Epidemiologi Penyakit & Aplikasinya (PH113) 23 Nov 2015, 11:00-12:50 Rossi Sanusi http://rossisanusi.wordpress.com

Tujuan Mendiskripsikan epidemiologi dari suatu penyakit prioritas. Menggunakan informasi epidemiologis penyakit prioritas tsb untuk merencanakan upaya pencegahan.

Epidemiologi Asal kata: epi (G) "among, upon" + demos (G) "people, district“ + logos (G) "word, speech, discourse“ (http://www.etymonline.com/) Epidemiologi penyakit X = Informasi tentang kejadian/keadaan penyakit X di suatu masyarakat atau wilayah.

What is epidemiology? “The study of the distribution and determinants of health related states and events in populations, and the application of this study to control health problems” John M. Last, Dictionary of Epidemiology There are a number of definitions of epidemiology. One of my favorites is the one in John Last’s Dictionary of Epidemiology: “The study of the distribution and determinants of health related states and events in populations, and the application of this study to control health problems” (3rd edition). Let’s examine the definition phrase by phrase. The definition refers to the distribution of health-related states. Epidemiology studies where diseases are found in the population – who gets them (e.g., young people, older people, women, men), where they occur (e.g., in urban areas, rural areas, industrialized countries, developing countries), and the patterns of disease occurrence by season and over time. “Distribution and determinants” – we say “determinants” because epidemiology is interested in the factors that influence the occurrence of disease – risk factors, environmental factors, and preventive factors. The object is to prevent disease, and in order to do that we need to identify the factors that affect its occurrence. I’ve been saying “disease” as a short-hand for “health-related states and events”. Epidemiology can be used to study any phenomena that exist (“states”) or occur (“events”). Besides disease, epidemiology can study positive conditions (e.g., immunity) and positive behaviors (e.g., physical activity) as well as adverse ones. Epidemiologists are usually most interested in studying events, since once a condition has existed for some time, its antecedents are often harder to discern. However, health-related states are also important to study, since with some conditions, e.g., anxiety, depression, and immunity, their duration may be as important as their occurrence. 8/15/2007 Introduction

Epidemiologi Penyakit Informasi apa? Bentuk informasi? Dikumpulkan/dihasilkan oleh siapa? Caranya? Digunakan oleh siapa? Untuk apa?

Host Lingkungan Patogen Dx/Sindrom Kasus klinis, Sub-Klinis & ResTi Biologis (Bakteri, Virus, parasit, fungus) Fisika, Kimiawi, Psikologis Biologis (Vektor, Carrier) Geologis, Metereologis, Social, Teknis

Sumber (12 Juni 2015): https://essenceofhumanbeing. wordpress

Sumber 12 Juni 2015: http://howmed

Lingkungan dari masing2 Anggota Keluarga --- Sekolah     Keluarga

Perjalanan Penyakit Pencegahan Penyakit Mulai Simpto-matik Sembuh/ Mati/Cacat Mulai ResTi Mulai Sakit P. Dasar P. Primer P. Sekunder P. Tersier Rehabilitasi Manajemen Patogen & Lingkungan Dx & Rx Kasus ResTi Dx & Rx Kasus A-Simptomatik Dx & Rx Kasus Simptomatik Pencegahan Penyakit Diagram PP menggambarkan Proses kasus utk UKP /Himpunan kasus utk UKM

UKP & UKM Respons Cepat Dx & Rx R. Terencana Distribusi Kasus menurut Tempat, Waktu & Ciri2 Penduduk (Re-)alokasi SD & BimTek, Koordinasi Pelaksanaan Respons Cepat Evaluasi UKP & UKM Dx & Rx Riset & S-R Env & Agent R. Terencana Rate kasus masing2 wilayah kerja Alokasi SD & BimTek, Advokasi, Kebijakan Perencanaan

Contoh Epidemiologi Demam Dengue

Contoh menggunakan epidemiologi utk merancang program pencegahan BBLR Mengapa BBLR penting: Prevalensi tinggi. Contoh: http://dinkes.kulonprogokab.go.id/index.php?pilih=hal&id=14 Beban penyakit tinggi: Jumlah tahun hidup hilang akibat kematian dini dan Jumlah tahun hidup sehat hilang akibat kecacatan. Hipotesis Barker.

Peningkatan Resiko Penyakit Menahun pada waktu dewasa (penyakit jantung iskemik, hipertensi, stroke, penyakit paru obstruktif, dan diabetes). Penelusuran lebih lanjut: The foetal origins of disease hypotheses (The Barker Hypothesis, The Foetal Programming Hypothesis)

Pencegahan Primer Kasus ResTi: WUS. Deteksi & Tindakan untuk WUS dengan FR Internal (meningkatkan kerentanan dari inang thd patogen) dan FR External (meningkatkan pemaparan dari inang thd patogen)

FR Internal Deteksi Tindakan St Gizi: BMI <18.5; defisiensi mikro-nutrien. St Antropometrik: TB <145cm St Reproduksi: “4 Terlalu” St Imunitas Makanan tambahan; mikronutrien. - KB Imunisasi

FR External Deteksi Tindakan Lingkungan Biologis: orang kontak (TB, PMS), Vektor (Malaria). Lingkungan Fisik (e.g., kecacingan, TB, Malaria). Lingkungan PsikoSos (gaya hidup, pendapatan, KAP) Pengobatan orang kontak, pengendalian vektor. PSN, Perbaikan Lingkungan Rumah, Tempat Kerja, Sekolah. Modifikasi gaya hidup, peningkatan pendapa-tan, pendidikan/ penyuluhan.

Evaluasi Program Output: Jumlah (%) WUS yg dilayani Outcome: Distribusi WaMil dgn IUGR (Intra Uterine Growth Retardation) Mean atau Rate WaMil dengan IUGR

Pencegahan Sekunder Kasus Sub-klinik: WaMil. Surveilans kasus WaMil dgn IUGR. Tindakan: Tambah makanan & mikronutrien, pengobatan infeksi, penyuluhan.

Evaluasi Program: Output: Jumlah (%) WaMil yg dilayani Outcome: Distribusi WaLin yg melahirkan bayi BBLR; dan, Mean atau Rate WaLin yg melahirkan bayi BBLR.

Pencegahan Tersier Kasus Klinis: WaLin yg bersalin dan bayi yg dilahirkan. Surveilans: Distribusi kasus BBLR. Tindakan: Penatalaksanaan kasus BBLR.

Evaluasi Program: Output: Jumlah (%) WaMil dan bayi BBLR. Outcome: Distribusi WaLin yg melahirkan bayi BBLR yg meninggal; dan, Mean atau Rate WaLin yg melahirkan bayi BBLR yg meninggal.

Pencegahan Primordial BBLR? Rehabilitasi BBLR?

Tugas Kelompok. Merancang program pencegahan primordial (intervensi dan ukuran keberhasilan intervensi). Pembagian Kelompok (@ 7 orang): ...