TUTORIAL REPORT

SCENARIO B BLOCK 22

GROUP 9
Tutor : dr. Putri Rizki Amalia Badri, M.
Vena Putri Mulya Nuralgisca 702018006
Yolanda Fitriani 702018012
Dimas Fahrizul Huda 702018015
Rindi Amelia 702018023
Novita Sari 702018047
Putra Pratama Adi Candra 702018054
Natasya Viana Permata Sugiantara 702018066
Dennisa Luthfiyah Fadilah 702018074
Selvi Triami 702018096
Aninda Afrilia Aryani 702018100

FACULTY OF MEDICINE
UNIVERSITAS MUHAMMADIYAH PALEMBANG
2021
 FOREWORD

Praise our thanks to Allah SWT for all His mercy and grace. We were able to
complete the tutorial report entitled “Tutorial Report Scenario B Block 22” as a
group competency assignment. Salawat along with greetings are always poured
out to our lord, the great prophet Muhammad SAW and his family, friends, and
followers until the end of time.
We recognize that this tutorial report is far from perfect. Therefore, we expect
constructive criticism and suggestions for improvement in the future. In
completing this tutorial report, the author received a lot of help, guidance and
advice. On this occasion, the author would like to respect and thank :
1. Allah SWT, who has given life with the coolness of faith.
2. Both parents who always provide material and spiritual support.
3. dr. Putri Rizki Amalia Badri, M. KM as the tutor for group 9.
4. Colleagues.
5. All those who help us.
May Allah SWT reward all the charities given to all those who have
supported the author and I hope this tutorial report is useful for us and the
development of science. May we always be protected by Allah SWT.

Palembang, November 2021

 CHAPTER I

PRELIMINARY
1.1 Background
Block of Community Medicine and Public Health is one of the blocks in
the seventh semester of the Medical Education Competency-Based
Curriculum, Faculty of Medicine, Muhammadiyah University of Palembang.
As we know that the learning program at FK UMP uses the KBK learning
system and problem based learning, so it is hoped that doctor graduates from
FK UMP will become doctors who are able to solve public health problems.

1.2 Purpose and Objectives

The purpose and objectives of this case study tutorial, namely:
1. As a report task group tutorial that is part of KBK learning system at the
Faculty of Medicine, Muhammadiyah University of Palembang.
2. Can solve the case given in the scenario with the method of analysis and
learning group discussion.
3. Achieving the objectives of the tutorial learning method.

1
 CHAPTER II

DISCUSSION

2.1 Tutorial Data

Tutor
: dr. Putri Rizki Amalia Badri, M. KM
Moderator : Putra Pratama Adi Candra
Secretary : Yolanda Fitriani
Secretary Board : Dennisa Luthfiyah Fadilah
Day and date : Tuesday, November 11nd, 2021
(13.00 am -14.30 pm)

Rule of tutorial : 1. Gadget should be nonactive or in silent mode.

2. Everyone in the group should express their
opinion.
3. ask for permission if want to go outside.
4. Eating and drinking are not allowed in the room.
2.2 Case Scenario
“Indiscriminate Dumping”

Ceria Village is located near the river, where there is a slaughterhouse.

Based on the report of the environmental health officer at the Puskesmas, the
slaughtering waste is directly dumped into the river. Community bathing,
washing and toilet activities use river water. The livelihoods of the people in
Ceria village are forest-encroaching farmers, who clear land by burning trees.
Dr. Susi has only worked for one year at the Puskesmas Bahagia, where
she received a report from the Puskesmas surveillance staff that the incidence
of diarrhea cases had doubled from the previous month, while from data of the
top ten diseases, acute respiratory infection (ARI) was ranked first. Dr. Susi is

2
 going to conduct an epidemiological investigation of diarrhea and provide
counseling on cases of infectious diseases.
2.3 Clarification of Terms

1. Epidemiological Identifies emerging infections in populations

investigation to discover the mechanisms of transmission,
with the eventual goal being to develop
interventions for the prevention, detection,
treatment, and control of the infections
2. Diarrhea Abnormal discharge of watery stools many
times
3. Acute respiratory Consists of upper respiratory tract infections
infection and lower respiratoryhanging from the
affected respiratory tract area (Zulaikhah et
al., 2017).
4. Surveillance The process of collecting, processing,
analyzing and interpreting data systemically
and continuously and disseminating
information to units that need to be able to
take action.
5. Incidence Major event or event
6. Infection Disease Diseases that can be transmitted to humanity
caused by biological agents, among others,
viruses, bacteria, fungi and parasites
7. Counseling An activity or efforts to convey health
messages to community, group or individual
with hope the presence of messages can get
knowledge about better health, ultimately the
knowledge can change his behavior
(Notoatmodjo, 2012).

3
2.5 Problem Identification
1. Ceria Village is located near the river, where there is a slaughterhouse.
Based on the report of the environmental health officer at the
Puskesmas, the slaughtering waste is directly dumped into the river.
Community bathing, washing and toilet activities use river water. The
livelihoods of the people in Ceria village are forest-encroaching
farmers, who clear land by burning trees.
2. Dr. Susi has only worked for one year at the Puskesmas Bahagia,
where she received a report from the Puskesmas surveillance staff that
the incidence of diarrhea cases had doubled from the previous month,
while from data of the top ten diseases, acute respiratory infection
(ARI) was ranked first. Dr. Susi is going to conduct an
epidemiological investigation of diarrhea and provide counseling on
cases of infectious diseases.
2.6 Priority of Problem
No. 1
Because it can increase morbidity and mortality
2.7 Analysis of Problem
1. Ceria Village is located near the river, where there is a slaughterhouse.
Based on the report of the environmental health officer at the
Puskesmas, the slaughtering waste is directly dumped into the river.
Community bathing, washing and toilet activities use river water. The
livelihoods of the people in Ceria village are forest-encroaching
farmers, who clear land by burning trees.
a. What the meaning Ceria Village is located near the river, where
there is a slaughterhouse. Based on the report of the
environmental health officer at the Puskesmas, the slaughtering
waste is directly dumped into the river. Community bathing,
washing and toilet activities use river water. The livelihoods of
the people in Ceria village are forest-encroaching farmers, who
clear land by burning trees?

4
 Answer :
Based on the report of the environmental health officer at
the Puskesmas, the slaughtering waste is directly dumped
into the river. Community bathing, washing and toilet
activities use river water : This means that there is river
pollution due to the disposal of slaughtering waste into the river
which is a risk factor for diarrhea outbreaks in cheerful village.
With the presence of pollution, the surrounding environment,
both the abiotic environment, the biotic environment, and the
social environment, will be disturbed by its function. This
greatly affects the health of the surrounding environment.
The livelihoods of the people in Ceria village are forest-
encroaching farmers, who clear land by burning trees : The
livelihoods of the local population are a risk factor for cases of
acute respiratory infections which are ranked first. The impact
of forest fires has caused a decline in the level of public health,
both directly and indirectly. The impact will be felt for children
under five years old and the elderly (elderly). The direct impact
of inhalation of forest fire smoke is upper respiratory tract
infection.
b. What is the impact of the factory waste is directly dumped into
the river?
Jawab :

According to Peraturan Pemerintah Republik Indonesia Nomor

82 Tahun 2001 tentang Pengelolaan Kualitas Air dan
Pengendalian Pencemaran Air pada Pasal 36 ayat (2), factory
waste can cause:
1. Influence on the empowerment of fish, animals, plants and
agriculture
2. Influence on water and soil quality
3. Influence on public health
5
c. What are the legal bases governing waste?
Answer :

Violation of water pollution results in absolute responsibility

for the perpetrator, this is in accordance with the Undang-
Undang Nomor 23 Tahun 1997 Pasal 35 Ayat 1 tentang
Pengelolaan Lingkungan Hidup, and it obliges the perpetrators
of pollution (in this case water pollution) to be obliged to pay
compensation. direct and instantaneous loss at the time of the
pollution incident, whether it was intentionally or due to
negligence with a fine of Rp. 100,000,000, - up to Rp.
750,000,000, - imprisonment. Further regulation regarding this
legal provision is regulated in Articles 41 - 48 of Law No.23 of
1997 concerning Environmental Management. An alternative
to the application of sanctions is civil sanctions, namely
compensation to sufferers and recovery costs to the state
(Polluter pays principle).
Apart from that there are several other legal grounds, such as :
1. UU Number 32 in 2009 about protection and management of
the environment.
2. UU Number 36 in 2009 about health in Pasal 163 about
environmental health.
3. UU Number 18 in 2008 about waste management tentang in
pasal 22.
4. Peraturan Pemerintah Number 82 in 2001 about management
of water quality and water pollution.
5. Peraturan Presiden Number 16 in 2015 about ministry of
environment and forestry.
6. Peraturan Menteri Lingkungan Hidup and Kehutanan Number
P.18/MenLHK-II/

6
d. How to processing factory waste before throw away?
Answer :

Wastewater treatment can be carried out in two ways, namely

(Chandra, 2006) :
a. Naturally
Natural wastewater treatment can be done by creation of a
stabilization pool. In the stabilization pond, wastewater
processed naturally to neutralize pollutants before the
wastewater is discharged into the river. Common stabilization
pool used are anaerobic ponds, facultative ponds (water
treatment waste contaminated with concentrated organic
matter), and maturation ponds (destruction of pathogenic
microorganisms). Because of that cost it takes cheap, this
method is recommended for tropical areas and is developing.
b. Artificially
Wastewater treatment with tools is carried out at the
installation Wastewater Treatment (IPAL). This processing is
done through three stages, namely primary treatment (first
processing), secondary treatment (second processing), and
tertiary treatment (processing advanced).
1. Primary treatment is the first treatment aims to separate solids
and liquids with using a filter (filter) and sedimentation tub.
Some the tools used are slow sand filter, sand filter fast,
multimedia filters, percoal filters, microstaining, and vacuum
filter.
2. Secondary treatment is the second treatment, aims to
coagulate, remove colloids, and stabilize organic substances in
waste. Waste treatment household aims to reduce material
content organic, nutrient nitrogen, and phosphorus.
Decomposition of organic matter this is done by living things
aerobically (using oxygen) and anaerobic (without oxygen).
7
 Aerobically, the decomposition of organic matter is carried out
by microorganisms oxygen assistance as an electon acceptor in
wastewater. In addition, this aerobic activity is carried out with
the help of mud active (activated sludge) which contains lots of
bacteria decomposer. The end result of perfect aerobic activity
is CO2, water vapor, and excess sludge. Anaerobic,
decomposition of materials organic is done without using
oxygen. The final result Anaerobic activities are biogas, water
vapor, and excess sludge.
Tertiary treatment is a continuation of the second treatment,
namely the removal of nutrients or nutrients, especially nitrates
and phosphate, and the addition of chlorine to destroy
pathogenic microorganisms. In wastewater treatment can done
naturally or artificially, it needs to be done various ways of
controlling, among others, using technology wastewater
treatment, production processing technology, recycling, resure,
recovery and also saving of raw materials and energy. In order
to meet quality standards, the industry must apply the
principles of waste control carefully and well integrated in in
the production process (in-pipe pollution prevention) and after
production process (end-pipe pollution prevention). Control in
the production process aims to minimize volume waste
generated, as well as concentration and toxicity contaminants.
While controlling after the process production is intended to
reduce the content of materials polluter so that in the end the
water meets the standard quality that has been determined.

e. What are the possible diseases that can be caused by factory

waste and polluted water? (generally)
Answer :

According to Priyanto (2011) diseases can cause by polluted water are :

8
1. Virus :
a. Rotavirus → diarrhea in children
b. V. hepatitis A → Hepatitis A
c. V. Poliomyelitis → Polio
2. Bacteria :
a. Vibro cholerae → cholera
b. E. Coli enteropathogenetics → diare/disentri
c. Salmonella typhi → typhus abdominalis
d. Salmonella paratyphi → paratyphus
e. Shigella dysenteriae → dysentery
3. Protozoa :
a. Entamoeba histolytica → dysentrie amoeba
b. Balantidia coli → balantidiasis
c. Giardia lambia → girdariasis
4. Metazoa :
a. Ascaris lumbricoides → Ascariasis
b. Chlonorchis sinensis → chlonorchiasis
c. Diphyllabothrium latum → Diphyllabothriasis
d. Taenia saginata/solium → taeniasis
e. Schistosoma → schistosomiasis
According to WHO (2011), Water-associated diseases are classified
into five main groups :
1. Waterborne diseases are caused by the ingestion of faecally
contaminated water. Cholera and typhoid fever are classical
examples of waterborne diseases, where only a few highly
infectious pathogens are needed to cause severe diarrhoea.
Shigellosis, hepatitis A, amoebic dysentery and other
gastrointestinal diseases can also be waterborne.
2. Water-washed (water-hygiene) diseases occur due to the lack of
adequate water supply for washing, bathing and cleaning. Pathogens
are transmitted from person to person or by contact with

9
 contaminated surfaces. Eye and skin infections as well as diarrhoeal
illnesses occur under these circumstances. Waterborne pathogens
include bacteria, viruses, protozoa and helminths. A short list of the
most important pathogens and their significance in water supplies is
shown in Table 2.1 below.
3. Water-scarce diseases occur due to the lack of water available for
washing, bathing and cleaning. Hence, pathogens are transmitted
from person to person or from contaminated surfaces to a person
and are spread by the faecal–oral route. In particular, eye
(trachoma) and skin infections (scabies), as well as diarrhoeal
diseases occur under those conditions.
4. Water-based diseases are caused by organisms, in particular by
different species of worms that spend parts of their life-cycle in
different habitats. They have spent one development cycle in
aquatic molluscs, and another as fully grown parasites in other
animal or human hosts. Because stagnating surface waters, such as
reservoirs, are the preferred habitat of parasitic worms, the
occurrence of water-based diseases such as dracunculiasis and
schistosomiasis can be heavily influenced by anthropogenic
activities.
Vector-borne diseases are caused by bites from insects that
breed in water. Insect vectors such as mosquitoes transmit
diseases such as malaria, Chikungunya and other diseases.

f. What are the criteria of clean water?

Answer :

According to Peraturan Menteri Kesehatan Republik Indonesia Nomor

32 Tahun 2017 Tentang Standar Baku Mutu Kesehatan Lingkungan dan
Persyaratan Kesehatan Air Untuk Keperluan Higiene Sanitasi, Kolam
Renang, Solus Per Aqua, dan Pemandian Umum, Environmental Health
Quality Standards for Water media for Sanitation Hygiene Purposes
10
include physical, biological and chemical parameters which can be
mandatory parameters and additional parameters. Mandatory
parameters are parameters that must be checked periodically in
accordance with statutory provisions, while additional parameters are
only required to be checked if geohydrological conditions indicate
potential contamination with respect to additional parameters. Water for
Hygiene Purposes Sanitation is used for personal hygiene maintenance
such as bathing and toothbrushes, as well as for washing foodstuffs,
eating utensils and clothes. In addition, water for sanitation purposes
can be used as raw water for drinking water.

Table 1. Physical Parameters in Health Quality Standards Environment

for Water Media for Sanitation Hygiene Purposes
No Mandatory Parameters Unit Quality Standards
. (maximum level)
1. Turbidity NTU 25
2. Colour TCU 50
3. Dissolved solid mg/l 1000
(Total Dissolved Solid)
4. Temperature ˚C Air temperature ± 3
5. Taste Tasteless
6. Smell Odorless
(Peraturan Menteri Kesehatan Republik Indonesia Nomor 32 Tahun
2017 Tentang Standar Baku Mutu Kesehatan Lingkungan dan
Persyaratan Kesehatan Air Untuk Keperluan Higiene Sanitasi, Kolam
Renang, Solus Per Aqua, dan Pemandian Umum).

Table 2 lists the mandatory parameters for biological parameters to be

checked for sanitary hygiene purposes which includes total coliform
and escherichia coli with colony forming units in 100 ml water samples.
Table 2. Biological Parameters in Health Quality Standards
Environment for Water Media for Sanitation Hygiene Purposes
No Mandatory Parameters Unit Quality Standards

11
 . (maximum level)
1. Total coliform CFU/100ml 50
2. E. Coli CFU/100ml 0
(Peraturan Menteri Kesehatan Republik Indonesia Nomor 32 Tahun
2017 Tentang Standar Baku Mutu Kesehatan Lingkungan dan
Persyaratan Kesehatan Air Untuk Keperluan Higiene Sanitasi, Kolam
Renang, Solus Per Aqua, dan Pemandian Umum).

Table 3 lists the chemical parameters to be checked for sanitary hygiene

purposes which includes 10 mandatory parameters and 10 additional
parameters. Additional parameters are set by the district / city
government and the port / airport authority.
Table 3. Chemical Parameters in Health Quality Standards
Environment for Water Media for Sanitation Hygiene Purposes
No Mandatory Parameters Unit Quality Standards
. (maximum level)
Required
1. pH mg/l 6,5-8,5
2. Iron mg/l 1
3. Fluoride mg/l 1,5
4. Hardness (CaCO3) mg/l 500
5. Manganese mg/l 0,5
6. Nitrates, as N mg/l 10
7. Nitrites, as N mg/l 1
8. Cyanide mg/l 0,1
9. Detergent mg/l 0,05
10 Total pesticides mg/l 0,1
Additional
1. Mercury mg/l 0,001
2. Arsenic mg/l 0,05
3. Cadmium mg/l 0,005
4. Chromium (6 valence) mg/l 0,05
5. Selenium mg/l 0,01
6. Zinc mg/l 15
7. Sulfate mg/l 400
8. Lead mg/l 0,05
9. Benzene mg/l 0,01
10 Organic matter (KMNO4) mg/l 10

12
(Peraturan Menteri Kesehatan Republik Indonesia Nomor 32 Tahun
2017 Tentang Standar Baku Mutu Kesehatan Lingkungan dan
Persyaratan Kesehatan Air Untuk Keperluan Higiene Sanitasi, Kolam
Renang, Solus Per Aqua, dan Pemandian Umum).

According to the Kemenkes RI (2018), the requirements for drinking

water are as follows :
1. Not tasteless
2. Nothing
3. Colorless
4. Does not contain harmful microorganisms
5. Does not contain heavy metals
Kemenkes RI. 2018. Apa saja syarat-syarat Air minum?. 10 November
2021. http://www.p2ptm.kemkes.go.id/infographic-p2ptm/hipertensi-
penyakit-jantung-dan-pembuluh-darah/apa-saja-syarat-syarat-air-
minum

g. What is the impact of community bathing washing and toilet

activities use river water?
h. What is the indicator of water pollution?
Anwer :
Polluted water has special characteristics that can be
distinguished from clean water, both physically, chemically
and biologically. The more people/population, the more waste
materials in nature. This condition will cause the water quality
to decrease as stated above. Physical, chemical and biological
changes in the aquatic environment can be shown by various
indicators/signs that the water is polluted. These indicators are:
1. Temperature is very important in a water, because it
determines the type of organisms that can live. Industrial
activities often use reactor machines in the production process.

13
If this is discharged into the waters it will result in changes in
water temperature. Changes in water temperature can also
occur due to natural events, which result in an increase in water
fertility so that types of aquatic plants that cause pollution (Red
Tide) will arise.
2. The degree of acidity (pH) for normal life ranges from 6.5 to
7.5. Water can be acidic or basic depending on the number of
hydrogen ions donated. Waste discharged into the waters can
reduce the pH to <7(Acid) or >7(Base).
3. Physical indicators that are easily detected by the five human
senses are Color, Taste and Smell. The change is caused by the
type and amount of waste material in the waters. Color, taste
and odor can reduce the aesthetics for the use of water for
drinking water purposes.
4. The emergence of sediment, colloidal and dissolved
materials.
sediment, colloidal and dissolved materials derived from
industrial waste materials in solid form. The form into a
precipitate or colloidal depends on the solubility of the waste
material. precipitates that cannot dissolve completely will be at
the bottom of the waters, while those that are partially soluble
will form colloids in the waters. The more sediment, colloidal
and dissolved materials will increase the BOd (Biological
Oxygen Demand) in the waters.
5. Microorganisms play a role in degrading waste materials.
The more waste material in the water, the more
microorganisms will degrade it. Along with the development of
microorganisms, the possibility of pathogenic microbes will
also arise. Pathogen microbes will cause various diseases.
6. Radioactive has been widely used in all fields, including
agriculture, medicine, industry and so on. Since the beginning

14
 of the formation of the earth, radioactivity has been present in
the formation of the earth through fusion reactions that require
very high energy. However, humans are prohibited from
intentionally dumping radioactive materials into the waters.
(Suyasa, 2015)
Suyasa, W. Pencemaran Air & Pengelolahan Air Limbah,
Udayana University Press, Bali.

Clean water parameters for health

According to Riyanto (2009), Water parameters related to health can be
done with physical parameters, chemical parameters and biological
parameters. If these parameters exceed the standard, it will have an
impact on human health.
1. Physical Parameters
Physical parameters include:
a. Temperature The maximum temperature allowed is 30 ° C. The
waste water temperature is generally higher than normal water
temperature. This is due to the condition of the water process in
industrial activities using a higher temperature.
b. Sedimentation substance The maximum permissible precipitate
is 1.0 mg / L. Substances deposited in water are caused by the
deposition process due to the gravitational force of the
substances floating in the water. The purpose of settling is to
purify the water so as to reduce turbidity. Precipitation is only
useful in separation coarse particles that descend fast. Another
result of deposition is the separation of bacteria. The percentage
of bacteria is proportional to turbidity.
2. Chemical Parameters
Chemical parameters that can be measured include :
a. pH pH shows the concentration of H + ions and is an important
parameter in determining the quality of wastewater and deep
water. The pH limit obtained is 6.5 - 8.5.
15
 b. Biological Oxygen Demand (BOD) Biological Oxygen Demand
(BOD) is the amount of oxygen needed for microbial growth.
The maximum permissible BOD is 30 mg / L as O2. if BOD
exceeds 30 mg / L, will reduce the growth of certain microbes
(good microbes) and cause the growth of &quot;bad&quot;
microbes. The high growth of bad microbes can cause various
diseases.
c. Chemical Oxygen Demand (COD) Chemical Oxygen Demand
(COD) is the amount of oxygen needed to oxidize chemical
substances in a water system. The maximum permissible COD
is 80 mg / L as O2, if it exceeds it can cause various diseases.
d. Dissolved oxygen (DO) is one of the parameters regarding
water quality. The availability of dissolved oxygen in water
determines life in these waters. The quality standard for DO
content in the river is 6 Mg / L. The higher the Dissolved
Oxygen (DO) content the better the water quality.
3. Biological Parameters Healthy water is water that does not contain
microorganisms such as pathogenic microbes. Pathogenic microbes
are the cause of various kinds of germs such as dysentery, typhoid,
cholera, protists, viruses and pathogenic bacteria that cause disease.
With these standards, the consumption water we use will be safe for
our health, therefore be selective human beings for our health and
also for our survival.

i. What is the impact burning forest?

Answer:

Health problems in the smoke affected communities

increased significantly during wildfires incident. One of the
highest cases is ARI. ARI is an acute disease that arises as an
instant impact of continues smoke exposure. The wider the

16
 exposure to smoke, ARI incidence in the exposed smoke area
is higher (Jhariya & Raj, 2020).
Fire is also effect on biomass and carbon accumulation by
directly reduce biomass and carbon stored in seasonally dry
tropical forests. Fire has influenced composition, structure and
landscape patterns of animal habitat. Wildlife may be affected
by fire both through direct mortality or habitat alteration. Some
fires alter the vegetation structure of forest, which is work as
shelter and hiding cover for wild-animals and vegetation
structure spatially arranged all the resource needed to live and
reproduce. Wildfire impacts includes total acres burned, cost of
fire suppression, damage to homes and structures, alteration of
wildlife habitat, damage to watersheds and water supply,
damage to public recreation facilities, evacuation of adjacent
communities, tourism impacts, damage to timber resources,
destruction of cultural and archaeological sites, costs of
rehabilitation and restoration, public health impacts,
transportation impacts (Jhariya & Raj, 2020)

j. What are the legal foundation of burning forest?

Answer :
1. KUHP Article 187 “Who deliberately causes fire, explosion
of floods is threatened with Punishment”
2. KUHP Article 188 “Whoever by mistake causes a fire,
explosion or flood, shall be threatened with punishment”
3. And also regulated in the PPLH Law Number 32 of 2009
(Law on Environmental Protection and Management).

k. What are the reqruirement for clean water?

l. What are the reqruirement for a healthy latrine?
Answer :

17
 According to the Peraturan Menteri Kesehatan No. 3 Tahun
2014 Tentang Sanitasi Total Berbasis Masyarakat Jamban
Sehat Efektif Untuk Memutus Mata Rantai Penularan Penyakit
in Depkes RI (2004), there are several requirements for healthy
latrines, including:
1. Do not pollute drinking water sources, the location of the
collecting holes is 10-15 meters from drinking water
sources.
2. It is odorless and the feces cannot be touched by insects or
mice.
3. It is wide enough and sloping towards the squatting hole
so that it does not contaminate the surrounding soil.
4. Easy to clean and safe to use.
5. Equipped with protective walls and roofs, waterproof and
colored walls.
6. Enough lighting.
7. Watertight floors.
8. Good ventilation.
9. Water and cleaning tools are available.
Depkes RI. 2004. Syarat-syarat Jamban Sehat. Jakarta:
Departemen Kesehatan RI.

m. What disease can cause by polluted air?

2. Dr. Susi has only worked for one year at the Puskesmas Bahagia,
where she received a report from the Puskesmas surveillance staff that
the incidence of diarrhea cases had doubled from the previous month,
while from data of the top ten diseases, acute respiratory infection
(ARI) was ranked first. Dr. Susi is going to conduct an
epidemiological investigation of diarrhea and provide counseling on
cases of infectious diseases.

18
a. What are meaning the incidence of diarrhea cases had doubled
from the previous month, while from data of the top ten
diseases?
Answer :
This means that there may have been an outbreak of diarrhea in
the area. An outbreak is an increase in the incidence of
pain/death, which extends rapidly in both the number of cases
and the extent of the disease area, and can wreak havoc.
b. What are assignment of the surveillance staff?
Answer :
The field of disease prevention and control has the main task of
carrying out some of the duties of the head of the health office
in the fields of epidemiological surveillance and immunization,
prevention and control of infectious diseases and mental health
as well as carrying out other tasks assigned by the head of the
health department.= kayakny ini bukan jawabanny
(tugas pokok dan fungsi dinkes temanggung)
c. What are are the duty and function of surveillance?
d. What is the meaning Acute Respiratory infections (ARIs) is in
the first rank from the data on the top ten disease?
Answer :
The meaning is that ARI is a disease with the highest
prevalence in the area. The meaning that Acute Respiratory
Infections (ARI) is in the first rank, is an increase in the
prevalence of Acute Respiratory Infections (ARI) cases.
e. What causes the increased incidence of disease?
f. What is incidence, prevalence, propotion, endemic, pandemic,
of disease?
Answer :

19
 Incidence: incidence is the number of new cases of a disease
found in a population of at-risk individuals during a certain
time interval
Prevalence: Prevalence is the number of cases of a disease in a
population at a time, as a proportion of the total number of
people in that population. As such, this measure can be thought
of as the frequency of disease in a population at any given time
and that is why it is sometimes referred to as point prevalence.
Ratio: Comparison of two values (a value divided by another
value)
Proportion: A special form of ratio, where the value of the
numerator is a subset of the denominator
Endemic: Endemic is a disease that appears and becomes
characteristic in certain areas, for example malaria in Papua.
Another example of disease in Indonesia is Dengue
Hemorrhagic Fever (DHF). This disease will always exist in
the area, but with a low frequency or number of cases.
Pandemic: A pandemic is a disease outbreak that occurs
simultaneously everywhere, covering a wide geographical area
(all countries/continents). In other words, this disease has
become a common problem for all citizens of the world.
Examples of pandemic diseases: HIV/AIDS and COVID-19.
Influenza was once a pandemic category disease and spread
throughout the world.
Arias E, Anderson RN, Kung H-C, Murphy SL, Kochanek KD. 2003. Deaths:
final data for 2001. National vital statistics reports; vol. 52 no. 3.
Hyattsville, Maryland: National Center for Health Statistics, 9:30–3.

g. How is the transmition of ARI in this case?

Answer :

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 Respiratory infections can be transmitted by direct contact,
infection from surface particles, or inhaling infectious viral
particles. Young children may serve as the reservoir of these
infections, passing infection to one another at school and into
homes. URIs are thought to spread when infected people
cough, sneeze, or rub secretions onto their hands. They then
pass the disease to others who infect themselves when they rub
their eyes or touch their noses or mouths. Infected people may
also sneeze or cough infected droplets into the air. The droplets
can then land directly on other people’s mucous membranes or
on surfaces (such as toys) mouthed by others. Secretions
generally lose their infectivity if allowed to dry, but they can
stay infectious for hours or even days on skin, nylon, and
surfaces such as stainless steel and Formica (Cold, n.d.)

h. How is the transmition of diarrhea in this case ?

i. What is the criteria of KLB (kejadian luar biasa)?
Answer:
An area can be declared in an extraordinary situation if it meets
one of the following criteria:
a. The emergence of a certain infectious disease as referred to
in Article 4 which previously did not exist or was not known in
an area.
b. Continuous increase in the incidence of pain for 3 (three)
consecutive hours, days or weeks according to the type of
disease.
c. An increase in the incidence of pain two or more times
compared to the previous period in the period of hours, days or
weeks by type
the disease.

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 d. The number of new patients in a period of 1 (one) month
showed an increase of two or more times compared to the
average number per month in the previous year.
e. The average number of cases of illness per month for 1 (one)
year shows an increase of two or more times compared to the
average
number of cases of illness per month in the previous year.
f. The case fatality rate of a disease (Case Fatality Rate) in a
certain period of time shows an increase of 50% (fifty percent)
or more compared to the case fatality rate of a disease in the
previous period in the same period.
g. The proportion of disease (Proportional Rate) of new
patients in one period shows an increase of two or more times
compared to the previous period in the same period.

(PERATURAN MENTERI KESEHATAN REPUBLIK

INDONESIA NOMOR 1501/MENKES/PER/X/2010)

j. What is the purpose of the Epidemiological Investigation

Action in an effort to control the epidemic?
k. What kind of of the Epidemiological Investigation?
Answer :
Epidemiological investigations are investigations carried out to
identify the nature of the causes, sources and modes of
transmission as well as the factors that can influence the onset
of an outbreak (Peraturan Menteri Kesehatan Republik
Indonesia Nomor 1501/MENKES/PER/X/2010 Tentang Jenis
Penyakit Menular Tertentu yang dapat Menimbulkan Wabah
dan Upaya Penanggulangan).
Epidemiology is the science that knows about the distribution
of disease and its determinants in humans. The distribution of
the disease can be described according to the factors of the
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 person (age, sex, race), place (geographic spread), and time,
while the assessment determines information about the
distribution pattern of the disease according to the factors that
cause it (Harlan, 2008).
According to the method of investigation used, epidemiology
is divided into (Harlan, 2008):
1. Descriptive epidemiology: studying the events and
distribution of disease.
2. Analytical epidemiology: studying the factors that
influence the distribution of disease (its 'determinants').
In this case, descriptive epidemiological research can be used,
because it will examine the incidence and distribution of
Hepatitis A, whose cases have doubled from the previous
month and Acute Respiratory Infection (ARI) which ranks first
in the top ten disease data
l. How is the process on the epidemiological investigations?
Answer :
According to Tutiany (2017), the process on the
epidemiological investigations are :
1. Preparation for Field Investigation
2. Ensuring an Outbreak
3. Confirm the diagnosis
4. Create a case definition
5. Find and count Cases
6. Descriptive epidemiology (time, place, people)
7. Make a hypothesis
8. Assessing hypotheses
9. Refine hypotheses and conduct additional research
10. Implement control and prevention
11. Deliver the results of the investigation / Outbreak Report
m. What are the triangle epidemiology in this case?

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 n. What are the methods measuring epidemiology?
Answer :
Definition of ratio
A ratio is the relative magnitude of two quantities or a comparison of
any two values. It is calculated by dividing one interval- or ratio-scale
variable by the other. The numerator and denominator need not be
related. Therefore, one could compare apples with oranges or apples
with number of physician visits.
Method for calculating a ratio
Number or rate of events, items, persons, etc. in one group

Number or rate of events, items, persons, etc. in another group

After the numerator is divided by the denominator, the result is often
expressed as the result “to one” or written as the result “:1.”
Note that in certain ratios, the numerator and denominator are
different categories of the same variable, such as males and females,
or persons 20–29 years and 30–39 years of age. In other ratios, the
numerator and denominator are completely different variables, such as
the number of hospitals in a city and the size of the population living
in that city.
Prevalence 
The measure of disease frequency we have calculated is the
prevalence, that is, the proportion of the population that has disease at
a particular time. Prevalence indicates the probability that a member
of the population has a given condition at a point in time. It is,
therefore, a way of assessing the overall burden of disease in the
population, so it is a useful measure for administrators when assessing
the need for services or treatment facilities.
Proportion
Definition of proportion

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A proportion is the comparison of a part to the whole. It is a type of
ratio in which the numerator is included in the denominator. You
might use a proportion to describe what fraction of clinic patients
tested positive for HIV, or what percentage of the population is
younger than 25 years of age. A proportion may be expressed as a
decimal, a fraction, or a percentage.
Method for calculating a proportion
Number of persons or events with A particular characteristic 
× 10  n
Total number of persons or events, of which the numerator is a subset
For a proportion, 10n is usually 100 (or n = 2) and is often expressed
as a percentage.
Rate
Definition of rate
In epidemiology, a rate is a measure of the frequency with which an
event occurs in a defined population over a specified period of time.
Because rates put disease frequency in the perspective of the size of
the population, rates are particularly useful for comparing disease
frequency in different locations, at different times, or among different
groups of persons with potentially different sized populations; that is,
a rate is a measure of risk.
Several epidemiological measures of rate are:
a. Crude Death Rate (CDR)
b. Mortality Rate by Age Group (ASDR)
c. Death rate due to certain diseases (CSDR)
d. Case Fatality Rate (CFR) = Number of deaths / Number of cases x
100%.
Incidence
Incidence Rate or IR is the number of new cases in a given time
period divided by the population at risk at the same time x constant.

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 Incidence in a short, limited period (epidemic) is called: Attack Rate
(in percent).
(Arias et al., 2001).
o. How to good and correct counseling methods?

3. What is the Islamic view in this case?

QS Yunus 11
Anbiy
2.8 Hypothesis
Dr. Susi will conduct an epidemiological investigation on diarrheal diseases
that have increased 2-fold from the previous month and conduct counseling on
infectious diseases, namely ARI which is ranked first because of air and water
pollution.

Dr. Susi akan melakukan penyelidikan epidemiologi deskriptif terhadap penyakit diare dan
melakukan penyuluhan terhadap penyakit menular karena terjadinya wabah diare dan prevalensi
ARI yang menduduki peringkat pertama akibat polusi udara dan air.

dr. Susi will conduct a descriptive epidemiological investigation of diarrheal and

provide counseling about cases of infectious diseases due to the outbreaks of
diarrheal cases and the prevalence of ARI is in the first rank caused by air and
water pollution.

2.9 Conceptual Framework

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Penyebaran covid-19 semakin
meningkat

Upaya pencegahan

Promosi Kesehatan

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