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EVIDENCE BASED PUBLIC HEALTH

PENUGASAN INDIVIDU BLOK 4.4 KESEHATAN MASYARAKAT

Oleh:
Nia Japlani
14711132
Kelompok Tutorial 12

Program Studi PendidikanDokter


Fakultas Kedokteran
Universitas Islam Indonesia
2018
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I. Kasus
Kandang Ternak Di Rumah
Berdasarkan hasil survey mawas diri di desa Kuring masih banyak masyarakat
desa yang belum memiliki rumah dengan kriteria sehat. Sebagian besar juga
memiliki kandang ternak/unggas di dalam/samping rumah. Adanya kandang
ternak yang berdekatan dengan rumah menjadi sumber penularan penyakit. Salah
satunya flu burung dengan case fatality rate >80%. Pada tahun 2010 di desa
Kuring pernah ada 1 warga yang meninggal akibat terinfeksi avian influenza.
Adanya outbreak flu burung beberapa tahun yang lalu tidak membuat masyarakat
menjadi berhati-hati. Dr Irma ingin mengetahui bagaimana respon masyarakat
terhadap outbreak flu burung/avian influenza di Indonesia?

II. PICO
Question Part Question Term Synonyms
Problem Outbreak avian influenza Outbreak flu burung
Intervention Pemberian edukasi Pemberian informasi
kepada masyarakat kepada masyarakat
Comparisson Tidak diberikan edukasi Tidak diberikan
kepada masyarakat informasi kepada
mengenai avian influenza masyarakat mengenai
avian influenza
Outcome Peningkatan respon Peningkatan pengetahuan
masyarakat terhadap masyarakat terhadap
avian influenza avian influenza
Dari analisis PICO di atas, maka dapat disimpulkan pertanyaan PICO pada
kasus ini adalah :“Bagaimana respon masyarakat terhadap outbreak avian
influenza?”

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III. Searching Keywords
Pencarian jurnal dengan menggunakan kata kunci sesuai dengan kalimat
dalam PICO, yakni perceptions OR response OR knowledge AND outbreak avian
influenza.
IV. Artikel Jurnal
Teknikpencarian Pencarian menggunakan perangkat bantuan google
scholar dengan kata kunci tersebut di atas.
Jurnal yang didapat
Judul Tulisan Perceptions on the risk communication strategy during
the 2013 avian influenza A/H7N9 outbreak in humans in
China: a focus group study
Penulis Richun Li, Ruiqian Xie, Chong Yang, dan Melinda frost
Nama jurnal dan WPSAR, 2016.
tahun

V. Form IsianCritical Appraisal

(A) Are the results of the trial valid?


Can't
No Questions Yes No
tell
1 Did the trial address a clearly focused issue? √
Consider: An issue can be ‘focused’ In terms of
a. The population studied √
Padapenelitianinidijelaskanmengenaipopulasi yang akanditeliti. Hal
inidapatdilihatpadababmethodsbagianproject contextbariske 5, yang berbunyi
“The project took place from 2005–2010 in 7 districts of Sofala Province, which
have a combined population of 1.1 million people. During the first 2.5 years, the
project implemented services in 4 districts (Caia, Chemba, Manga, and
Marringue) with 42% of the total project population (Area A). During the final
2.5 years, the project expanded to an additional 3 districts (Dondo, Gorongosa,

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and Nhamatanda) with another 58% of the project population (Area B).”

b. The intervention given √


Padabagianmethods sub bagianintervention,disanadijelaskansecara detail
apasajaperlakuan yang akandiberikankepadasubjekpenelitian. Selainitu,
padaabstrak pula telahtertulismengenaiperlakuan yang akandiberikan.
Berikutadalahkutipannya, “About 50,000 households with pregnant women or
children under 2 years old were organized into blocks of 12 households. One
volunteer peer educator (Care Group Volunteer, or CGV) was selected for each
block. Approximately 12 CGVs met together as a group every 2 weeks with a paid
project promoter to learn a new child-survival health or nutrition message or
skill. Then the CGVs shared the new message with mothers in their assigned
blocks.”
c. The comparator given √
Padamethods
dijelaskankelompokpembandingdalampenelitianiniadalahantaraibu yang
telahdiberikanperlakuanberupahealth promotion, dengankelompokibu yang
tidakdiberipaparan. Hal inisecaratidaklangsungtercantumpadakalimatberikut:
“mothers who were practicing a particular behaviour (the ‘‘doers’’) were
compared with those who were not”
d. The outcomes considered √
Padatabelhalaman 41-42 telahdicantumkanbagian-bagianapasaja yang
digunakansebagaiindikatorpenilaianhasilpenelitianini.
2 Was the assignment of patients to treatments √
randomised?
Consider

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a. How was this carried out, some methods may √
produce broken allocation concealment
Penelitianinimenggunakansistemacakseperti yang
tersebutkanpadajurnalpadabagianmethodsakhirkalimathalaman 38, “We
conducted baseline and endline Knowledge, Practices, and Coverage (KPC)
surveys in both project areas, with randomly sampled households that had either
pregnant women or mothers of young children (the beneficiaries of the
project).”Tetapiwalaupundemikian,
metodepengacakansecararincitidakdijelaskanlebihlanjutolehpenelitinya.
b. Was the allocation concealed from researchers? √
Padapenelitianinitidakdituliskanlebihlanjutapakahpengacakantersebuttersem
bunyidaripenelitiatautidak.
3 Were patients, health workers and study personnel √
blinded?
Consider
a. Health workers could be; clinicians, nurses etc √
Padapenelitianinitidakadasistemblinding padatenagakesehatan yang
ikutserta.
b. Study personnel – especially outcome assessors √
Tidakadasistemblinding padaanggotapenelitian, terutamapenilaihasil.
4 Were the groups similar at the start of the trial? √
Consider: Look at
Other factors that might affect the outcome such as √
age, sex, social class, these may be called baseline
characteristics
Penelitianinimengambilsubjekpenelitianpadasatulokasi yang
dimanadisanakelas strata sosialnyasetara, seperti yang
dituliskanpadabagianmethodssub bagianproject context,yakni “Findings from the
baseline household survey (described below) showed that 50% of women with a
child 0–23 months old had never attended school, 35% had obtained some

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primary-level schooling, and 15% had obtained 6 or more years of education.”
Untukpersamaankarakteristiklainnyasudahdisebutkanpadakriteriainklusisubj
ek, yaknitertulispada sub bagianintervention: “all pregnant women and mothers
of children under 24 months old in the project area.”
5 Aside from the experimental intervention, were the √
groups treated equally?
Seluruhsubjekdilakukansamaolehmerekaselainintervensi yang diberikan. Hal
iniditunjangdaripernyataanjurnalberikut “The area is almost entirely rural, and
many villages are at considerable distance from a health facility. Residents are
primarily subsistence farmers with small plots of land. Motorized transport in the
form of motorcycles and vehicles is limited. During the project period, there were
no community-level health workers trained by the government and no other
nongovernmental organizations (NGOs) working in nutrition in the project
areas.”
Padabagianinterventionhalaman 38 jugadijelaskanbahwa“In general, all
mothers received the same health promotion or nutrition message in a given 2-
week period.”Dengandemikiandapatdibuktikanbahwaselainintervensi yang
diberikan, keseluruhansubjekpenelitianmendapatkanperlakuan yang sama.
6 Were all of the patients who entered the trial properly √
accounted for at its conclusion?
Consider
a. Was the trial stopped early? √
Padapenelitiantidakterjadipenghentianperlakuansebelumakhirwaktu yang
telahditentukan.
b. Were patients analysed in the groups to which they √
were randomised?
Analisasubjekdilakukansecara per kelompok, namuntidakdijelaskanlebih
detail apakahdilakukansistempengacakanatautidakpadamasing-
masingkelompoknya.
(B) What are the results?

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No Questions Yes Can't No
tell
7 How large was the treatment effect? √
Consider
a. What outcomes were measured? √
Hasilpenelitianterukursepertihasil yang disebutkanpadabagianresults,
yakni“The surveys to measure outreach of CGVs revealed that 44% of CGVs
were elected by their mother groups, while 55% were selected by either the
community leader or promoter. Mothers may have been more likely to select a
‘‘hub’’ in their social network, which could have facilitated behavior change,
since some nutrition and health behaviors are transmitted through social
networks,18–19 and some behaviors ‘‘cluster’’ in social networks.”
b. Is the primary outcome clearly specified? √
Hasilpenelitian yang diberikanolehpenelititergolongspesifik. Hal
inidibuktikandenganditulisnyapernyataan “The evaluation also demonstrates that
the Care Group model achieved a statistically significant decline in the
percentage of children ages 0–23 months with global
undernutrition”padabagiandiscussion.
c. What results were found for each outcome? √
Penelitianinimenghasilkankeluaransesuaidenganpernyataanpadabagianresult
s halaman 44, yakni“Baseline and endline KPC household surveys indicate
several statistically significant positive improvements ( P 50.01 or less) in
nutritionrelatedbehaviors (with increases as high as 52 percentage points),
including with exclusive breastfeeding, provision of solid foods at least 3 times
per day for children 9–23 months, adding oil to weaning foods for children 6–23
months, consumption of at least one vitamin-A rich food during the previous day
in children 6–23 months, and provision of the same amount of food or more
among children with diarrhea during the previous 2 weeks.”
d. Is there evidence of selective reporting of outcomes? √
Tidakdisebutkanlebih detail mengenaiapakahadaatautidakpelaporan yang

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selektifmengenaihasil yang telahada.
8 How precise was the estimate of the treatment effect? √
Consider
a. What are the confidence limits? √
Apabiladilihatdarihasilnya, yakni “percentage points (P,0.001), from 25.9%
(95% confidence interval [CI]=22.2%–29.6%) at baseline to 17.8% at endline
(95% CI=14.6%–20.9%). In the delayed implementation area, global
undernutrition declined by 11.5 percentage points (P,0.001), from 27.1% (95%
CI=23.6%–30.6%) to 15.6% (95% CI=12.6%–
18.6%)”makapenelitianinidapatdipercaya.
b. Were they statistically significant? √
Nilaisignifikanpenelitianiniadalah P=0.001,
sedangkantingkatsignifikansebuahpenelitiandapatdilihatdarinilai P yang
hasilnyakurangdari 0.05. Olehkarenaitu, penelitianinidikatakansignifikan.
(C) Will the results help locally?
No Questions Yes Can't No
tell
9 Can the results be applied in your context? (or to the √
local population?)
Consider
Do you have reason to believe that your population of √
interest is different to that in the trial? If so, in what
way?
Untukmeningkatkankualitasibudananakterutamauntukmenurunkaninsidensig
izikurangpadabalita, makalangkahedukasidirasamerupakanhal yang paling tepat.
Edukasimerupakansarana yang
dapatmeningkatkanpengetahuanibumengenaikesehatan.
Ketikaseorangibumemilikitingkatpengetahuan yang baik,
makahaliniakansebandinglurusdengankualitasbayi yang
dilahirkan. Dalampenelitianinimenggunakanintervensicare program, dimana para

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ibu yang
memilikirisikountukmelahirkanbayigizikurangdiedukasimengenaibeberapafaktort
erkait. Dari penelitianinidihasilkankeluaran yang
dirasacukupbaikuntukditerapkan,
yaknipenurunanangkainsidensigizikurangpadadaerahtersebut.
10 Were all clinically important outcomes considered? √
Consider
a. Is there other information you would like to have √
seen?
Penelitianinimenjelaskansegalainformasi yang berhubungan pula
denganterjadinyagiziburukpadaseorangbalita. Sepertimisalcontohnyaadalahketika
segalaintervensi yang dilakukanberhubunganmengenaisegalafaktorrisikoterkait.
Hal iniditunjangdalambagianjurnalresults sebagaiberikut“1) Improved nutrition
(exclusive breastfeeding, appropriate complementary feeding, adding oil to
weaning foods, and ingestion of vitamin A rich foods). 2) Diarrhea treatment
(provision of increased fluids for childhood diarrhea, continued feeding with
diarrhea, and knowledge of how to prepare ORS correctly). 3) Diarrhea
prevention (handwashing and point-of-use water purification in the home).”
b. Was the need for this trial clearly described? √
Segalasesuatu yang
dibutuhkanuntukterlaksananyapenelitianinidijelaskansecararinci,
mulaidarikriteriasubjekpenelitianhingga dana yang dibutuhkan.
Sepertimisalcontoh dana yang dibutuhkanadalahseperti yang
tercantumpadabagiancost penelitian, “Thisrepresents an average cost of $0.55
per capita per year (when considering the entire project population of 1.1 million
people) and $2.78 per beneficiary per year (when considering the 219,617
mothers with children ages 0–23 months in the project areas as the project
beneficiaries).”
11 Are the benefits worth the harms and costs? √
Consider

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Even if this is not addressed by the trial, what do you
think?
Menurutpenelitianinipadabagiancost halaman 45-46 disebutkanbahwabiaya
yang dikeluarkantergolongmurahdanmenghasilkanefek yang efektif. Hal
inidiperjelasdenganrincianpengeluaransebagaiberikut “Total project costs were
US$3.0 million, representing an average cost of US$0.55 per capita per year
(among the entire population of 1.1 million people) and US$2.78 per beneficiary
(mothers with young children) per year.”

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