not be recruited as
teachers.
Most of the respondents graduated from undergraduate program with the
percentage of 75,6%. The rest of the respondents came from various education level
which includes high school, diploma and postgraduate study. In the pre-test, it was
found out that only S1 graduates had good level of knowledge on first aid of DHF.
It was found that there was no relationship between education and level of
knowledge on first aid of DHF. However, several studies suggest otherwise. A study
suggests that with higher education, people will more likely to have more knowledge
on first aid as well as prevention and behavior.11
Higher educational level was also
proven to associate with level of knowledge of dengue in Jamaica.12
Previous study
by Syed et al13
also proves significant relationship is found between knowledge and
education.
This can be due to many reasons. First, the respondents had never been
exposed to knowledge on first aid of DHF during their education deeply. Most of the
teachers came from the same education level which may also be a reason on why
there was no relationship between education and level of knowledge on first aid of
DHF.
All of our respondents were teachers. However, the level in which they teach
varied from kindergarten to high school. No relationship between occupation and
knowledge on first aid of DHF was found. It may be due to lack of exposure to
Effectiveness pf healt..., Gladys Saleha Sungkar, FK UI, 2013
information about first aid of DHF. There was no specific topic or field in the level of
education which they taught about this.
Most of the respondents had never had history of dengue infection. Only
32,9% of the respondents had ever encountered dengue infection previously. In fact, 3
respondents who had good knowledge prior to the health education had never had
history of dengue infection. On the contrary, none of the respondents who had history
of dengue infection had good knowledge. It was found that there is no relationship
between history of the infection and the level of knowledge on first aid of DHF.
Respondents who had history of dengue infection might not have applied proper first
aid when they faced dengue infection. Most patients with dengue infection would be
admitted to the hospital and be treated parenterally. Not only that, doctors rarely
explains about the proper first aid needs to be done when the patients re-encounter
dengue infection. Thus, they are lacking of knowledge towards first aid of DHF.
Using the health education, the level of knowledge may be improved and it is
expected that the respondents will transfer the knowledge to others and apply the
knowledge in their daily activities.
The Effectiveness of Health Education on First Aid of DHF
Knowledge is a very important determinant in someone’s behavior towards
certain diseases. DHF is one of the examples of this; studies have shown that higher
level of knowledge towards DHF will lead to better preventive methods towards
DHF.14-16
It was also proven that health education can improve knowledge, attitude,
and behavior towards DHF.17-19 Not only that, study done by Kooenradt et al20
also
supports this theory by stating that there association between knowledge and the
effort of vector control. With proper knowledge on first aid of DHF, mortality and
morbidity caused by DHF can be decreased.
In this research it was found that before the health education, 80,5% of the
respondents had poor level of knowledge and only 3,7% of the respondents had good
level of knowledge. Hence, before the health education, the knowledge on first aid of
DHF was lacking because more than half of the respondents had poor knowledge.
Poor knowledge had by the respondents may be caused by lack of information source
to the respondents. All this time, the government effort emphasizes to control DHF
vector which were given through health education and promotion using various
media. There was lack of information circulating in public as to how we can give
Effectiveness pf healt..., Gladys Saleha Sungkar, FK UI, 2013
proper first aid to the DHF patients. This is very important to be given because
proper first aid to the DHF patients may reduce the morbidity and mortality of DHF.
Health education on first aid of DHF can be given using various media and
promotion. Newspaper, radio, or television is few of the possible ways in which
knowledge on first aid of DHF can be given to people. Not to mention, health
education and workshops can also be done in effort of doing so. Best ways to educate
people about this topic is using television and health education by doctors. Study by
Khynn et al21
provs that people who are exposed to various mass media, for example
posters, television, newspaper, and journals, will have deeper knowledge of DHF
compared to people who are not exposed. This is also supported by Itrat et al,22
who
stated that the most influential media to transfer the knowledge of DHF is through
television.
In this research, it was found that health education is effective to improve the
knowledge on first aid of DHF. This result is also supported by previous study done
by Setiawan,10
which also proved that health education is effective to improve the
knowledge of DHF. Another study done in Jeddah also proves that health education
can improve knowledge significantly compared to knowledge before the education.23
Effectiveness of the health education itself is affected by multiple factors, some of
them are the resource person of the education and also people who attend.
Resource persons of this health education are undoubtedly experts in their
fields. They are also experienced in giving health education in several occasions
before. The materials of the presentations were given in interactive, simple, and
interesting ways as well as using presentation slides which could emphasize on the
importance of the materials. Not only that, the respondents were teachers, they had
passed several educational stages that need to be fulfilled as teachers. They were also
enthusiastic in listening to the health education and involved actively in question and
answer session of the health education.
Proportion of the Question Answered to the Question regarding the Knowledge
on First Aid of DHF
There were 5 questions about the first aid of DHF. Before the health education
was delivered, questionnaires were distributed as pre-test. After the health education,
questionnaires were distributed as post-test. As it was mentioned above, the level of
Effectiveness pf healt..., Gladys Saleha Sungkar, FK UI, 2013
knowledge on first aid of DHF before the health education was generally poor.
The first question was regarding the proper first aid of the DHF. Options
given were to drink a lot, to eat a lot, to rest, unknown, or others. The correct answer
is to drink a lot. In this question, 85,4% of the respondents answered correctly in the
pre-test. After the health education was given, the percentage increases to 97,6%.
Nearly all of the respondents answered correctly which indicates that the content of
the health education regarding this question was clearly understood by the
respondents.
The second question was regarding the proper management to lower the fever
in DHF patients. Options given were cold compress, warm compress, alcohol
compress, unknown, or others. The correct answer was warm compress. In the pre-
test, it was found that 30,5% of the respondents answered warm compress. However,
in the post-test it was found that the percentage declined to 29,3%. This may be due
to the beliefs that cold compress should always be given in cases of fever. On the
contrary of the beliefs, warm compress should be given. Other possibility is that the
material of the health education regarding this topic was too difficult to be understood
by the respondents.
The third question was the correct drug to lower the fever in DHF patients.
The choices of answer were paracetamol, aspirin, antibiotic, unknown, or others. In
this question, the correct answer was paracetamol. It was found in the pre-test that
67,1% of the respondents answered correctly. The percentage rose to 93,9%. In this
question, we can say that people have known what drug should be given in case they
face DHF cases. Materials regarding this topic was also clearly understood which can
be seen in the percentage that almost all respondents answered this correctly.
The fourth question was when to refer DHF patients to the doctor or hospital.
In this question, respondents could answer more than one correct answer. Before the
health education, none of the respondents answered this correctly. After the health
education was given, only 1,2% of the respondents answered this using correct
answer. However, improvement could be found as more respondents got higher score
for this question, although not perfect, in the post-test. The correct answers were
persistent high fever, patient feels sleepy and continuously sleeps, and cold sweat.
The answers were signs of shock. We want to prevent the occurrence of shock. This
indicates low knowledge on shock and the danger of it. This may be due to lack of
information regarding shock. Furthermore, difficult question and difficult materials
Effectiveness pf healt..., Gladys Saleha Sungkar, FK UI, 2013
regarding this can be also the causes.
Last question was about the correct fluid to be administered to DHF patients.
In the pre-test, almost all respondents with the percentage of 91,5% answered
incorrectly. It means that only 8,5% respondents answered it correctly. The
percentage of respondents who answered correctly doubled in post-test to 17,1%.
However, the percentage of respondents who answered this question incorrectly was
still high, 82,9%. The incorrect answers that were chosen were guava juice and
angkak. Angkak is the result of red rice fermentation by mold, Monascus sp. The
correct answer was oralit. It is believed that guava and angkak can increase the level
of thrombocyte. However, this has never been proven scientifically. Guava is
recommended to be given due to its rich electrolyte content. DHF patients should be
given fluid replacement therapy as soon as possible to avoid shock.
CONCLUSION AND SUGGESTIONS
Conclusion
1. Prior to the health education, 3 teachers had good knowledge towards first aid
of DHF, 13 teachers had average, and 66 teachers had poor level of
knowledge. After the health education, the teachers who had good knowledge
increased to 5 teachers and the number of teacherse who had average
increased to 26 people and the number of teachers with poor level of
knowledge decreased to 51 people.
2. The knowledge on first aid of DHF has no association with gender, education
level, occupation, and history DHF exposure.
3. Health education is proven effective to increase the level of knowledge on first
aid of DHF.
Suggestions
1. 1. Health education on first aid of DHF should be given continuously using
public health campaign through mass media.
Effectiveness pf healt..., Gladys Saleha Sungkar, FK UI, 2013
2. Health education and public health campaign must be given to all teachers
without considering demographic characteristics.
3. Further research is needed to study the behavior of the teacher about their
daily implementations on this knowledge.
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