File: P/Wlkt mkl Bangkok

TB PERSPECTIVE At North Jakarta Municipal Administrationin connection with Global Climate Change

By. M. Effendi Anas

. The accurate prediction of scientist on negative effect of global warming

. The occurrence of uncertain world climate

. Severe flood in Jakarta year 2004 & 2007 inundated 50-65% of Jakarta area …> activities paralyzed

On the field of farming. The farmers have difficulties to predict when the

harvest season is ?. In Indonesia year 2003, 43.000 Ha paddy field was

hit by flood, and the drought as wide as 21.705 Ha

On the field of fishery . The increase temperature of sea water…> coral

reef was damaged. The damage of coral reef ….> plankton

disappears ….> fish food chain was disturbed …..> fish population was decreasing ……> the result of fisherman was decreasing.

North Jakarta Municipal Administration . The increasing of temperature …>ice melted on

the poles ….> The sea level rose ….> threaten coastal area ….> flood

The spread of disease . The increasing of temperature …> incubation of

mosquito growth shortened ….> the increasing of mosquito population ….> the increasing of DHF, malaria

TBC disease . In Indonesia …> 1 -2 sufferer per 1.000 population. The third cause of the death after cardiovascular, upper

respiratory system infection . In Jakarta ….> priority program since 2001. Tend to increase ….>year 2003 (2.589 cases), year 2004

(3.437 cases), year 2005 (4.169 cases), year 2006 (4.653 cases).

. Climate change ….> affect to the increasing of TB …..> it was worsened by geographical location of north Jakarta ….> many slum areas, prone to flood, many people resided in unhealthy housing residence.

. Topography of North Jakarta ….> lower land area 0 – 2 M from the sea level …..> as estuary 13 rivers

. Climate change ….> prone to flood as the sea level rises .…> Can increase humidity ….> the appropriate

temperature for the growth of TB Bacteria. ….> prolonged dry season ..> increase air

pollution (dust) ..> Bacteria grow on the dust …> prone to

the transmission of the disease

NORTH JAKARTA NORTH JAKARTA NORTH JAKARTA BORDER• NORTH : KEP.SERIBU (THOUSAND ISLAND)• WEST : WEST JAKARTA BARAT AND TANGERANG• SOUTH : CENTRAL JAKARTA , EAST JAKARTA & WEST

JAKARTA • EAST : EAST JAKARTA AND BEKASI

SUB DISTRICTS : 6VILLAGES : 31HAMLETS : 414NEIGHBORHOODS :

4.746

HOSPITALS : 16SUB DISTRICT PHC : 6VILLAGE PHC : 42

THE POPULATION OF NORTH JAKARTA 2006 :

1.173.935 PEOPLE , THE WIDTH 142.3 Km2

. Topography of North Jakarta ….> lower land area 0 – 2 M from the sea level …..> as estuary 13 rivers

. Climate change ….> prone to flood as the sea level rises .…> Can increase humidity ….> the appropriate

temperature for the growth of TB Bacteria. ….> prolonged dry season ..> increase air pollution

(dust) ..> Bacteria grow on the dust …> prone to the

transmission of the disease . Climate change worsens the quality of environment

…….>bacteria grow……>the case is increasing.

INDICATOR OF ENVIRONMENTAL HEALTH

Aspects Result standard

1. Permanent house : 70.4 % : 95.0 %2. House and occupancy rate : 34.6 % : 5.0 %3. House and ventilation : 68.1 % : 95.0 %4. House and the light : 74.4 % : 95.0 %5. House and plantation : 62.3 % : 75.0 % Survey .2003)

. Prevention approach ….> Host intervention - Agent ….> CDR …> searching of sufferer …> in Jakarta target up to 2006 is 70%, North Jakarta has

reached the target .…> DOTS …> short term medication by inspection ….> Indicator is CR /cure rate ….> In north jakarta ….> CR 2006 was 63.9 % >> still under target which was 85% .…> DOTS evaluation (year 2006) ..> CR was 63.9

%, complete medication 17.5% ….> 10.4%

neglected /DO ..> 7 % migrate ..> 0.9% died ..>0.2% fail

THE DATA OF HEALTH FASILITIES IN

NORTH JAKARTA MUNICIPAL ADM.

NO SUB DISTRICTS

INTEG

RA

TED

HEA

LTH

PO

ST

HEALTH FASCILITIES

Expl

PH

C

clinics

hosp

itals

pra

ctitioners

mid

wife

Priv

ate

mate

rnity

hosp

.

HOSPITAL

1 PENJARINGAN 73 7 0 4 220 7 5 4  

2 PADEMANGAN 33 5 0 0 60 35 4 0  

3 TG. PRIOK 132 14 1 7 222 45 4 7  

4 K O J A 85 8 8 2 120 47 7 2  

5 KLP. GADING 29 4 1 2 160 12 1 2  

6 CILINCING 164 10 2 1 70 6 2 1  

TOTAL 516 48 12 16 852 152 23 16  

. DOTS APPROACH …> supported by all Health Facilities in North Jakarta

….> Networking …> medicating and reporting on the same place

.…> Internal networking …> all units from Health service division.

handle TB sufferer by DOTS .…> External networking …> all units from Health

Service division coordinate with Public Health Division.

. DOTS …> supported by LABORATORY…> as referral for recovered sufferer, fail …> Verify germ Resistance against drugs.

. IDEALLY …> TBC Prevention should be comprehensive ….> consider environmental aspect. …..> the theory of Biology law (John Gardon) and the theory of - Health Status (HL. Blum)

. Climate change …> can change strengths and weaknesses of environmental factors effecting the growth of TB bacteria …> the significant influence is the increasing of case prevalence

. Harmonization …> TB prevention approach by Jakarta Province Health Dept. / Public Health Sub Division from North Jakarta Municipal Administration

- with, . Infrastructural development …> physical aspect ..> Long term : Infrastructure; realization of BKT (East canal flood

project), Healthy storey house (Rusunawa 1000 towers), slum area management , re plantation at RTH (Green space management), Reclamation & management of coastal area by planting mangrove

..> Mid term : build secondary and tertiary networking, prepare urban drainage system, relocate slum housing under toll road.

build Voder (water canal) & provide water pump, consistent space management, etc

…> short term : residential area managemen, renovation TB suferrer’s house, Put TB suferrer into storey house, etc

. Climate change …> can hamper the objective of TB prevention program either in the environmental perspective or the approach of TB prevention prgram by Jakarta Province Health Dept or North Jakarta Municipal Administration.

. Climate change …> can hamper the achievement of MDG’S commitment declared by 180 countries which is reduce poverty and world retardation

. Climate change brings into bad effects on Health Program

. The effects on health program : …>hamper the succes of Communicable disease control program.

. We supprot the action of efforts to curb green house effect. …>reduce the use of chemical substances effecting the depletion of ozone layer.

. We are ready to cooperate in responding the effects of global warming.

POPULATION PER SUB DISTRICT

PENJARINGAN : 176.586 PEOPLE PADEMANGAN : 121.839 PEOPLE TANJUNG PRIOK : 311.440PEOPLE K O J A : 221.631 PEOPLE KLP. GADING : 105.699 PEOPLE CILINCING : 236.740PEOPLE

---------------------------North JAKARTA 1.173.935 PEOPLE

1.952

2.355

2.639

1809

1.111

1.485

1.814

2.014

1472

1.478

0 1.000 2.000 3.000 4.000 5.000

TH 2003

2.004

2.005

2.006

2007

MALE FEMALE

THE NUMBER OF TB SUFERRERS BY GENDERNORTH JAKARTA

YEAR 2003 UP TO SEPT 2007

910

1.159

1.242

896

1.026

1.205

1.351

1.463

997

523

879

1134

1326

936

43

63

5615

594

92

37

6

8

13

19

0 500 1.000 1.500 2.000 2.500 3.000 3.500 4.000 4.500

TH 2003

TH 2004

TH 2005

TH 2006

TH 2007

BTA POS BTA NEG CHILDREN RECURE EXTRA PARU

THE NUMBER OF TB SUFERRER IN NORTH JAKARTA YEAR 2003 UP TO Sept 2007

92.6 87.572.6

31.516.5

92.0105.6

0.0

20.0

40.0

60.0

80.0

100.0

120.0

PADEMANGAN

CILINCING

KOJA

TG PRIOK

PENJARINGANKLP GADING

JAK UTR

CDR OF TB SUFERRERS (+ SPUTUM SMEAR) IN NORTH JAKARTA

YEAR 2006

Target 70%

79.4

57.6 55.7

37.117.7

64.1

102.0

0.0

20.0

40.0

60.0

80.0

100.0

120.0

PADEMANGAN

CILINCINGTG PRIOK

KOJA

PENJARINGANKLP GADING

JAK UTR

CDR OF PULMONARY TB SUFERRERS (+ SPUTUM SMEAR) IN NORTH JAKARTA

JANUARY - SEPTEMBER 2007

Target 70%

26.9 29.2 34.3

67.2

91.5 92.0

64.1

26.2

0

10

20

30

40

50

60

70

80

90

100

TH2000 TH2001 TH2002 TH2003 TH2004 TH2005 TH2006 TH2007

CDR OF PULMONARY TB SUFERRERS (+ SPUTUM SMEAR) IN NORTH JAKARTA

YEAR 2000 UP TO SEPT 2007

Target 70%

80.074.5 73.4 72.7 70.3 68.1 68.1

56.8

7.4

70

83.8

0.0

20.0

40.0

60.0

80.0

100.0

KOJA TG PRIOKPENJARINGANPADEMANGANKLP GADINGYSA CILINCINGHOPE

RSI

SUKAPURARSU KOJAJU

PULMONARY TB SUFERRERS (+ SPUTUM SMEAR) 2OO6EXPERIENCING CONVERSION IN NORTH JAKARTA

Target 80%

82.0 84.975.2

64.2 68.5 70.078.6

0

10

20

30

40

50

60

70

80

90

TH 2000 TH 2001 TH 2002 TH 2003 TH 2004 TH 2005 TH 2006

CONVERSION OF TB (+SPUTUM SMEAR)IN NORTH JAKARTA

YEAR 2000 UP TO 2006

Target 80%

RECOVERED TB SUFERRERS (+ SPUTUM SMEAR)RECOVERED TB SUFERRERS (+ SPUTUM SMEAR)IN NORTH JAKARTA IN NORTH JAKARTA

73.3 70.064.6 66.7

73.8 76.3

52.243.3

0.0

63.9

77.4

0.0

20.0

40.0

60.0

80.0

100.0

KOJA TG. PRIOKCILINCINGHOPE YSA PENJARINGANPADEMANGANKLP GADING

RSI

SUKAPURARS KOJAJAK UTR

Target 85%

72.1

57.7

70.3

59.7 63.967.2

0

10

20

30

40

50

60

70

80

TH 2000 TH 2001 TH 2002 TH 2003 TH 2004 TH 2006

CR OF PULMONARY TB (+SPUTUM SMEAR) IN NORTH JAKARTA

YEAR 2000 - 2006

Target 85%

2.589

3.437 3.594 3.281

4.653

1.888

0

500

1.000

1.500

2.000

2.500

3.000

3.500

4.000

4.500

5.000

YEAR 2002YEAR 2003YEAR 2004YEAR 2005YEAR 2006YEAR 2007

TB CASES FOUND AND MEDICATED AT PUBLIC HEALTH CENTERIN NORTH JAKARTA

YEAR 2002 - SEPT 2007

17,5

10,4 7,0 0,9 0,2

63,9

0,0

10,0

20,0

30,0

40,0

50,0

60,0

70,0

RECOVERED COMPL MED NEGLECTED MIGRATE DIED FAILED

EVALUATION OF TB SUFERRERS (+SPUTUM SMEAR)IN NORTH JAKARTA

YEAR 2006

The flow of diagnose of TB patient in hospital

Microbilology Lab.General clinic

Patient

Pharmacy

DOTS Unit Hospital

Other HealthService units

Specialist clinic

Emergency unit Patology clinic

Radiology

Medical Record

Promotion services

Treatment

The flow of implementation

Patients

Anamnesis,PF,Sputum 3x,Ro,Lab

TB Diagnose Therapy Kat.I,II,III

Follow up every 2 weeks

Control Control late 2 days

Hospital call supervisor

Supervisor call PHCOn the same day

House visitThe following day

Feedback

THE REFERRAL SYSTEM FOR TB PATIENTS

HospitalPublic Health

Center

coordinator HDL at Sub

district

Patient, Anti TB drug , TB.01, referral letter

(TB.09)

TB Supervisor Sub district

informconfirm

(TB.09)