The World Health Organization (WHO, 2014) over the world every year more than 800 mothers die during pregnancy or maternity every day. Based on the Indonesian Health Demographic Survey (2017), the average maternal mortality rate (MMR) was recorded at 309 per 100 thousand live births. This death rate is higher than the results of the 2007 IDHS which reached 228 per 100 thousand live births (Ministry of Health, 2013). One of the efforts made by the government in suppressing AKI is to provide antenatal care during pregnancy provided through pregnancy care standards, including identifying pregnant women by making home visits and interacting with the community regularly for counseling and motivation for early and regular examinations (Dewi & Musfiroh, 2013).
Coverage K1 is the coverage of pregnant women who get antenatal care according to the standard for the first time during pregnancy and does not depend on gestational age (K1) consisting of pure K1 (first pregnancy visit with 0-12 weeks gestation) while K1 contact is the first visit through from 12 weeks' gestation, while coverage of K4 pregnant women's visits is the coverage of pregnant women who have received antenatal care according to the standard at least 4 times in one work area at a certain time period. Pregnant women are advised to carry out antenatal supervision at least 4 times, namely once in the first trimester, once in the second trimester, and twice in the third trimester (Romauli, 2011). Antenatal Care (ANC) is a pregnancy examination to optimize the physical mental health of pregnant women so that they are able to face childbirth, during puerperium, preparation for breastfeeding and the return of reproductive health naturally to reduce maternal mortality. Antenatal care services can detect complications in pregnancy and childbirth (Candra, 2013).
Data from the Ministry of Health based on the results of the National Basic Health Research (Riskesdas, 2010) coverage of K1 in 2010 was 95.26% and K4 coverage was 85.56%. The amount is still less than the national target, namely 100% K1 and 95% K4 coverage. Whereas in the National Basic Health Research (Riskesdas, 2013) data, 95.4% of pregnancy examinations (K1) and pregnancy frequency of at least 4 times during pregnancy were 83.5%. The ideal K1 coverage nationally is 81.6% with the lowest coverage in Papua (56.3%) and the highest in Bali (90.3%). National K4 coverage is 70.4%. The difference between ideal K1 coverage and K4 nationally shows that 12% of mothers who receive ideal K1 do not continue ANC according to the minimum standard (K4).
Report of the West Papua Provincial Health Office (2016), in 2014 K1 coverage was 58.1% and K4 was 33.6%, while in 2015 K1 coverage was 56% and K4 was 24%. While the 2015 Manokwari District Health Office Data K1 coverage is 111% and K4 is 49.4%. In 2016 K1 coverage was 118.3% and K4 was 45.3% and in 2017 K1 coverage was 91% and K4 was 45%. This shows that the target of ANC coverage in 2017 experienced a decline in K1 and K4 which was not reached according to the 95% standard (Manokwari District Health Office, 2017). Based on Local Area Monitoring (PWS) data in Sanggeng Health Center, Manokwari Regency in 2015 K1 coverage was 94.3% and K4 was 69.8%, in 2016 K1 coverage was 23.7% and K4 was 14.9%, in 2017 coverage K1 is 77% and K4 is 24%. Local Area Monitoring Data (PWS) declined in all three puskesmas, especially K4, and was the lowest of 23 Puskesmas in Manokwari District. So that is the reason for researchers to conduct research at the Sanggeng Health Center.
Increasing antenatal health services is affected by the use of antenatal services. With no use of antenatal care facilities can be caused by many factors such as inability in terms of costs and location of services that are too far away (Prawirohardjo, 2012).
In accordance with the above problems, the researcher was interested in conducting a study entitled 'Factors that influence K4 visits at Sanggeng Health Center, Manokwari Regency, West Papua Province'.
Material and method
Types and Design of Research
This research is a quantitative descriptive study with a cross sectional study design. The cross sectional study is an epidemiological study design that studies variables including risk factors and variables including effects observed at the same time (Notoatmodjo, 2012).
Time and Location of Research
The study was conducted at the Sanggeng Health Center in Manokwari Regency. The reasons for choosing this Puskesmas as a place of research are:
- Low coverage and K4 from year to year are getting lower.
- No research has been conducted on K4 coverage at Sanggeng Community Health Center, Manokwari Regency.
Population and sample
Population
The population in this study were all pregnant women who visited in July to September 2018 in the Sanggeng Health Center as many as 606 pregnant women.
Samples
The sample is part of the number and characteristics possessed by the population (Sugiyono, 2013). The sample size in the study was 86
Physical Environmental Effects on the incidence of Dengue Hemorrhagic Fever
Physical environmental conditions such as types of containers or water reservoirs that are rarely drained, will be a breeding ground for mosquitoes. This can cause disease in humans if poor health behavior (Hidayat, 2011). Environment is everything that exists around humans that affects the development of human life both directly and indirectly. Environmental conditions have a major influence on the spread and transmission of dengue disease (Mufidah, 2012). The results of the study show that the physical environment of the respondents in Sorong City is generally 97% of the walls are made of cement cast, 62% install wire mesh on ventilation and 86% use the ceiling ceiling. The condition of the home page has 30% plant pots / flowers inundated and 32% stated that there were excavated trash cans to dispose of waste and 47% stated that there were water reservoirs outside the house, and 82% stated that there were sewerage and wastewater flowing with smoothly, so that it does not cause puddles as a breeding ground for mosquitoes. The physical condition of the respondents was 51.5% risky, that is, as much as 68.2% in the DHF case group while in the control group or not suffering from DHF as much as 38.6%. This shows that physical environmental conditions that are at risk of causing DHF.
The results of statistical tests stated that there were physical environmental influences on the incidence of Dengue Hemorrhagic Fever in Sorong City and the incidence of DHF in the physical environment of respondents who were at risk of 3,403 times compared to respondents with a non-risky physical environment.
This study is in line with Umaya (2013) who conducted research in the Talang Ubi Pendopo Health Center work area stating that poor physical environmental factors caused a risk of 4 times the incidence of DHF rather than good physical environmental factors. This is because physical environmental conditions cause mosquito nesting sites to breed. Poor physical environment conditions are very risky to the people around them because of the large number of mosquito populations so that people around them experience the bite of the Aedes aegypti mosquito.
Environmental sanitation is also one of the efforts to achieve a healthy environment through controlling physical environmental factors, especially those that have a detrimental impact on the physical development of health and human survival. Environmental sanitation business is a health effort that focuses on efforts to control physical environmental factors that might cause and cause harm in physical development, health and human survival (Notoatmodjo, 2011).
The physical environment of the house and the environment in the Sorong City area needs attention from local health agencies in controlling dengue fever, because this requires awareness of all elements of society to create healthy physical environmental conditions in preventing environmental-based diseases.
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Effect of the Social Environment on the incidence of Dengue Hemorrhagic Fever
Community habits that are detrimental to health and lack pay attention to environmental cleanliness such as hanging habits clothes, the habit of taking a nap that is not safe from the bite of the Aedes aegypti mosquito, does not clean the landfill regularly, low habits cleaning the yard, and also low community participation
especially in the context of eradicating mosquito nests (PSN), it will pose a risk of transmission of dengue transmission in the community. This habit will get worse where people find it difficult to get clean water, so they tend to store water in reservoirs or tubs, because the landfill is often not washed and cleaned regularly and eventually becomes a potential breeding place for Aedes aegypti mosquitoes (Zulkoni, 2011).
The social environmental conditions for respondents in Sorong City were as much as 47% at risk. This is due to 97% of residential and adjoining homes, 59% of the habit of families hanging clothes, lack of family habits cleaning the home environment (85%), lack of community participation in cleaning the drainage channels in the environment which causes water to not flow smoothly or inundated (68 %), there are 33% of ponds around the residence and 68% of them state the dirty environment of the residence and rarely even the presence of devotion in the local environment in the Eradication of Mosquito Nests (PSN).
Respondents in the DHF case group in the risky social environment were (68.2%) and not at risk (31.8%). This shows the risk of poor social environment causing high DHF sufferers. The results of statistical tests revealed the existence of social environmental influences on the incidence of Dengue Hemorrhagic Fever in Sorong City with a large risk of dengue incidence in the respondent's social environment by 3,750 times compared to respondents with a non-risky physical environment.
Research conducted by Purwanti (2013) revealed that the family social environment had an effect on the incidence of Dengue Fever. Socio-cultural environment conditions such as high population density will facilitate the occurrence of dengue virus infection, because densely populated areas will increase the number of incidents of dengue cases. In addition, the habit of hanging clothes made by families causes the nesting place of mosquitoes and the risk of transmitting dengue fever.
Social environmental conditions can be anticipated to prevent environmental-based diseases such as Dengue Hemorrhagic Fever with an active role in families that have a habit of maintaining environmental cleanliness and the community in the environment in maintaining cleanliness, especially at mosquito breeding sites. This needs support from health workers in overcoming social environmental problems by providing counseling regularly.
Effects of Knowledge on the incidence of Dengue Fever
Behavior based on knowledge will last more than behavior that is not based on knowledge. People will make efforts to Eradicate Mosquito Nests (PSN) to prevent DHF if they know what the goals and benefits are for health or their families and the danger of not doing the eradication (Ministry of Health, 2014). The respondent's knowledge about Dengue Hemorrhagic Fever disease was 57.6% well-informed and 42.4% lacked knowledge. This shows that the public's understanding of dengue fever is still low, especially in the causes of the transmission of dengue fever. In the DHF case group, there was 50% less knowledge and good knowledge (50%). The results of statistical tests stated that there was no effect of knowledge on the incidence of Dengue Hemorrhagic Fever in Sorong City and was not a risk factor for the incidence of Dengue Hemorrhagic Fever.
Research conducted by Novrita (2017) in Ogan Ilir District revealed that knowledge was not related to the incidence of Dengue Fever, because the knowledge of dengue fever mostly had good knowledge. According to the researchers' assumption that the absence of a knowledge relationship to the incidence of dengue hemorrhagic fever is a disease that often occurs in the community and the community generally knows about dengue fever, causes and prevention, but the questions given do not know how to transmit Dengue Fever, so community knowledge must be improved ... This is also expressed by Fentia (2017), that there is still an assumption in society that creates inappropriate behavior, such as; the assumption that DHF only occurs in slums and the eradication of mosquito nests (PSN) does not appear to be clear compared to fogging. This assumption is often overlooked, even though it greatly influences people's behavior in making decisions especially in the transmission of dengue (Fentia, 2017).
Effects of Attitudes on the incidence of Dengue Hemorrhagic Fever
According to Fishbein and Ajzen in Azwar (2013), that positive or negative attitudes formed in a person depend on whether or not there is a benefit from the knowledge component, the more benefits that are known to be the more positive attitudes that are formed. Respondents' responses to dengue hemorrhagic fever were mostly in the good category as much as 65.2% and less as much as 34.2%. The respondent's lack of attitude about Dengue Hemorrhagic Fever is that cleaning / draining the bath once a week does not affect the spread of dengue fever including storing hanging clothes. Besides that, the attitude response is lacking because they assume that supervision of mosquito larvae is not necessary and fogging is not effective in preventing dengue fever.
Attitude response in the DHF case group in respondents who behaved less as much as 54.5% and good attitude as many as 10 people 45.5%. The results of statistical tests stated that there was an attitude effect on the incidence of Dengue Hemorrhagic Fever in Sorong City and the risk of attitude was less when viewed from OR = 3.600; CI95% (1,221 - 10,618) which is interpreted that the attitude of respondents who are less likely to be at risk with the incidence of DHF is 3,600 times compared to respondents who have a good attitude. This study is in line with what was done previously by Suyasa (2016), that the attitude influences the incidence of dengue fever because the attitude that does not support causes low enthusiasm and motivation in doing prevention of Dengue Hemorrhagic Fever. The attitude of respondents in the city of Sorong to drain water storage was not accompanied by awareness as an action to remove the larvae of Aedes aegypti mosquitoes, but more towards poor physical conditions of water. In people who lack 3 M (Drain, Close and Bury) water storage areas and do not improve sanitation and physical condition of houses in the use of wire mesh and habits not cleaning the environment have a high risk of developing Dengue Hemorrhagic Fever and presumption, which important is not the family itself who has Dengue Fever even though it is known that mosquitoes do not recognize social status and other attributes so that the attitudes and actions taken will be different in responding to the prevention of Dengue Fever.
There is still the attitude of the people who are less concerned with the disease of Dengue Hemorrhagic Fever in Sorong City, so they will be at risk of developing dengue disease which tends to cause outbreaks (extraordinary events). Attitude awareness efforts are an effort to raise awareness of the belief as the underlying aspect, so that awareness of anyone if it is not successful will have the same risk of developing Dengue Hemorrhagic Fever. When the house and the environment are clean, but family members can be bitten by mosquitoes when schooling and so on
Effect of Actions on the incidence of Dengue Hemorrhagic Fever
Every reported DHF sufferer is treated with patient care, epidemiological investigations in the field, and control efforts. The high rate of dengue morbidity is caused by an unstable climate and quite high rainfall in the rainy season which is a potential breeding tool for Aedes aegypti mosquitoes (Ministry of Health, 2014).
Dengue Hemorrhagic Fever Case, the right method to prevent DHF is the Eradication of Mosquito Nests (3M) through 3M plus (draining, closing and burying) plus other activities that can prevent or eradicate mosquitoes Aedes aegypti breed, including the use of wire netting, using mosquito repellent lotion, and using mosquito nets and this requires community participation in acting to prevent blood emam (Republic of Indonesia Ministry of Health, 2014).
The actions of respondents who were good at doing prevention of Dengue Hemorrhagic Fever as much as 60.6% and less action as much as 39.4%. The respondent's actions were lacking, from the respondent's answer about the habit of throwing or burying water reservoirs such as cans, jars, unused used tires as much as 74%, cleaning the sewerage channel as much as 89% and periodically preventing mosquito breeding as much as 71% . This shows that the core actions in the prevention of dengue fever are still low. Respondents whose actions were lacking in the DHF cases group were 63.6% and good actions were 27.3%. This shows that while there is less action, the higher the incidence of DHF. The results of statistical tests stated that there was an effect of action on the incidence of Dengue Hemorrhagic Fever in Sorong City and the risk of the actions of respondents who were less risky with the incidence of DHF was 3.600 times compared to respondents who had good actions.
Some family actions in Sorong City still tend to be unclean, causing the breeding of Aedes aegypti mosquitoes, where in 2016 as many as 46 cases and in 2017 as many as 37 cases this was due to family actions that many still hung clothes, there were water shelters that were not closed , and the bath is rarely drained, a habit like this must be corrected to anticipate the occurrence of dengue disease.
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