The Role of Health Education To Improve the Teachers Knowledge about Clinical Symptoms of Dengue Hemorrhagic Fever In Jakarta Utara, 2011

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1 The Role of Health Education To Improve the Teachers Knowledge about Clinical Symptoms of Dengue Hemorrhagic Fever In Jakarta Utara, 2011 Khairunnisa Yodia Ditakusuma Saleha Sungkar General Medicine, Faculty of Medicine Universitas Indonesia ABSTRAK Nama Program Studi Judul : Khairunnisa Yodia Ditakusuma : Pendidikan Dokter Umum :Peran Penyuluhan dalam Meningkatkan Pengetahuan Guru Sekolah Swasta Mengenai Gejala Klinis Demam Berdarah Dengue (DBD) di Jakarta Utara, 2011 Jakarta Utara merupakan salah satu dari enam daerah di Provinsi DKI Jakarta dengan insidens demam berdarah dengue (DBD) yang tinggi. Pengetahuan mengenai gejala klinis DBD kepada guru swasta di Jakarta Utara dibutuhkan agar dapat mendeteksi dini DBD. Tujuan penelitian adalah untuk meningkatkan pengetahuan guru sekolah swasta mengenai gejala klinis DBD di Jakarta Utara. Penelitian ini menggunakan desain penelitian pre-post study. Pengambilan data dilaksanakan pada tanggal 22 September 2011 dan seluruh guru swasta yang hadir saat penyuluhan menjadi subyek penelitian dengan mengisi kuesioner yang berisi lima pertanyaan mengenai gejala klinis DBD sebelum dan sesudah penyuluhan. Data diproses dengan SPSS versi 18 dan diuji dengan marginal homogeneity. Hasilnya menunjukkan dari 82 responden, terdapat 34 (41,5%) guru perempuan dan 48 (58,5%) guru laki-laki. Hasil pre-test, guru yang memiliki tingkat pengetahuan baik adalah 25 (30,5%) orang, cukup 22 (26,8%), dan kurang 35 (42,7%) orang. Pada post-test jumlah guru dengan pengetahuan baik menjadi 55 (67%) orang, cukup 20 (24,4%), dan kurang 7 (8,6%). Uji marginal homogeneity menunjukkan perbedaan bermakna pada tingkat pengetahuan sebelum dan sesudah penyuluhan (p<0,01). Disimpulkan penyuluhan berperan dalam meningkatkan pengetahuan guru swasta mengenai gejala klinis DBD. Kata kunci:dbd; gejala klinis; pengetahuan guru swasta, penyuluhan

2 ABSTRACT Name Study Program Title : Khairunnisa Yodia Ditakusuma : Medicine : The Role of Health Education to Improve the Teachers Knowledge about Clinical Symptoms of Dengue Hemorrhagic Fever in Jakarta Utara, 2011 Jakarta Utara is one of six districts in DKI Jakarta with the high incidence of dengue hemorrhagic fever (DHF). It is necessary to giving the knowledge about clinical symptoms of DHF in private teachers in Jakarta Utara in order tomake the early diagnosis of DHF. This study used pre-post study design. The data was taken in 22 September 2011 in Jakarta Utara Walikota office by filling the questionnaire that contain five questions about the clinical symptoms of DHF before and after the health education. All private teachers who attended the health education are becoming the subject of the research. Data processed with SPSS version 18 and used marginal homogeneity test. The results show of 82 respondents, there were 34 (41.5%) female teachers and 48 (58.5%) male teachers. Pretest results, teachers who have good knowledge level is 25 (30.5%) people, moderate knowledge is 22 (26.8%), and poor knowledge is 35 (42.7%) people. In post-test, the number of teachers who have good knowledge is 55 (67%) people, moderate knowledge is 20 (24.4%), and poor knowledge is 7 (8.6%) people. By using the marginal homogeneity test it is showed significant differences in the level of knowledge before and after extension (p <0.01). It was concluded that health education have the role in improving teachers' knowledge about the clinical symptoms of Dengue Hemorrhagic Fever (DHF) in Jakarta Utara. Keywords: clinical symptoms; DHF; health education; private teacher knowledge

3 INTRODUCTION 1.1 Background Dengue hemorrhagic fever (DHF) is a disease caused by dengue virus and transmitted by the Aedes aegypti mosquito as the vector of actual and Aedes albopictus as a vector potensial. 1 Until recently, dengue is one of the public health problem in Indonesia. Jakarta is a province with the highest incidence rate (10-20/ inhabitants) and incidence rate continues to increase. Jakarta consists of five regions, namely Jakarta Utara, Jakarta Selatan, Jakarta Barat, Jakarta Timur and Jakarta Pusat. 2 In Jakarta Utara, in 2008 there were 4037 patients and increased to 5571 patients in 2009, whereas in 2010 the number of people reduced to 2443 people. There are 32 villages in Jakarta Utara, nine of them including the red zone DHF, eleven villages belonging to the yellow fever zone, and only twelve villages that are categorized as green zones DHF. Red zone is the area in three consecutive weeks and there are more than nine patients with dengue fever or have died due to dengue. Yellow zone is the area that there are 1-8 cases of DHF, while the green zone is the area that there is no dengue cases in three consecutive weeks. 3 Based on the data above, the DHF must be aware by recognizing the symptoms that can be done by early diagnosis and appropriate management. Therefore, people need to be equipped with knowledge about DHF symptoms that can be done by providing health education. Teachers are the people who are dealing with students in giving the education. Since the children are often infected DHF than adult, teachers need to be equipped with the knowledge about clinical symptoms of DHF so that they can deliver it to the students. Based on the above, we want to give the health education to teachers in Jakarta Utara. Due to the limitation of the research, we have chosen to give the health education to the private teachers. After health education, the level of teachers knowledge assessed to determine whether the knowledge society has reached a good category. 1.2 Identification of Problems According to the background information above, the following research questions are: 1. Does the level of knowledge about DHF clinical symptoms associated with the demographic

4 characteristics in 2011? 2. Is health education about DHF clinical symptoms improve private teachers knowledge in Jakarta Utara in 2011? 1.3 Research Objective General Objective To find out whether there are improvement of knowledge level after health education about DHF on private teachers in Jakarta Utara, Specific Objectives 1. To know the demographic characteristic of private teachers (age, level of education, occupation, and history of DHF infection) in Jakarta Utara. 2. To know whether the level of DHF clinical symptoms knowledge among the private teachers in Jakarta Utara has association with the demographic characteristic. 3. To know the level of DHF clinical symptoms knowledge among the private teachers in Jakarta Utara before and after the health education. 4. To find out if there are any improvement in knowledge after health eduation about DHF clinical symptoms on private teachers in Jakarta Utara. LITERATURE REVIEW 1.1 Dengue Hemorrhagic Fever Etiology DHF is an infectious disease caused by dengue virus and is transmitted through mosquito vector called Ae. aegypti. DHF is a health problem in Indonesia because of the high incidence and widespread distribution. Dengue virus belongs to a group named arthropod-borne viruses (Arboviruses). They are now known as the genus Flavivirus, family Flaviviridae. There are four serotypes, namely DEN-1, DEN-2, DEN-3, and DEN-4. The four serotypes of dengue virus can be found in various regions of Indonesia. DEN-3 is the most commonly found serotype in Jakarta. If someone has been infected by one serotype, then there will be a

5 lifetime of antibodies against all serotypes. It concerned but there is no protection against other serotype Pathogenesis Immunopathologic process plays an important role in the pathogenesis of dengue disease. This supports the concept of disappearance of dengue virus rapidly from the circulation of blood and tissues, the response of formation of antibody with the formation of anti-dengue IgG antibodies in blood circulation during early disease, and the decreased of serum complement C3 that primarily happen on shock phase. In dengue infection, antibodies are formed. It consists of functional immunoglobulin G that inhibits the increased viral replication in monocytes. It is enhancing and neutralizing antibody. Monocytes that had been infected with dengue virus will stimulate the T lymphocytes and release interferon (IFN) alpha and gamma. In secondary infection, dangue infections with different serotypes compared to the first infection will produce CD4 T lymphocytes which are proliferating and producing IFN alpha. IFN alpha will stimulate dangue virus-infected cells and causes monocytes to produce mediators that lead to leakage of plasma and hemorrhage Pathophysiology The main pathophysiological phenomena that determine the weight of dengue disease are the increased permeability of blood vessel s wall, decrease of plasma volume, hypotension, thrombocytopenia and hemorrhagic diathesis. During the course of the disease, plasma began to seep from the onset of fever until culminated in the shock. The hematocrit value increased along with the disappearance of plasma through the endothelial walls of blood vessels. The increased amount of hematocrit values determined that the shock occurs. It is proven due to the leakage of plasma into extravascular areas through the damaged capillaries. The clinical appearance of skin bleeding in DHF patients are generally caused by capillary factor, platelet dysfunction and thrombocytopenia. Meanwhile the massive bleeding disorder caused by a more complex mechanism, namely thrombocytopenia. Thrombocytopenia is caused by impaired clotting factors and most likely by disseminated factors of intravascular coagulation. 6

6 2.1.4 Sign and Clinical Symptoms Clinical manifestations of dengue virus infection can be asymptomatic, meaning that there is an absent of typical fever, dengue fever or dengue shock syndrome. DHF is characterized by four clinical manifestations such as high fever, bleeding especially in skin, hepatomegaly, and circulatory failure. Sudden fever accompanied by non-specific clinical symptoms such as anorexia, weakness, back pain, bone, joints and headache. Fever as the main symptoms were present in all patients. The old fever occurs between 2-7 days before being treated. The occurrence of seizures accompanied by loss of consciousness in some cases might be consider as encephalitis instead of DHF. Bleeding manifestations are most often found in DHF is skin bleeding. It should be confirmed by the positive tourniquets test, bruising and bleeding at the site of venous blood sampling. On the other hand, Petechial finely dispersed in the limbs, face, and axilla. It is often found in the early days of fever. Bleeding can occur in any organ of the body. Epistaxis and bleeding gums are rarely found meanwhile, severe gastrointestinal bleeding occurs more often. It usually occurs after a shock that cannot be overcome. Tourniquets test as manifestation of the lightest skin bleeding can be considered as a presumptive test. It is because the test was positive in the first day of fever especially in dengue endemic areas. Tourniquets test performed as follows: 1. Check your child's blood pressure 2. Give pressure between systolic and diastolic pressures at gauges mounted on the arm above the elbow; pressure is cultivated settled during trial. 3. After pressure for 5 minutes note the emergence of petechial in the forearm skin in the medial third of the proximal part. 4. Test positive when expressed on a single square inch (2.8 x 2.8 cm) obtained more than 20 petechial. DHF patients, tourniquets test generally gave positive results. It also can give negative or weakly positive results during severe shock. When the examination was

7 repeated for the second times after the shock is recovered, it will bring positive or even strong positive results. Hepatomegaly can generally be palpated at the beginning of the disease. The size of liver enlargement was not parallel with the progression of the disease itself. Tenderness is often found without jaundice. Liver in children aged 4 years and or more with good nutrition is usually hard to palpate. Vigilance should be increased in children whose hearts originally cannot be palpated at the time of hospital admission and during treatment of heart enlargement. In contrast with the children who already have an enlarged liver at the time of hospital admission and during the liver treatment, a larger progression and rubbery state of heart need to get more attention because it leads to the occurrence of shock. In approximately one third of patients with dengue fever, the clinical manifestation will be lasts a few days and suddenly deteriorated. It usually occurs during or after the fever down, between day one until day seven. In patients with the signs of circulatory failure which has a damp and cold clammy skin, cyanosis around the mouth, the pulse will becomes rapid in the end, the blood pressure will drop Diagnosis The diagnosis of DHF determined based on the standard of World Health Organization. The standard includes the sudden high fever between two until seven days, signs of bleeding such as petechial, epistaxis, or hematemesis, hepatomegaly and symptoms of shock. In laboratory tests, present of thrombocytopenia ( /ul or less) and hemoconcentration will be found, such as increased hematocrit value about 20% or more compared to the value of hematocrit in the covalent. The discovery of two or three clinical benchmarks with thrombocytopenia and hemoconcentration was enough to make a diagnosis of DHF. In addition to clinical criteria and laboratory investigations that may be used for diagnosis of dengue serological diagnosis are hemagglutination inhibition test, examination of IgM and IgG by ELISA, and its diagnosis by polymerase chain reaction (PCR) Management

8 Maintenance of fluid circulation is appropriate therapy for the treatment of DHF. Patients should be given adequate fluid intake, especially oral fluids, 1 ½ -2 liters in 24 hours, whether it be water, tea, sugar, syrup, milk, juice or oral rehydration salts. The management of dengue fever is very supportive. Early replacement of plasma will be more effective by giving fluids containing electrolytes, and plasma or plasma expanders. It gives good results in most patients. Hematocrit value and platelet count should be checked every day from day one until day three of hospitalization. It should be last until 1-2 days after the patient is no longer fever Prevention and Promotion Control of dengue fever is the efforts to prevent and deal with incidents of DHF including the measurement to limit the spread of dengue fever. Nowadays, the most commonly use for dengue control is mass spraying before disease transmission season in rural or urban endemic dengue s area. The strategy was reinforced by encouraging promotion of community participation in the activities of mosquito control nest, implementing countermeasures focus on the patient's house and in the neighbourhood. This control aims to reduce the dissemination of dengue affected areas, reducing the increase in the number of cases of DHF and commercialize mortality (case fatality rate/cfr) does not exceed 3% per year. Physician role in dengue control program is to discovery, diagnosis, treatment and patient care, reporting cases to the public health service center as well as provide health education in the context of the mobilization of the program in the neighborhood of patients. RESEARCH METHOD 3.1 Study Design This research used pre-post study design with the health education about the clinical symptoms of DHF as the intervention. 3.2 Time and Place of Study This research took place in Walikota Jakarta Utara Office for one day in 22 nd September

9 3.3 Population In this research, the target population was private teachers in Jakarta Utara, while the accessible population is the private teachers in Jakarta Utara that come to the DHF health education program in Walikota Jakarta Utara office in 22 nd September Data Sampling population). All private teachers who attend the health education were recruited as the samples (total 3.5 Variables Dependent variables in this study were the level of knowledge of respondents regarding the clinical symptoms of DHF after the health education been given. The independent variable is the health education given to the respondent and the confounding variable is the honesty of respondents in filling questionnaires. 3.6 Methods for Data Collection Research subjects are the private teachers who attend the DHF health education in Walikota Jakarta Utara office. They were be given an explanation about research to be done then requested approval. Subjects have right to refuse if they are not willing to follow the research. After that, subject will fill the first questionnaire (pretest) and after they completed the quesionnaire, they will listen to the education for 60 minutes and followed by filling the second questionnaires were returned (postest). During the questionnaire filling, the subject was accompanied by a researcher to complete the data. The data obtained will be kept confidential. After data collection is completed, researchers gave souvenirs as a token of appreciation Data Analysis 1. Data Verification Data verivication will be done immediately after filling the questionnaire. The questionnaire that has been filled checked the completeness and suitability. 2. Data Entry

10 The data which has confirmed, complete and appropriate will be classified according to the scale of measurement. The measurements are numerical, ordinal, and nominal. Education level, gender, and sources of information about DHF classified into nominal scale. Meanwhile, the sum of the value of knowledge of the teachers about clinical symptoms of DHF clinically classified into ordinal scale. 3. Processing Data This data will be process using SPSS programs for Windows version Data Interpretation Data interpretation was procced by using descriptive and analytic method for significant relationship between two variables using chi-square and fisher s. 3.7 Operational Definition 1. Respondents are private teachers in Jakarta Utara. 2. Level of formal education is the study being pursued by the respondent at the time of data retrieval research. Operational limitation is the level of education at the level high school graduated, diploma, S1 and S2. 3. Knowledge is the information known to the respondents regarding the clinical symptoms of DHF. Knowledge of data obtained through questionnaires and assessed from the question by giving scores to each answer. Knowledge is categorized into 3 categories: 1. Good knowledge is when the value is 80% of the maximum value. 2. Moderate knowledge is when the value is 60% - 79% of the maximum value. 3. Poor knowledge is when the value is 59% of the maximum value. RESULTS It is necessary to give the health education to the teachers, it is then expected they will deliver the knowledge to the students and the students will deliver it to the family. This study involved 82 respondent. Table 4.1 shows that there are more males than females and the S1 graduates has the highest percentages among others. In the land of teacher s occupation

11 variable, 47.6% are SMP Teachers. Mostly based on the research, the private teachers haven t experienced DHF. Tabel 4.1 Demographic Characteristic of Private Teachers in Jakarta Utara, 2011 Variable Category Frequency Percentages Gender Male 48 58,5% Female 34 41,5% Education Level SMA Diploma S1 S ,9% 8,5% 75,6% 11% Teacher s Occupation TK SD SMP SMA ,7% 26,8% 47,6% 22% History Yes No ,9% 67,1% Based on table 4.2 there was no significant difference between the knowledge level on DHF clinical symptoms and education level, gender, teachers occupation and history of DHF infection. Thus, there was no association between the level of knowledge and the demographic characteristics. Table 4.2 Respondent Pretest Level of Knowledge about Clinical Symptoms of DHF with other influence Factors Variables Education Level Knowledge p Test Category Poor Moderate Good SMA ,729 Fisher s Diploma 2 1 4

12 S S Gender Male ,437 Chi- Female Square Teacher s Occupation TK ,663 Fisher s SD SMP SMA History Yes ,769 Chi- No Square Table 4.3 it represents the result of the research before and after the health promotions and has significant difference, meaning that the health education was proved to be effective. Table 4.3 The Level of Knowledge on DHF Clinical Symptoms s Before and After the Intervention Variable Level of Knowledges Test Good Moderate Poor Pretest 25 (30,5%) 22 (26,8%) 35 (42,7%) Marginal Posttest 55 (67%) 20 (24,4%) 7 (8,6%) homogeneity (p<0,01) Regarding table 4.4, there are five questions under the knowledge about clinical symptoms of DHF. The first question is asking about the earliest symptoms that are visible in DHF. The answers include redness of the skin, nausea, high fever, do not know and more. The right answer is high fever. About 79.2% of the respondents gave the right answer in pretest and raise to 93.9% in the posttest. In the second question which is how the temperature of fever that occurred in the early symptoms of DHF appear. The options are a saddle horse like chart, high fever that persisted for one week, fluctuates irregularly, do not know and more. The correct answer is a saddle horse like chart. From the data analysis, it found that there are an increase percentages from 42.7% to

13 58.5%. Question number 8 which is the third is the clinical symptoms of DHF that appear the most after fever. The answer need to be choose includes hemoglobin, haematokrit, plateles, do not know, and more. The answer is platelets. The percentage also raise from 89% to 95.1%. The raise is almost near 100%. The fourth question (Question number 9) is in the situation of severe DHF, what kind of experience that the patient will feel. It may be unconscious, blood pressure rises, anemia, do not know or more. The answer is unconscious. Same as the others, the percentages are increasing from 57.3% until 80.5%. The raise is almost 30%. The last question is people who diagnosed as DHF must suffer from sudden high fever and accompanied by what kind of symptoms. In this question, the respondents instructed to choose two answers. The two right answers are sign of bleeding and dengue serology test positive. The very last question gained 69,3% for pretest and an increase up to 76,3% in posttest. From the five questions above, it is known that all of the questions are increase significantly in percentage, thus result in a meaningful differences. Table 4.4 The Score Proportion Regarding Clinical Symptoms of DHF Questions No Questions Total Score Pre Post Max Score 1. The first clinical symptoms 325 (79.2%) 385 (93.9%) The pattern of DHF 175 (42.7%) 240 (58.5%) The second clinical symptom 365 (89%) 390 (95.1%) The fever of DHF 235 (57.3%) 330 (80.5%) The location of DHF 284 (69.3%) 313 (76.3%) 410 DISCUSSIONS DHF is very crucial in Indonesia especially in Jakarta. Several variables related to the knowledge about clinical symptoms of DHF. In this section, the variables that relate the most are gender, teacher s occupations, level of educations and history that previously had been infected

14 by DHF. Knowledge about clinical symptoms of DHF is very important to make the early diagnosis. In this term, the knowledge about DHF can be improved by giving the education to the people. This knowledge will eventually make the people more aware and common with DHF infection. Sekartini et al 7 have studied about knowledge and behavior of mother that has an elementary school child. The result shown that respondent that had more knowledge about the deseases will be better to prevent and manage the disease compares to the one who haven t got the knowledge before. Benthem et al 8 who studied about the level of knowledge of people in Thailand about prevention and management of DHF reported that people who have better level of knowledge about DHF have applied better prevention in their family. This kind of study also related to the study that Konraadt et al 9 had done. He stated that knowledge about DHF prevention is proportional to the effort of doing the prevention of DHF. This study shows that 30.5% of respondents had a good knowledge about the clinical symptoms of DHF, which is a sudden high fever with a pattern like a saddle horse, red spots on the skin, weak weakness, nausea, vomiting, nosebleeds and headaches. The results showed that most respondents do not have a good knowledge about the clinical symptoms of DHF. In addition, there are still 42.7% of respondents who have high levels of bad knowledge and 26.8% of the respondents have sufficient knowledge level. This is because most of the respondents have not received the knowledge of DHF previously. Therefore, there are still questions answered incorrectly by the respondents. 5.1 Relationship of Education to the Teacher s Level of Knowledge about Clinical Symptoms of DHF The results of this study indicate that health education is effective in improving teachers' knowledge about DHF. This is due to the teachers who follow are mostly undergraduated students that have been used to receiving material in the form of lecture so they can listen and receive information properly. Another thing that affects the increase of knowledge is the teachers have new information that has not been obtained so that they are enthusiastic to the health eductaion. Besides, health education is given by experienced clinicians so as to provide well informed and interesting DHF

15 materials. Suprapto (quoted from Pasaribu 21 ) stated that the interactive lecture method is a twoway communication takes place between the respondent and the extension, so it can provide good results. The results are match with what have said from Pasaribu, that health education methods by lecture had an influence on the level of knowledge of respondents. Pasaribu 9 examines the extension methods between lectures and reading interesting books (comics). The results showed that both methods are equally providing a meaningful difference to the increased knowledge of the respondent. Nonetheless, the lecture better than comics because the talks going on two-way communication. 5.2 Relationship between gender and the level of Clinical Symptoms of DHF knowledge Gender is a division of roles, attributes, traits, attitudes and behaviors that grow and thrive in the community and gender roles are divided into productive roles, social role and reproductive role. 10 In this study, one of the variables is gender. Based on the result, there are no relation between gender and the level of clinical symptoms of DHF knowledge. This might due to gender equality that become usual and there is no boundary to enggange more about the information and education among the respondent this day. Promoting equality is generally seen to be part of the work of schools and other educational organizations. There has been an important focus on race equality over the past decades Relationship Between Teacher s Occupations with the Level of Clinical Symptoms of DHF knowledge This research conducted to the private teachers in Jakarta Utara that have different level of occupation, namely kindergarden teachers, elementary teachers, junior high teachers and high school teachers. After the researcher analyzed the data, there are no relationship between the teacher s occupations and the the level of DHF clinical symptoms knowledge. This is due to the teachers didn t give the education about DHF to the students in various level of education, either in kindergarden, elementary, junior high or even high school students. In Cuba, DHF is included in the school curriculum. In kindergarden students, they were taught about DHF vector by coloring the Ae. Aegypti picture. The higher the level of education they are taught to understand more deeply about DHF.

16 5.4 Relationship Between the Level of Education with the Level of Clinical Symptoms of DHF knowledge Education is a form of learning in which knowledge, skills, and habits of people are transferred from one generation to the next through teaching, training, research, or simply through autodidacticism. 12 In this study, the respondents are come from different level of education, namely, high school graduates (SMA), diploma, S1 and S2. However, there is no association between the level of education of the teachers and the level of clinical symptoms of DHF knowledge in this study. This is because the education system in Indonesia does not include the deep and complete knowledge about DHF in the school curriculum. This kind of situation makes the teachers just exposed to the knowledge of clinical symptoms of DHF outside the occupation. 5.5 Relationship Between the History of DHF with the Level of Clinical Symptoms of DHF knowledge There are no association between the history of having DHF and the level of clinical symptoms of DHF knowledge. Because when people infected by DHF, they will be hospitalized immediately and treated with parenteral infusion. In Indonesia, the doctors rarely gives explanation about the disease to the patients, including DHF patients. Although the people have experienced DHF, their knowledge is remain the same. 5.6 Proportion of question answered on the knowledge of clinical symptoms of DHF This research used a questionnaire containing five questions about clinical symptoms of DHF. Before the health education is given, in general, many respondents have low score yet in the posttest all the questions score increase. The significant progression located in the question number 4 with the increase of 95 (23.2%). It is because the question is about the clinical symptoms that is commonly occur after the fever. There was a quite progression in the question number 3 with the increase of 25 (6.1%). This is due to the laboratory finding that has medical jargons which is not known for common people. Based on the questions score, health education should be given accordingly to the topic that is difficult for the respondents. In the field of dthose difficult questions, health

17 education should be delivered slowly with the layman terms. CONCLUSSIONS AND SUGGESTIONS 6.1 Conclusions 1. Before the intervention, the number of respondents who have a good level of knowledge of 25 people, moderate 22 people, and poor level of knowledge 35 people. After the health education, the respondent that has a good level of knowledge is 55 people, moderate level of knowledge 20 people, and about 7 people has poor level of knowledge. 2. There was no association between knowledge about symptoms of DHF with gender, education level, occupation, and experience DHF. 3. Health education has a role in improving the respondent knowledge about DHF. 6.2 Suggestions 1. Knowledge of teachers in Jakarta Utara needs to be improved based on the questionnaires to reach the better categorized. Health education must be given continuously by giving posters, leaflets and banners. REFERENCES 1. World Health Organization. Dengue status in South East Asia Region: an epidemiological perspective; Available from: 2. Dinas Kesehatan Provinsi DKI Jakarta. Data pasien tersangka DBD bersumber surveilans aktif rumah sakit. Jakarta: Depkes RI; Nainggolan L. Demam berdarah dengue di Indonesia. Kelompok kajian demam berdarah dengue. Jakarta: FKUI; Suhendro, Nainggolan L, Chen K, Pohan HT. Demam berdarah dengue. Dalam: Sudoyo AW, Setiyohadi B, Alwi I, Simadibrata M, Setiati S, ed. Buku ajar ilmu penyakit dalam. Jilid III. Edisi IV. Jakarta: Departemen Ilmu Penyakit Dalam; hal Sungkar S. Demam berdarah dengue. Jakarta: Yayasan Penerbitan Ikatan Dokter Indonesia; 2002.

18 6. Soedarmo SP. Demam berdarah dengue pada anak. Jakarta: Penerbit Universitas Indonesia; Sekartini R. Wawolumaya C. Kesume W. Memy YD. Yulianti. Syihabul S. et al. Pengetahuan, sikap, dan perilaku ibu yang memiliki anak usia sd tentang penyakit cacingan di Kelurahan Pisangan Baru, Jaktim. [internet]. Available from: 8. Benthem BHB, Khantikul N, Panart K, Kessels PJ, Somboon P, Oskam L. Knowledge and use of prevention measures related to dengue in northern Thailand. Trop Med Int Health. 2002;7: Koenraadt CJM, Tuiten W, Sithiprasasna R, Kijchalao U, Jones JW, Scott TW. Dengue knowledge and practices and their impact on Aedes aegypti populations in Kamphaeng Phet, Thailand. Am J. Trop Med. Hyg. 2006; 74(4): Ginting A. Faktor-faktor yang berhubungan dengan kejadian kecacingan pada anak sekolah dasar di desa tertinggal Kecamatan Pangururan Kabupaten Samosir. [skripsi] Medan: FKM USU; Mardiana D. Prevalensi cacing usus pada murid sekolah dasar wajib belajar pelayanan gerakan terpadu pengentasan kemiskinan daerah kumuh di wilayah DKI Jakarta. Jurnal Ekologi Kesehatan. 2008;7(2): John D. (1916/1944). Democracy and education. The Free Press. pp. 1 4