INTRODUCTION
Public housing in Indonesia still faces several unsettled issues these past years, especially that associated with environment health quality. In Indonesia, the governments has launched several programs to reduce the incident rate for each disease yet many of those programs still haven’t meet great result until today. “10 patterns of infectious diseases“ is a list consists of 10 most common and infectious diseases spread among Indonesian caused by poor environment’s quality acccording to latest surveys conducted in chosen health facilities. Some diseases are caused by microbe in the poor indoor air quality, bacteria brought by animals who live in the slump area, unhyegenic foods, virus, and also the unhealthy lifestyle among residents.
NO
Disease
Total Case in Indonesia
1
Accute Respiratory Infection (ARI) (non-Pneumonia)
63,031,115
2
Diarrhea
8,713,537
3
Pneumonia
657,490
4
Malaria
252,027
5
Tuberculosis (TB)
176,677
6
Dengue Fever
100,347
7
Leprosy
16,131
8
Measles
12,943
9
AIDS
5,494
10
Leptospirosis
519
(Source: Indonesia’s Annual Health Report by Indonesian Public Health Office (Dinkes))
HOST
Living in a substandard housing may creates a variety of health risks including an AGENT increased risk of chronic disease, for extended periods of time (Krieger 2002; Ruel 2010). An outbreaks of infectious diseases is caused by the interrelationship of bacteria/microbe as the ‘agent’, humans as the ‘host’, and environment quality (Gordon 1916). The quality of one of these parameters could affect the quality of other parameters. In other words, a physical environment –which consists of houses as well as its surrounding environment– with bad quality and poor human health quality may enhance the likelihood of a disease in human ENVIRONMENT settlement. (Source: John Gordon’s Epidemiology Triangle Theory)
Public Health in Indonesia Residential Environment Indonesia has 125-299 cases per 100,000 population per-year. USAID’s TB Care I also added that total 302,861 all TB cases and 296,272 new TB cases reported in 2010. These facts bring Indonesia as a country with third highest tuberculosis burden which majority occured in rural area.
FIGURE 1. World’s TB Incidence Rate in 2013
ANGGANA FITRI SATWIKASARI, LILY TAMBUNAN, ALLIS NURDINI | Bandung Institute of Technology | e:
[email protected] This research aim to explore and find the impact of some indicators and variables divided as physical and non-physical environment factors which are affecting the occupant’s health, in this case it will be measured with the tuberculosis status. According to similar prior studies, there are some variables consist in physical factor which are known to have a close relationship with the occupant’s TB status are residential density, daylighting, ventilation quality, humidity and temperature, as well as the building material (Adrial 2006; Supriyono 2003; Dahlan 2001; Rochendy 2002; Sugiarto 2004; Budiyono 2003; Kustijadi 2001; AH Mahpudin 2006; Mareta 2013; Didik 2003; TL Tobing, 2009). Whereas the indicators consists as non-physical factor are nutritional status, lifestyle, sociodemographic factors, history of contact with people with TB, and history of comorbidities (Adrial 2006; Sugiarto 2004; Tobias 2009; Seren 2010; Sudarsono 2014).
FIGURE 2.TB Incidence Rate between 1990-2010 in Indonesia per 100.000 population
Table 1. Indicators & Variables Affecting Tuberculosis Prevalence in Public Housing Based on Prior Researchs FACTOR VARIABLES INDICATOR
Physical (House & Environment)
Non-Physical (Human’s Heallth)
1. Residential Density 2. Ventilation 3. Daylighting 4. Temperature 5. Humidity 6. Building Material Quality 1. Age 2. Sexuality 3. Contacts with TB Patients 4. Lifestyle
Area per-person Ventilation Area Daylighting Intensity in a room Actual Temperature Actual Humidity Floor&Wall’s Material Type
-Smoking -Floor cleaning routine -Mosquito Coils usage -Firewood usage to cook
5. Humidity 6. Building Material Quality
REFERENCES
(2005). Public Health in Public Housing: Improving Health, Changing Lives. U.S. Department Of Health And Human Services Adrial (2006) . Hubungan Faktor Lingkungan Fisik Rumah Terhadap Kejadian TB Paru BTA+ di Kota Batam. Tesis Universitas Indonesia. Dinas Kesehatan Provinsi Jawa Tengah (2013). Buku Profil Kesehatan Provinsi Jawa Tengah Tahun 2012 Egan, Matt et al (2015). Neighbourhood demolition, relocation and health. A qualitative longitudinal study of housing-led urban regeneration in Glasgow, UK. Fatimah, Siti (2008) : Faktor Kesehatan Lingkungan Rumah yang Berhubungan dengan Kejadian TB Paru di Kabupaten Cilacap. Magister Kesehatan Lingkungan Universitas Diponegoro Semarang . Frias, Marco Mesa (2014). Quantifying Uncertainty in Health Impact Assessment: A Case-Study Example on Indoor Housing Ventilation. Environmental International Journal. Frick, Heinz (2006) : Arsitektur Ekologis. Penerbit Kanisius: Semarang. Frick, Heinz (2007) : Dasar-dasar Arsitektur Ekologis. Penerbit Kanisius: Semarang. Frick, Heinz (2008) : Ilmu Fisika Bangunan. Penerbit Kanisius: Semarang. Gochenour , Sharon J dan Andersen, Marilyne (2009) : Circadian Effects of Daylighting in a Residential Environment. In Proceedings LuxEuropa. Gordon, John. Linch, Charles (1916) : Bovine Tuberculosis. Hapsari, Dwi, et al (2013). Ten-Year Trend of Acute Respiratory Infection (ARI) and Diarrhea Diseases Based on Healthy Houses in Indonesia. Kadir, Abdul (2012) : Hubungan Aspek Fisiologis Rumah dengan Kejadian TB Paru di Wilayah Kerja Puskesmas Sambutan Tahun 2012. http://kadirsemantik.blogspot.com/2012/12/hubungan-aspek-fisiologis-rumahdengan.html (22/04/13) Kamali, Nehzat Jalal dan Abbas, Mohamed Yusoff (2011) : Healing Environment: Enhancing Nurses’ Performance through Proper Lighting Design. Centre for Environment-Behaviour Studies (cE-Bs) , Faculty of Architecture, Planning & Surveying (FAPS). Universiti Teknologi MARA (UiTM), Malaysia. Kamali, Nehzat Jalal dan Abbas, Mohamed Yusoff (2012) : Healing Environment: Enhancing Nurses’ Performance through Proper Lighting Design. Procedia - Social and Behavioral Sciences Journal vol. 35. Kementerian Kesehatan Republik Indonesia (2013). Data dan Informasi Tahun 2014: Profil Kesehatan Indonesia. Kim, Gon dan Kim, Jeong Tai (2010) : Healthy-daylighting design for the living environment in apartments in Korea. Building and Environment Journal vol. 45. Kinsler LE, Frey AR, Coppens AB, and Sander JV (2000). Fundamentals of Acoustics. JohnWiley & Sons, Inc. Fourth Edition. Kumar, Ranjit (2005) : Research Methodology. SAGE Publications Ltd: London. Lechner, Norbert (1991) : Heating, Cooling, Lighting. PT RajaGrafindo Persada: Jakarta. Lee, Tang G (1996) : Vital Signs. Health and the built environment: Indoor Air Quality. The Faculty of Environmental Design, The Universitu of Calgary: Canada Nurhidayah , Ikeu et al (2007) : Hubungan Antara Karakteristik Lingkungan Rumah Dengan Kejadian Tuberkulosis (Tb) Pada Anak Di Kecamatan Paseh Kabupaten Sumedang. Fakultas Ilmu Keperawatan Universitas Padjajaran Bandung. Rosiana, Anggie Mareta (2012) : Hubungan Antara Kondisi Fisik Rumah dengan Kejadian Tuberkulosis Paru. Unnes Journal of Public Health. Ruel, Erin et al (2010). Is Public Housing the Cause of Poor Healthor a Safety Net for the Unhealthy Poor?. New York: Journal of Urban Health. Ruel, Erin et al (2010). Is Public Housing the Cause of Poor Health or a Safety Net fir the Unhealthy Poor?. The New York Academy of Medicine. Setyowati, Erni; Setioko, Bambang (2013) : Buku Ajar Metodologi Riset dan Statistik, Metodologi Penelitian Kualitatif & Kuantitatif. UPT UNDIP Press Semarang. Statistik Perumahan dan Permukiman (2013). Badan Pusat Statistik (BPS) Indonesia Sugiarto, Agus (2004). Faktor-Faktor yang Mempengaruhi Kejadian TB Paru BTA pada Penghuni Rumah Kebun, Bengkulu. Tesis Universitas Indonesia Supriyono, Didik (2003). Lingkungan Fisik Rumah Sebagai Faktor Risiko Terjadinya Penyakit TB Paru BTA+ di Kabupaten Bogor. Tesis Universitas Indonesia. Suyatno. Studi Etnografi Terfokus pada Penyakit Tuberculosis di Kabupaten Kebumen Jawa Tengah . Thomson, Hilary. Thomas, Sian (2015). Developing empirically supported theories of change for housing investment and health. Social Science & Medicine Journal. Tobing, Tonny Lumban (2008). Pengaruh Perilaku Penderita TB Paru dan Kondisi Rumah Terhadap Pencegahan Potensi Penularan TB Paru pada Keluarga Di Kabupaten Tapanuli Utara. Sekolah Pascasarjana, Universitas Sumatera Utara Tobing, Tony Lumban (2008). Pengaruh Perilaku Penderita TB Paru dan Kondisi Rumah Terhadap Pencegahan Potensi Penularan TB Paru pada Keluarga di Kabupaten Tapanuli Utara. Tesis Universitas Sumatera Utara.
METHODS Ÿ 3 districts with the highest TB prevalence number
in Kebumen Regency were chosen as the research’s population. Ÿ The obtained data were later analysed through distributive, correlative, and regressive analytical methods. Ÿ TB prevalence data was classified into 3 categories that were adjusted to the type of data for each analysis process (table 2). Ÿ The indicators and variables which used for the assessment process are abstracted from Indonesian Government’s regulation, similar prior researchs (table 1), and interview with BP4 Kebumen’s staffs as the experts.
Table 2. New Indicators & Variables Affecting Tuberculosis Prevalence in Public Housing VARIABLES INDICATOR FACTOR 1. Residential Density
Area per-person Area-per-family Building Coverage Ratio
2. Building System
Ventilaton System - Ventilation Type, Size, Area, & Direction Daylighting - Daylighting Source Area & Factor Percentage - Windows-to-wall Ratio (WWR) Actual Humidity Actual Temperature Wall’s Material Type Floor’s Material Type
Physical (House) 3. Humidity & Temperature 4. Material Quality
Physical (Environment)
- the surrounding rural context may contribute to air contamination - the surrounding urban context may affect air quality - proximity to garbage dumpsters - nearby construction activities, - transportation activities near a building - industrial activities may pollute the air
TB Status
Non-Physical (Human’s Heallth)
- Duration of registered as patients in BP4 (month) - Percentage of TB patients in 1 house (%) - Duration of registered as patients in BP4 (3 categories; < 6 months, 6-12 months, > 12 months)
Medical Records
Medical history of chronical diseases (if any) Kind of chronical disease (if any)
Nutritional Status
Rapid Weight Loss
Lifestyle
- Smoking - Floor cleaning routine - Mosquito Coil Usage - Firewood usage - Outdoor Activities Duration
Physical contact with TB patients
- Number of other residents who share same bed with patients - Duration of physical contact with TB patient (> 12 hours)
RESULTS Ÿ The first set result from the analysis showed that 58% of the total TB patients in Kebumen are
male, 96% are > 20 years old, and 58% work as non-private jobs, in addition to housewives and farmers. Ÿ The majority of respondents do not have regular habits frequently found in similar case in other regions, but 66% of them do not go outdoor oftenly and 56% still intensively interact with other occupants. 98% of the residential use brick-wall, 70% has tiled and cement floors. Ÿ 92% houses have area per-person ≥ 10 m2 /individu, 90% has more than 60 m2 of land, 70% has KDB values ≥ 60%. As for ventilation and lighting indicators, the result shown that more than 60% of the buildings’ air intake openings percentage are below the standard, more than 70% of the houses don’t have proper lighting intensity which is ≥ 2%. Ÿ Moreover, 98% of the buildings’ humidity exceeds the standard or resulted over than 60% and 74% of the buildings’ temperature scale ≥ 30 C. The results of the correlative and regressive analytical proved there are some indicators that have a relationship with TB’s prevalence, such as residential density, especially broad-per-soul (r: -0.47; Rsquare: 0.22), daylighting system in particular the percentage of Windows-to-wall ratio or WWR (r: 0,33; Rsquare: 0.11), humidity (r: 0.21,) and temperature (r: 0.27).
The results showed that there’s a small direct relationship between Windows-to-wall ratio with TB case found in a public housing. It’s consistent with the previous studies that stated that daylighting system affected TB prevalence. The conclusions from the analytical process could be used to formulate residential design criteria which can suppress the prevalence of TB. However, this study still need further development to explore other factors aside from those that have been found. In general, Indonesian government also need to review and revamp their policy regarding public housing control and the public health. This study is still a ground exploratory research and it’s also still too early to conclude that by improving the quality of the house and its surrounding, we will be able lift up the poor health of public housing’s resident. The most important thing is even if we started from a small step, hopefully we could ignite other people’s spirit to start paying attention with their surrounding, evaluating their wrongdoing, and rebuilt a better living environment.
CONCLUSION
