Corresponding Author :
Chandra
Kurniawan
E-mail:
[email protected]
INTRODUCTION
Pneumonia can be caused by
viruses, bacteria, parasites, or fungi. The bacteria that cause pneumonia in
toddlers are Streptococcus pneumonia and Haemophilus influenza (Ruwandasari,
2019) . Pneumonia is an acute respiratory infection caused by a
bacterial, viral, or fungal infection that attacks the lungs, especially the
alveoli. In childhood pneumonia, the alveoli will be filled with pus or other
fluid which causes difficulty in breathing, pain when breathing, lack of oxygen
intake and a high risk of death (Hasadiki,
Muhammad HasbyeHasadiki, 2021) .
Pneumonia is caused by
inflammation of the lungs that makes breathing painful and oxygen intake less.
The high rate of under-five mortality due to pneumonia has resulted in the 4th
MDG's (Millennium Development Goals) target which aims to reduce child mortality
by 2/3 from 1990 to 2014 not being achieved. Pneumonia is the second cause of
death for children under five in Indonesia after diarrhea. The number of
pneumonia sufferers in Indonesia in 2013 ranged from 23%-27% and deaths from
pneumonia were 1.19%. According to the Indonesian Ministry of Health (2014),
Central Java in 2013, there were 55,932 cases of pneumonia, 67 deaths with CFR
= 0.27%.
Toddler pneumonia is a
disease that attacks the lung tissue and/or is characterized by coughing and
difficulty breathing, which is commonly referred to as rapid breathing or
shortness of breath in children under five (Wahyuningsih
et al., 2014) . Pneumonia is a cough and cold disease
accompanied by rapid breathing.1 The proportion of pneumonia under five in
Indonesia from 2008 was 49.45%, in 2009 was 49.23% and in 2010 was 39.38% of
the total number of children under five in Indonesia. The national average
incidence of pneumonia from 2001 to 2010 was in the yellow area or areas that
had an incidence rate of between 1-4 per 100,000 population and were in the
moderate category, only in 2001 and 2004 were in the red category or areas that
had an incidence rate more than >4 per 100,000 population and included in
the high category (Kurniasih
et al., 2015) .
Mathew's research (2015) in
2010-2011 estimated that there were more than 120 million cases of pneumonia of
which occurred in children under five years of which more than 10% of the
conditions were concerning. Pneumonia is an acute infection of the lung tissue
(alveoli) caused by bacteria, viruses or fungi (Azizah
& Kusuma, 2021) . Pneumonia can also occur as a result
of accidents due to inhalation of liquids or chemicals. Populations susceptible
to pneumonia are children aged less than 2 years, elderly people more than 65
years, or people who have health problems (malnutrition, immunological
disorders) (Lutfah
& Oxytocin, 2017 ).
Factors that cause high
pneumonia cases, including age less than two years, population density, winter,
antibiotic resistance, daycare attendance, exposure to cigarette smoke,
nutritional status, and the influence of comorbidities (Badriah,
nd) ; (Adinatha
et al., 2020) . The under-five mortality rate in Indonesia
is still high at 40/1000 live births (equivalent to 23 deaths per hour). The
Indonesian Ministry of Health has set a goal of reducing the under-five
mortality rate by 20/1000 live births. Pneumonia and diarrhea are 50% of the
causes of under-five mortality in Indonesia, Pneumonia in Central Java Province
is the highest contributor to under-five mortality (20.57%). According to the
Ministry of Health of the Republic of Indonesia, the low coverage rate for
finding pneumonia under five can be caused, among others, because the reporting
system has not been maximized, case detection at puskesmas is still low and
reporting completeness, especially from districts/cities to provinces is still
low. The case of finding pneumonia in the Public Health Center of Demak
Regency, Karangawen began in 2010.
The case of infant mortality
in the Public Health Center of Demak Regency is a case of death that occurs in
infants aged 0-11 months (including neonatal). The infant mortality rate in
Demak Regency in 2015 was 149 consisting of 82 boys and 67 girls. So the Infant
Mortality Rate (IMR) in Demak Regency in 2015 was 7.2/1.00 live births, an
increase of 0.8/1000 when compared to 2014 which was only 6.4/1000 live births.
In the case of infant death, the cause of the infant's death is not yet clearly
reported at the Karangawen health center, Demak district.
Based on the results of the
researcher's interview with the pneumonia handling section at the Demak
District Health Center, there was a decrease in infant mortality per year from
2017-2019, while the examination of toddler visits at the Demak district health
center was carried out by midwives in the Maternal and Child Health Room (KIA
poly). Health workers owned by 8 midwives, general practitioners and
specialists in internal medicine. Midwives have a very important role in
finding cases of pneumonia patients, especially toddlers. However, in reality,
the practice of midwives in finding cases of pneumonia is still not optimal.
The Indonesian Ministry of Health stated that midwives who had been trained in
the Integrated Management of Sick Toddlers (MTBS) still had not fully practiced
their knowledge and skills in the workplace so that pneumonia detection was
still not optimal. It is proven by the fact that pneumonia in the Public Health
Center in Demak is still very minimal, sometimes there is no pneumonia in
infants.
The purpose of the M-KIA
application is for parents to provide information about their baby's health
whether phenomonia is detected or not? The M-KIA application in the mother and
toddler class section, in which there are 3 pieces of information including
information about all matters related to groups of infants aged 0 to 1 year, to
groups of children aged 5 years. Each section is also equipped with a schedule
for giving immunizations to the stages of child development.
Based on this background,
the authors are interested in taking the title of this study
"Effectiveness of M-KIA Applications in Mothers Toddlers on Early
Detection and Prevention of Pneumonia in Demak Regency". The results of
this study are used to develop prevention and control strategies for pneumonia
that reach all levels of society, especially marginal groups and provide
recommendations related to child pneumonia advocacy. Recommendations are given
to policy makers at local and national levels as initial information to develop
programs and advocacy as an effort to reduce morbidity and mortality of
childhood pneumonia in Indonesia. The aims of this research are to:
1.
Analyzing the effectiveness of the M-KIA
application on mothers of children under five in early detection of pneumonia
in Demak Regency.
2.
Analyzing the effectiveness of the M-KIA
application on mothers of children under five in the prevention of pneumonia in
Demak Regency.
3.
Analyzing the response to the use of the
M-KIA application for mothers of children under five in Demak Regency.
4.
Analyzing risk factors that can affect
pneumonia in toddlers
METHOD
The
research method used in this study is a quantitative study with a
cross-sectional approach aimed at seeing the relationship between the
effectiveness of early detection of pneumonia using an application system. And
to see the relationship of risk factors with the incidence of pneumonia. This
study aims to explain the problem or detect pneumonia early. With a diagnostic
test to determine the sensitivity and specificity. The research was conducted
with the intention of seeing the consequences of a treatment. The
research location was conducted at posyandu in six villages in Demak Regency.
The study was conducted from December 2021 to February 2022. The population in
this study were all children under five who attended the Posyandu Demak. The
population of this study was 6 villages with 7 posyandu. 1 posyandu consisted
of 60 mothers of children under five, so the total population in this study was
420 mothers of children under five.
RESULTS
AND DISCUSSION
1.
Overview of the Demak District Health Office
The Demak District Health
Office is one of the Regional Offices established based on the Demak District
Regulation Number 5 of 2016 concerning the Establishment and Composition of the
Demak Regency Regional Apparatus with typology B. The Health Service is located
at Jalan Sultan Hadiwijaya Number 44 Mangunjiwan Village, Demak District, Demak
Regency, in accordance with with regulation Number 42 of 2016 has the task of
assisting the Regent in carrying out government affairs in the health sector
which is the authority of the Region. The Health Service which is the
implementing element of government affairs in the health sector which is under
the authority of the Region, is led by the Head of the Service who is under and
responsible to the Regent through the Regional Secretary.
The Demak District Health
Office has the task of carrying out regional autonomy in the health sector. The
Health Office in carrying out these tasks, the Demak District Health Office
carries out the following functions:
1.
Formulation of technical policies in the
health sector
2.
Granting of permits and implementation of
public services
3.
Guidance on the Service's Technical
Implementation Unit in the health sector,
4.
Management of administrative affairs of the
office.
The organizational structure of the
Demak District Health Office is as follows:
a)
Head of Department
b)
Secretariat, in charge of:
1.
Program and Finance Sub-Section, and
2.
General and Personnel Sub-Section
c)
Public Health Sector, which is in charge of:
1.
Section of Family Health and Nutrition
2.
Promotion and Community Empowerment Section,
and
3.
Occupational Health and Sports Environmental
Health Section
d)
Disease Prevention and Control Division,
which is in charge of:
1.
Surveillance and Immunization Section
2.
Communicable Disease Prevention and Control
Section, and
3.
Section on Prevention and Control of
Non-Communicable Diseases and Mental Health
e)
Health Services and Resources in charge of:
1.
Health Services Section
2.
Pharmaceutical Section of Medical Devices and
Household Health Supplies, and
3.
Health Human Resources Section
f)
Service Technical Implementation Unit
g)
Functional Position Group
2. Respondent
Description
Description of the respondents in this study
is the people of Demak who have toddlers. Description of respondents in this
study consists of:
1.
Level of education
Based
on the results of the analysis that respondents who have more children under
five at the high school education level as many as 66, more details are
presented in the table below:
Table
1. Results of Education Level Description
|
Level of education
|
Frequency
|
Percentage
|
|
Bachelor
|
6
|
7.5
|
|
SD
|
2
|
2.5
|
|
SENIOR
HIGH SCHOOL
|
67
|
82.5
|
|
JUNIOR
HIGH SCHOOL
|
6
|
7.5
|
|
Total
|
81
|
100%
|
The table shows that
respondents who have an undergraduate education level of 6, 2 elementary
schools, 67 senior high schools, and 6 junior high school education levels.
many have high school education. Mothers who have a high school education must
have understood very well about home health or for their toddlers.
2.
Type of work
The results of the analysis show that 77.8% of
respondents who have children under five in Demak are housewives. Details for
the description of the type of work are presented in the table below:
Table
2. Descriptive Results of Types of Work
|
Type of work
|
Frequency
|
Percentage
|
|
Housewife
|
63
|
77.8
|
|
Private
sector employee
|
13
|
16.0
|
|
Consultant
|
1
|
1.2
|
|
Trader
|
1
|
1.2
|
|
Shopkeeper
|
3
|
3.7
|
|
Total
|
81
|
100
|
Source:
Primary Data, 2022
3.
Income
The results of the analysis show that the income of
respondents who have toddlers in Demak is more in the range of 1 million – 3
million as much as 67, the rest is in the table below:
Table
3. Descriptive Results of Income
|
Income
|
Frequency
|
Percentage
|
|
<
1 million
|
8
|
9.9
|
|
1
million – 3 million
|
67
|
82.7
|
|
4
million – 5 million
|
6
|
7.4
|
|
Total
|
81
|
100
|
Source:
Primary Data, 2022
3. Description
of Toddler
The descriptions of
toddlers in this study were about toddler age, weight, nutritional status, immunizations,
and pneumonia identification. Based on the individual factors of toddlers to
detect pneumonia seen in:
1.
Toddler Age
The
smallest age between 1-12 months has a large enough risk of getting pneumonia
and the age of 12-60 months is a vulnerable age with the highest risk of
developing pneumonia where the peak risk is at 24-48 months of age (Sinaga,
2019). The results of the analysis in this study indicate that the toddlers who
were the material in this study had more of 4 years of age as many as 42 and 23
years of 3 years. More details are presented in the table below:
Table
4. Descriptive Results of Toddler Age
|
Age
|
Frequency
|
Percentage
|
|
19
mths
|
1
|
1.2
|
|
2
yrs
|
2
|
2.5
|
|
3
yrs
|
23
|
28.4
|
|
3
yrs.1 mth
|
1
|
1.2
|
|
3
yr.10 mth
|
1
|
1.2
|
|
3
yr.4 mth
|
1
|
1.2
|
|
3
yrs. 7 months
|
1
|
1.2
|
|
4
yr.6 mth
|
1
|
1.2
|
|
4
yrs
|
42
|
51.9
|
|
4
yr.2 mth
|
2
|
2.5
|
|
4
yr.3 mth
|
2
|
2.5
|
|
4
yrs. 4 mths
|
1
|
1.2
|
|
4
yrs. 5 months
|
2
|
2.5
|
|
5
yrs
|
1
|
1.2
|
|
Total
|
81
|
100
|
Source:
Primary Data, 2022
2.
Toddler Weight
The weight of children under
five based on the Ministry of Health of the Republic of Indonesia is presented
in the table below:
Table
5. Ideal Toddler Weight
|
Age
|
Girl
|
Boy
|
|
1-2
yrs
|
8.9
kg- 11.5 kg
|
9.6kg-14.3kg
|
|
2-3
yrs
|
11.5kg-13.9kg
|
12.2kg-14.3kg
|
|
3-4
yrs
|
13.9kg-16.1kg
|
14.3
kg- 16.3 kg
|
|
4-5
yrs
|
16.1
kg-18.2 kg
|
16.3
kg-18.3 kg
|
Table
6. Results of the Description of Toddler Weight
|
Weight
|
Frequency
|
Percentage
|
|
Not
enough
|
49
|
60.5
|
|
Normal
|
32
|
39.5
|
|
Total
|
81
|
100
|
Source:
Primary Data, 2022
The table shows that the
weight of children under five in Demak who has less body weight is 49 (60.5%)
and children who have normal weight are 32 (39%). Based on the respondent's
description of parents of toddlers in Demak, their income is more than 1
million-3 million, so that the toddler's food intake is sufficient according to
the abilities and income of the parents of the toddlers. Adequate food intake
can cause underweight toddlers.
3.
Nutritional status
Toddler
with nutrition malnutrition
and malnutrition increase the risk of pneumonia in children under five. What
if the toddler is malnourished/poor, the system
the body's defenses decrease so that the impact is
easy to get infection. The thymus organ is
very sensitive to malnutrition because protein deficiency can cause thymus
atrophy. Almost all of the body's defense mechanisms deteriorate in a state of
malnutrition.
Vitamin A is a determining
factor in the process of cell differentiation, especially goblet cells that can
secrete mucus (Nurnajiah
et al., 2016) . Mucus protects epithelial cells from
invading microorganisms and other harmful particles. Vitamin A deficiency
blocks the function of the glandular cells that secrete mucus and are replaced
by dry, scaly epithelial cells. Mucous membranes are no longer able to excrete
mucus properly so they are easily attacked by bacteria. Retinol in vitamin A
affects the differentiation of B lymphocytes.
Vitamin A metabolism is also
aided by the presence of micro minerals such as zinc (Zn). Zinc plays an
important role in mediating non-specific immunity such as neutrophils and NK
cells and non-specific immunity such as balance of Th cells. Zinc deficiency of
100 mg is one of the main determinants of pneumonia. Malnutrition
caused by a lack of protein energy will be accompanied by a deficiency
of vitamin A (Beta Carotene), vitamin E (Alphatocopherol), vitamin B6, vitamin
C (Ascorbic Acid), folate, zinc, iron, copper, and selenium. Antioxidants can
prevent oxidative stress and tissue damage, and prevent increased production of
pro-inflammatory cytokines. Antioxidants can also repair tissues/cells that
have been damaged by free radicals. Antioxidant deficiency can lead to immune
suppression that affects T cell mediation and adaptive immune responses.
Vitamin B6 deficiency can reduce antibody formation (Nurnajiah
et al., 2016) . Folate deficiency can cause DNA metabolism
disorders resulting in changes in the morphology of rapidly dividing cells,
such as red blood cells, white blood cells, and gastric and intestinal
epithelial cells.
Severe and chronic
malnutrition is the main cause of thymus atrophy which is very important in the
defense mechanism. When a person's immune system is not perfect or compressed,
malnourished toddlers will be susceptible to chronic and recurrent infections (Nurnajiah
et al., 2016) . The effect on the mucosa and barrier
function against pathogen invasion changes during malnutrition (Desmawati,
2016). The analysis is presented in the table below:
Table
7. Results Description of Nutritional Status
|
Nutritional status
|
Frequency
|
Percentage
|
|
Well
|
79
|
97.5
|
|
Pretty
good
|
2
|
2.5
|
|
Total
|
81
|
100
|
Source: Primary Data,
2022
The table shows that the
nutritional status of children under five in Demak who have good nutritional
status is 79 (97.5%) and 2 (2.5%). The conclusion is that under five in Demak,
the nutrition obtained is good, it can be through the posyandu which provides
additional nutritional intake for toddlers.
4.
Immunization
Incomplete immunization is
often found in children with pneumonia. Immunizations to prevent pneumonia are
pneumococcal and Haemophilus influenza type B immunizations to prevent direct
pathogen infection, as well as pertussis immunization in DPT and measles to
prevent pneumonia as a complication of previous illnesses, including basic
immunizations for <1 year. This analysis is more clearly presented in the
table below:
Table 8.
Immunization Analysis Results
|
Immunization
|
Frequency
|
Percentage
|
|
Less
complete
|
1
|
1.2
|
|
Complete
|
80
|
98.8
|
|
Total
|
81
|
100%
|
Source: Primary Data,
2022
The table shows that 80
(98.8%) children under five in Demak have complete immunizations, while only 1
child (1.2%). So toddlers in Demak have good immunity, so they are not easily
infected with viruses that cause pneumonia. The results of the analysis of
toddlers with pneumonia from 81 respondents, none of them in Demak suffers from
pneumonia.
4. Toddler
Environmental Factors
The existence of a
healthy home is an important factor that can be directly related to the
environment the community lives in. Poor housing conditions can facilitate the
transmission of pneumonia. Physical environmental conditions such as the
presence of family members who smoke, use of mosquito coils, residential
density, ventilation area, floor type, wall type, lighting intensity, house
temperature and humidity can affect the incidence of pneumonia.
1. Indoor
Air Ventilation
Toddlers who live at home
with lighting intensity that does not meet the requirements will be at risk of
7.364 times suffering from pneumonia compared to toddlers who live at home with
lighting intensity that meets the requirements. A healthy home requires natural
light that contains ultraviolet light. Ultraviolet light has a wavelength <
290 nm. At a wavelength of 253.7 nm, it can kill germs, bacteria, viruses and
fungi that can cause various health problems.
Table
9. Results of Indoor Air Ventilation Analysis
|
Indoor Air Ventilation
|
Frequency
|
Percentage
|
|
There
is
|
51
|
63
|
|
There
isn't any
|
30
|
37
|
|
Total
|
81
|
100%
|
Source: Primary Data,
2022
The table shows that there
are 51 (63%) children under five in Demak who have indoor air ventilation and
30 (37%). So it is quite easy for toddlers in Demak to get pneumonia because of
the lack of light in the house.
2. Residential
Density
The
physical condition of the building, one of which is residential density, is
closely related to disease transmission. If the occupants are too crowded and
there are residents who are sick, it will accelerate the transmission or
transmission of disease. The more the number of occupants will accelerate the
decline in indoor air quality due to decreased oxygen levels and increased CO2.
The impact of increasing room CO2 is a decrease in air quality which will allow
germs to multiply more quickly. Toddlers will be easily infected or easily
infected with pneumonia.
Table 10.
Results of House Density Analysis
|
House Density
|
Frequency
|
Percentage
|
|
Congested
|
32
|
39.5%
|
|
Not
solid
|
49
|
60.5%
|
|
Total
|
81
|
100%
|
Source: Primary Data,
2022
The table shows that the
under-five environment is seen in the density of houses that are not densely
packed as much as 49 (60.5%) while those with dense houses are 32 (39.5%). So
it can be concluded that some toddlers in Demak can easily transmit or become
infected with pneumonia because the houses occupied by toddlers are dense while
not densely packed there is no risk of contracting or being infected with
pneumonia.
3. Floor
Type
Toddlers who live in homes
with floors that do not meet the requirements will be at risk of 3,400 times
suffering from pneumonia compared to toddlers who live in homes with types of
floors that meet the requirements. The dust will cause toddlers to have
difficulty breathing because it can enter the respiratory tract. Bacteria that
are often found include Streptococcus pneumoniae, Staphylococcus aureus,
Haemophulus influenza and Streptococcus pyogene. Secretions in the form
of phlegm and mucus can come out through the nose, throat and mouth along with
droplets when coughing or sneezing (Yusela
et al., nd) . The secretions will later fall to the
floor, stick or mix in the air. These bacteria mixed in the air will be inhaled
when breathing and infect family members (Yusela
et al., nd) .
Table
11. Results of Floor Type Analysis
|
Floor Type
|
Frequency
|
Percentage
|
|
Tiled
|
58
|
71.6%
|
|
Untiled
|
23
|
28.4%
|
|
Total
|
81
|
100%
|
The table shows that the
residences for toddlers in Demak are 58 (71.65) tiled floors and 23 (28.45)
untiled houses. So it can be concluded that the tiled children's residence has
a small risk for toddlers to be infected with pneumonia, while those without
tiles have a greater risk of developing pneumonia.
4. Presence
of Smokers in the House
Toddlers who live at home
with family members who smoke will have a 3.116 times risk of suffering from
pneumonia compared to toddlers who live in homes with family members who do not
smoke. According to Permenkes No. 1077/Menkes/Per/V/2011 states that cigarette
smoke enters the source of chemical pollutants that affect air quality.
Cigarette smoke has worse side effects than other smoke because it can irritate
the respiratory tract mucosa and cause ARI. Free radicals contained in
cigarette smoke can damage lung tissue (Yusela
et al., nd) .
Table
12. Presence of Smokers in the House
|
The Presence of Smokers in the House
|
Frequency
|
Percentage
|
|
There
is
|
37
|
45.7
|
|
There
isn't any
|
44
|
54.3
|
|
Total
|
81
|
100%
|
Source: Primary Data,
2022
The table shows that the
place of residence of children under five in Demak is seen in the presence of
smokers in the house who do not have 44 (54.3%) and 37 (45.75) smokers in the
house. So it can be concluded that the place of residence of children under
five in Demak where there are smokers in the house has a high risk of
developing pneumonia in children under five, while there is no smoker in the
house of toddlers who have a small risk of developing pneumonia.
5. Use
of mosquito coils
Toddlers who use mosquito
coils have a 9.750 times greater risk of suffering from pneumonia compared to
toddlers who do not use mosquito coils. Burning mosquito coils produce smoke
containing carbonyl compounds ( formaldehyde and acetaldehyde )
which are carcinogenic . In addition, mosquito repellent smoke is also
an irritant which causes irritation of the respiratory tract.
Exposure through breathing
is very dangerous because the active ingredient particles can be quickly
absorbed by the lungs into the bloodstream, causing serious damage to the nose,
throat and lung tissue if inhaled in sufficient quantities and for a long
period of time.
According to Chen et al
(2008) stated that burning insect repellent will cause lung cancer because
mosquito coils will release a number of particulate matter and formaldehyde
(Sari
et al., 2018) . The full analysis is presented in the table
below:
Table 13. Results of Analysis of the Use of
Mosquito Repellent
|
Use of Mosquito Remedy in
the House
|
Frequency
|
Percentage
|
|
There is
|
10
|
12.3
|
|
There isn't any
|
71
|
87.7
|
|
Total
|
81
|
100
|
Source:
Primary Data, 2022
The table shows that the
place where the toddlers live is seen in the use of mosquito coils in the
existing house amounting to 10 (12.3%) while there is no use of mosquito coils
amounting to 71 (87.7%). So it can be concluded that the majority of toddlers
who are demak do not experience the risk of suffering from pneumonia but a small
portion have a greater risk of suffering from pneumonia.
6. Temperature
Air temperature that
is too low below 18ºC can cause the room to become humid and if the temperature
is too high above 35ºC the room will become stuffy. Healthy home temperature
requirements are 18ºC - 30ºC. Streptococcus pneumoniae bacteria can grow
in a temperature range of 25ºC - 40ºC and can grow optimally in a temperature
range between 31ºC-37ºC.
Table 14. Results of
Temperature Analysis
|
Temperature
|
Frequency
|
Percentage
|
|
>30oC
|
23
|
28.4
|
|
18oC-30oC
|
71
|
71.6
|
|
Total
|
81
|
100
|
Source: Primary Data, 2022
The table shows where
children live in Demak for 23 (28.45%), house temperatures > 30°C and 71
(71.6%) . So it can be concluded that toddlers in Demak have a
small risk of suffering from pneumonia and most of them have a smaller risk of
developing pneumonia because they have a normal and healthy temperature.
5. Toddler
Pneumonia
Classification
of pneumonia in toddlers based on age groups include:
1. Children
aged 2 months - <5 years, coughing which indicates no pneumonia, no rapid
breathing and no downward pull of the chest wall, while pneumonia is
characterized by rapid breathing and no downward pull of the chest wall and
severe pneumonia characterized by wall pull lower chest forward.
2. Age
less than two months of cough is not pneumonia characterized by the absence of
rapid breathing, if pneumonia, there will be rapid breathing and a strong pull
in the lower chest wall.
Pneumonia in neonates
aged 3 weeks to 3 months is most often caused by bacteria (Kaunang
et al., 2016) . Usually Streptococcus pneumoniae
bacteria . In toddlers aged 4 months to 5 years, the virus is the most
common cause of pneumonia, namely respiratory syncytial virus. In developing
countries, bacteria are the largest aspect in the incidence of pneumonia in
children under five around 50%.
The results of this
research analysis regarding the condition of toddlers in Demak through the
distribution of questionnaires filled out by parents of toddlers are presented
in the table below:
Table 15. Results of
Analysis of Pneumonia Findings
|
Question
|
Yes
|
Percentage
|
Not
|
Percentage
|
|
Toddler
has cough
|
9
|
11.1
|
72
|
88.9
|
|
Toddler
has seizures, does not want to suckle, decreased consciousness, fever.
|
1
|
1.2
|
80
|
98.8
|
|
Toddler
has shortness of breath.
|
1
|
1.2
|
80
|
98.8
|
|
Toddlers
often drink breast milk
|
6
|
7.4
|
75
|
92.6
|
|
Toddler
sleeping snoring
|
5
|
6.2
|
76
|
93.8
|
|
Toddler
Liquid CHAPTER
|
9
|
11.1
|
72
|
88.9
|
|
Toddler
has a cold
|
15
|
18.5
|
66
|
81.5
|
|
Toddlers
get basic immunizations according to the child's age
|
27
|
33.3
|
54
|
66.7
|
|
Toddlers
get breast milk for 0-6 months without any additional food
|
72
|
88.9
|
9
|
11.1
|
|
There
are parents or other family members who have a habit of smoking in the house.
|
14
|
17.3
|
67
|
82.7
|
|
You
pay attention to your toddler's nutritional intake
|
6
|
7.4
|
75
|
92.6
|
|
You
regularly monitor the health of your toddler
|
8
|
9.9
|
73
|
90.1
|
|
You
do not provide any form of protection to
your
toddler (covering nose, keeping away, giving mask) if your child is exposed
to air pollution (cigarette smoke, dust, vehicle fumes, smoke
waste
burning)
|
21
|
25.9
|
60
|
74.1
|
|
Do
you regularly clean the house?
|
7
|
8.6
|
74
|
91.4
|
|
You
support the search for health services or
treatment
when your toddler is sick
|
20
|
24.7
|
61
|
75.3
|
|
Your
toddler is being cared for by someone else
|
70
|
86.4
|
11
|
13.6
|
good health condition
is evidenced by the questions Toddler has cough 88.9% answered no, Toddler has
seizures, does not want to suckle, decreased consciousness, fever 98.8% answered
no, Toddler experienced shortness of breath 98.8% answered no, Toddler liquid
defecation 88.9% answered no, and a small proportion of toddlers have a risk of
suffering from pneumonia.
6. The
Effectiveness of the M-KIA Application on Early Detection and Prevention of
Pneumonia
Based on the data that has been declared
normal and homogeneous, so that the hypothesis testing uses the two-way
analysis of variance test in the SPSS 24.0 statistical application. This
hypothesis test is used to examine whether there is an effect of a treatment,
namely the use of the M-KIA application on early detection and prevention of
pneumonia. Hypothesis testing using independent T-test with the help of
SPSS version 24 program with the output results can be seen in Table
4.16.
Table 16. Independent T-test . Test
Results
|
Group
|
Average value
|
SD
|
Results of Sig. (2-tailed)
|
Influence
|
|
Experiment
|
69.6
|
6.2
|
0.000 < 0.05
|
Significant
|
|
Control
|
57, 2
|
4.8
|
0.337
< 0.05
|
Not
significant
|
Based
on the data obtained from the results of data analysis in Table 4.16, it shows
that the average score of the experimental group is better than the control
group, with a much different distribution of values. This is indicated by the
value of the standard deviation (standard deviation), the more the standard
deviation of the data approaches zero, the more uniform the distribution of the
data with the average value of the existing data. This means that the
distribution of the data obtained is getting better. The results of the T-test
in the experimental group showed that there was a significant effect on the
sig value. 0.000 < 0.05 so Ho is rejected and Ha is accepted, so there is a
difference in the average use of the M-KIA application before and after the use
of the M-KIA application in early detection and prevention of pneumonia.
Table
17. Effectiveness of early detection of pneumonia before and after using the
M-KIA application system
|
Detection Type
|
Mann-Whitney test
Mean Rank
|
Effectiveness (%)
|
p
|
|
Not enough
|
Enough
|
Well
|
|
Conventional
|
11.65
|
32.5
|
10.0
|
7.5
|
0.000
|
|
M-KIA Application
|
29.35
|
7.5
|
20.0
|
22.5
|
Table 17 shows the
effectiveness of early detection of pneumonia using the M-KIA application
system which states that it is good as much as 22.5% when compared to before
using the M-KIA application. The results of the Mann-Whitney test from
the results of the mean rank of the effectiveness of early detection of
pneumonia with the M-KIA application system better than before using the
M-KIA application, namely the conventional way using the MCH book.
7.
Feedback on the use of the M-KIA Application
1. Feedback
about the display on the M-KIA application is good
The response of
parents of toddlers in Demak with the M-KIA application, most respondents
answered quite agree. This shows that the M-KIA is classified as less
effective, possibly because its features are unattractive or cannot be learned
by parents of toddlers. The results of the response recap of parents of
toddlers are presented in the table below:
Table 18. Respondents' Responses Regarding
Display on the M-KIA application
|
Response
|
Frequency
|
Percentage
|
|
Agree
|
29
|
35.8%
|
|
Just Agree
|
52
|
64.2%
|
|
Total
|
81
|
100%
|
The table shows that the respondents who said the display
on the application was good were 29 (35.85) and answered quite agree were 52
(35.8%). So it can be concluded that the M-KIA application is seen from the
appearance of the respondents who are not interested.
2. Respondents'
Responses About How to Use the M-KIA Application
Respondents'
responses on how to use the M-KIA application for parents of toddlers in Demak
mostly answered quite agree, amounting to 50 (61.7%). This shows that the M-KIA
application cannot be understood by parents of toddlers. The results are more
clearly presented in the table below:
Table 19. Respondents'
Responses About How to Use the M-KIA Application
|
Response
|
Frequency
|
Percentage
|
|
Agree
|
31
|
38.3%
|
|
Just Agree
|
50
|
61.7 %
|
|
Total
|
81
|
100%
|
The table shows that
the responses of respondents regarding how to use the M-KIA application,
parents of toddlers who answered agreed were 31 (38.3%) and those who answered
quite agreed were 50 (61.7%). So it can be concluded that the M-KIA application
is not in accordance with the needs of parents of toddlers in Demak, possibly
because the M-KIA application is difficult to run so that parents of toddlers
feel that the M-KIA application does not work.
3. Respondents'
Responses About Comfort using the M-KIA application
Respondents'
responses regarding the convenience of using the M-KIA application, parents of
toddlers mostly answered quite agree as many as 47 respondents. This shows that
the M-KIA application for parents of toddlers in Demak does not feel
comfortable as they wish. The results of this analysis are presented in full in
the table below:
Table 20. Respondents'
Responses About the Convenience of the M-KIA Application
|
Response
|
Frequency
|
Percentage
|
|
Agree
|
32
|
39.5%
|
|
Just Agree
|
47
|
58%
|
|
Don't agree
|
2
|
2.5%
|
|
Total
|
81
|
100%
|
So it can be
concluded that the M-KIA application parents of toddlers in Demak feel more
uncomfortable in using the M-KIA application, but only a small part feel
comfortable as evidenced by 32 (39.5%).
4. Respondents'
Responses About the information provided by the M-KIA application is clear and
easy to understand.
Respondents'
responses to the information provided by M-KIA are clear and easy to understand,
parents of children under five in Demak mostly answered quite agree, amounting
to 46 (56.8) than those who answered agree. The results of this analysis are
presented in the table below:
Table 21. Respondents'
Responses About Information From M-KIA
|
Response
|
Frequency
|
Percentage
|
|
Agree
|
35
|
43.2%
|
|
Just Agree
|
46
|
56.8%
|
|
Total
|
81
|
100%
|
So it can be
concluded that the M-KIA application has not provided the information that
parents of toddlers want only a small part of them have received clear and
understood information.
5. Respondents'
responses to the M-KIA Application for information on the danger signs of
pneumonia in toddlers
Respondents'
responses regarding the M-KIA application for information on the danger signs
of pneumonia in toddlers, parents of toddlers in Demak said they agreed as much
as 42 (51.9%). This shows that the M-KIA application can provide and is useful
for detecting toddlers whether they have pneumonia or not. The results of this
analysis are presented in full in the table below:
Table 22. Respondents'
responses to the M-KIA application
For Information on Danger
Signs of Pneumonia in Toddlers
|
Response
|
Frequency
|
Percentage
|
|
Agree
|
42
|
51.9%
|
|
Just Agree
|
37
|
45.7%
|
|
Don't agree
|
2
|
2.5%
|
|
Total
|
81
|
100%
|
So it can be
concluded that most parents of toddlers in Demak feel that the M-KIA
application can detect the danger signs of pneumonia in toddlers, a small
proportion have not felt the function of the M-KIA application to detect the
dangers of pneumonia.
6. Respondents'
Responses Regarding the Performance of the M-KIA
Application To Know Toddler Health
Respondents'
responses regarding the performance of the M-KIA application to determine the
health of toddlers, most of the parents of toddlers answered agree, amounting
to 51 (63%). This shows that parents of toddlers feel helped by the M-KIA
application because they can find out the health of their toddlers earlier. The
results of this analysis are presented in full in the table below:
Table 23. Respondents'
Responses to the Performance of the M-KIA Application
To Know Toddler Health
|
Response
|
Frequency
|
Percentage
|
|
Agree
|
51
|
63%
|
|
Just Agree
|
29
|
35.8%
|
|
Don't agree
|
1
|
1.2%
|
|
Total
|
81
|
100%
|
So it can be
concluded that the M-KIA application 63% of parents of toddlers find it useful
for detecting the health of toddlers and 37% do not feel the M-KIA application
is useful for detecting children's health.
According to Martani
and Lubis (2007), there are three approaches that can be used to measure the
effectiveness of an organization, namely:
1.
Source approach ( resource approach )
which measures the effectiveness of the input. The approach prioritizes the
success of the organization to obtain resources, both physical and non-physical
in accordance with the needs of the organization.
2.
The process approach is to see the
effectiveness of program implementation from all internal process activities or
organizational mechanisms.
3.
Approach targets ( goals approach )
where the focus is on the output, measuring the success of the organization to
achieve the results (outputs) in accordance with the plan.
The conclusion is
that early application is less effective because parents of toddlers in Demak
have not all felt the function of the M-KIA application in meeting the health
needs of toddlers, especially for early detection of pneumonia. The obstacle
faced by the community in Demak is the lack of knowledge of using the M-KIA
application so that only some understand so that they feel the use of the M-KIA
application to detect pneumonia in toddlers early.
8.
Pneumonia Risk Factors
This study corroborates the
findings of previous studies in which children who are not exclusively
breastfed until the age of six months can suffer from various infectious
diseases including pneumonia (Hartati
et al., 2012) . Raising awareness of women and families for
breastfeeding, especially exclusive breastfeeding, is very necessary to reduce
the risk of pneumonia. Developing a support system for families and communities
is critical to the success of exclusive breastfeeding.
The survey found that more
girls had a history of pneumonia in the past year than boys. Similar findings
were found in a Brazilian study corroborating that a significantly higher risk
of developing pneumonia was among female children compared with male children.
However this contradicts the findings of another study in Indonesia which found
that boys were a risk factor for developing pneumonia (Lubis,
2020) . Further research is needed to explore whether the
differences are caused by biological or social factors.
This study also found that
the capacity of families to provide proper care for their sick children needs
to be addressed. This fact explains that most of the children in this study had
more than one episode of pneumonia in the past year or had a relapse. Lack of
capacity of parents to provide proper care at home for their sick children can
be due to lack of knowledge of caregivers or parents about the causes and
prevention of pneumonia. This lack of capacity may be related to a lack of
information or skills transferred from health workers or an inability to follow
up on information or skills received. This gap raises questions about the
effectiveness of professional health workers and informal public health cadres
in educating the public about pneumonia. Prevention of recurrence of childhood
disease is important because the more sick a child is, the higher the risk of
death. Pneumonia is a disease with a high risk of recurrence. Children are
under family care when they are healthy and as such, the support and assistance
of health professionals for families with regard to the maintenance of child
health and disease prevention is essential.
Perceptions of a disease,
from those held by service providers to policy makers locally and nationally
because it can influence how it is treated and prevented. In the family
context, previous research found that the perception of pneumonia influenced
caregivers' habits of making decisions regarding bringing their child to a
health care center.
This study found a lack of
knowledge about childhood pneumonia. Lack of knowledge about the symptoms of
childhood pneumonia has been studied previously and was found to influence
behavior in seeking care from caregivers. Previous studies have also shown that
public knowledge about pneumonia has an impact on health behavior (Syakurah
& Moudy, 2020) . A study in Indonesia found an
association between the level of knowledge of parents, especially mothers, with
recurrence of pneumonia where more complete knowledge was associated with fewer
recurrences.
Previous research has found
that distance to health services is associated with utilization of health
services, especially when it comes to child health. Children living 5
kilometers from the nearest health facility were about twice (95% CI: 1.11,
2.72) more likely to delay medical care than those living at a closer distance
from the health care facility. Families who have good health knowledge and
awareness of pneumonia will not delay bringing their children to health
facilities (Habibi,
2018) . Raising family awareness about the importance of
bringing children with pneumonia symptoms to health services is a very
significant preventive measure that can reduce child mortality and morbidity.
Various barriers in treating and preventing childhood pneumonia have been
identified quantitatively and qualitatively in this study.
CONCLUSION
The conclusion is that the effectiveness
in this study: The effectiveness of the use of the M-KIA application on the
early detection and prevention of pneumonia in Demak Regency, it was found that
there was a significant effect on the sig value. 0.000 < 0.05 so Ho is
rejected and Ha is accepted, so there is a difference in the mean of early
detection and prevention of pneumonia before and after using the M-KIA
application. There are still many people in Demak who have toddlers who say the
M-KIA application does not understand and is not clear in meeting the needs for
their toddlers. Most mothers of toddlers in Demak with the M-KIA application
are able to detect pneumonia early. The results of the responses to the use of
the M-KIA application are less effective because parents of toddlers in Demak
have not all felt the function of the M-KIA application in meeting the health
needs of toddlers, especially for early detection of pneumonia. The risk
factors are mostly related to the health and development of children and their
environmental conditions. Most of these risk factors can be prevented, this
shows the importance of preventive measures to reduce the risk of pneumonia.
The multi-dimensional nature of pneumonia risk also needs to be underlined
because it has an impact on the importance of inter-agency collaboration among
stakeholders to address issues outside the health sector. The obstacle faced by
the community in DEmak is the lack of knowledge of using the M-KIA application
so that only some understand so that they feel the use of the M-KIA application
to detect pneumonia in toddlers early.
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