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Kesmas: Jurnal Kesehatan Masyarakat Nasional (National Public Health Journal)
Published by Universitas Indonesia
ISSN : 19077505     EISSN : 24600601     DOI : https://doi.org/10.7454/kesmas
Core Subject : Health,
Health Professions Public Health
The focus of Kesmas is on public health as discipline and practices related to preventive and promotive measures to enhance the public health through a scientific approach applying a variety of technique. This focus includes areas and scopes such as Biostatistics, Environmental Public Health, Epidemiology, Health Policy, Health Services Research, Nutrition, Occupational Health and Industrial Hygiene, Public Health, Public Health Education and Promotion, Women Health.
Arjuna Subject : Kedokteran - Epidemilogi
Articles 928 Documents
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Media Visual Poster dan Leaflet Makanan Sehat serta Perilaku Konsumsi Makanan Jajanan Siswa Sekolah Lanjutan Atas, di Kabupaten Mandailing Natal Siagian, Albiner; Jumirah, Jumirah; Tampubolon, Fourgelina
Kesmas Vol. 4, No. 6
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Kebutuhan energi, protein, dan zat besi dapat disumbangkan oleh makanan jajanan masing-masing sekitar 36%, 29%, dan 52%. Namun, makanan jajan yang tersedia disamping tidak selalu sehat dan bergizi juga perilaku siswa tidak selalu positif untuk kebutuhan gizi. Tujuan penelitian ini mengetahui pengaruh media visual poster dan leaflet terhadap perilaku makanan jajanan pelajar suatu SMA di Kabupaten Mandailing Natal, Sumatera Utara, 2009. Dengan desain eksperimen kuasi one pre- and post-test group, penelitian dengan perlakuan pajangan poster dan leaflet di sekolah ini menilai pengaruh intervensi 2 minggu setelah perlakuan. Analisis data dilakukan dengan metode uji T-berpasangan terhadap sampel 80 pelajar kelas khusus. Sebelum dan setelah perlakuan, skor rata-rata pengetahuan siswa adalah 1,99 dan 3,00, skor rata-rata sikap adalah 1,80 dan 3,00. Tindakan konsumsi makanan para pelajar juga meningkat sebelum (x=1,76) dan sesudah (x=1,86) intervensi. Terdapat perbedaan yang bermakna antara perilaku konsumsi makanan jajanan pada anak sekolah sebelum dan sesudah intervensi. Dapat disimpulkan bahwa penyuluhan gizi menggunakan media poster dan leaflet mampu meningkatkan perilaku gizi anak sekolah. Disarankan pihak sekolah dan puskesmas menggunakan poster dan leaflet sebagai salah satu media penyuluhan gizi menyampaikan informasi gizi tentang makanan jajanan dan isu kesehatan lain untuk mempromosikan upaya kesehatan sekolah. Street food plays an important role in students’ nutrition. About 36%, 29%, and 52% of energy, protein, and iron, respectively, can be contributed by street food. The aim of the research was to know effect of nutritional extension using healthy food poster and leaflet on street food consumption behaviour among Senior Height School students in District of Mandailing Natal. The research is quasi-experiment with one pre- and post-test group design. The intervention was conducted by displaying poster and giving leaflet to students. Effects of interventions were evaluated two weeks after intervention. Subjects are 80 students. Data were analyzing by using paired sample T-test. Result showed that the average scores of knowledge of students were 1.99 and 3.00 before and after intervention, respectively. The average scores of attitude were 1.80 and 3.00 before and after intervention, respectively). Also, the practice of food consumption among students also increases (1.76 and 1.86 for before and after intervention, respectively). There was a significant difference in street food consumption behavior among students between before and after intervention. It can be concluded that nutritional extension using visual posters and leaflets increase student’s nutritional behaviour. It is suggested that, both school and puskesmas, use poster and leaflet as media of nutritional extension regarding street food and other health issues to promote school health.
Persepsi Risiko Berkendara dan Perilaku Penggunaan Sabuk Keselamatan di Kampus Universitas Indonesia, Depok Salihat, Ing Kurnia; Kurniawidjaja, L. Meily
Kesmas Vol. 4, No. 6
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Kematian dan cedera akibat kecelakaan lalu lintas telah menjadi masalah kesehatan masyarakat di seluruh dunia termasuk Indonesia. Di lingkungan Universitas Indonesia, setiap tahun terjadi peningkatan kejadian kecelakaan. Penelitian ini bertujuan melihat hubungan antara persepsi risiko keselamatan berkendara dengan perilaku penggunaan sabuk keselamatan pada mahasiswa Universitas Indonesia. Penelitian ini menggunakan pendekatan semi kuantitatif dan desain penelitian potong lintang. Partisipan adalah 98 mahasiswa Universitas Indonesia di Kampus Depok, berusia 18-25 tahun yang mengendarai kendaraan sendiri. Faktor internal yang membentuk persepsi risiko keselamatan berkendara secara bermakna adalah pengalaman (nilai p = 0,000) dan kepercayaan (nilai p = 0,008), sedangkan faktor eksternal yang signifikan adalah pengaruh teman (nilai p =0,000). Responden yang mempunyai persepsi risiko keselamatan berkendara yang buruk berisiko tidak menggunakan sabuk keselamatan 72 kali lebih besar [OR 72,46 (15,26; 344,02)] daripada responden yang mempunyai persepsi risiko terhadap keselamatan berkendara yang baik. Perlu dilakukan upaya meningkatkan persepsi risiko antara lain melakukan hazard communication dengan menggunakan pengalaman teman sebagai salah satu sumber informasi bagi individu, disebarluaskan melalui website, pemutaran film kejadian kecelakaan, dan membuat papan informasi yang diletakkan pada gerbang utama, meliputi informasi secara berkala dan berkelanjutan tentang kejadian kematian, cedera, dan luka-luka akibat kecelakaan lalu lintas. Deaths and injuries caused by traffic accidents has become a public health problem not only in Indonesia but throughout the world. Based on the data of UPTK3LH University of Indonesia, there is increasing incident and accident in campus within the university each year. The aim of this study is to see the relationship between perception of risk driving safety with safety belts usage behavior among the University of Indonesia students, using semi-quantitative approach and cross-sectional research design. Participants were 98 students of University of Indonesia Depok aged 18 to 25 years who drive their own vehicles. With 5% a, 80% power of the test and SPSS 10:00 software, obtained significant internal factors shape the perception of safety risks are the driving experience (p value = 0.000) and confidence (p value = 0.008), whereas a significant external factor is the influence of friends (p value =0.000). Respondents who have bad perceptions of the driving safety risk have a chance of 72 times [OR 72.46 (15.26; 344.02)] for not using safety belts compared to respondents who have a good perception of driving safety risk. Efforts are required to increase the risk perception include hazard communication by using the experience of a friend as one source of information for individuals, spread through websites, film screenings of an accident scene, and create information boards placed at the main gate, from the death scene information, injury, and injuries due to traffic accidents. The most important things is regular socialization
Konsumsi Makanan dan Kejadian Anemia pada Siswi Salah Satu SMP di Kota Makassar Syatriani, Sri; Aryani, Astrina
Kesmas Vol. 4, No. 6
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Anemia di kalangan remaja masih merupakan masalah kesehatan yang penting akibat pertumbuhan remaja sangat pesat. Penelitian ini bertujuan untuk mengetahui hubungan konsumsi protein, zat besi, vitamin B12, dan vitamin C dengan kejadian anemia pada siswi salah satu SMP di Makassar. Penelitian ini dengan disain studi cross sectional. Sampel adalah siswi kelas I dan II yang dipilih secara purposive sampling sebanyak 50 orang. Pengumpulan data konsumsi makanan dengan formulir recall 24 jam dan pengukuran kadar Hb dengan alat hemocue. Hasil penelitian dengan analisis chi-square diperoleh ada hubungan antara konsumsi protein (p=0,000), konsumsi zat besi (p=0,002), konsumsi vitamin B 12 (p=0,044), dan konsumsi vitamin C (p=0,006) dengan kejadian anemia. Untuk itu, disarankan para siswi meningkatkan konsumsi makanan sumber protein terutama protein hewani, zat besi, vitamin B12, dan vitamin C serta mengatur pola makan. Anemia is a public health problem which is still higher prevalence in teenagers because during this period in very rapid growth. This study aims to determine the relationship of several factors such as consumption of protein, iron, vitamin B12, and vitamin C with the incidence of anemia in junior high school students in Makassar. The study was cross sectional study. Sample are first and second grade students who are selected by purposive sampling is 50 people. Food consumption data collection was performed with 24 hour recall form and measurement of Hb by using hemocue. The result with chi-square analysis found that there is relationship between protein consumption (p=0,000), consumption of iron (p=0,002), intake of vitamin B12 (p =0,044), and consumption of vitamin C (p=0,006) with the incidence of anemia. It is suggested that the student increase the consumption of food from protein, especially animal protein, iron, vitamin B12, and vitamin C as well as regulate diet.
District Health Information System on Maternal, Newborn and Child Health How Good Is It? A Case of Deli Serdang and Sumedang Districts Achadi, Anhari
Kesmas Vol. 4, No. 5
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Data dan informasi yang valid sangat penting untuk program kesehatan, terutama untuk perencanaan, pemantauan, dan evaluasi. Sistem Informasi Kesehatan Kabupaten dibuat untuk menghasilkan data rutin tentang indikator proses dan output program kesehatan di tingkat kabupaten. Studi ini, yang dilakukan di kabupaten Deli Serdang dan Sumedang, bertujuan untuk mengetahui proses bekerjanya SIK Kabupaten, serta ketersediaan, kualitas dan penggunaan data yang dihasilkan. Pengumpulan data dilakukan dengan menggunakan beberapa cara, yaitu wawancara mendalam dengan para pemangku kepentingan di desa, fasilitas kesehatan, dan kabupaten, pemeriksaan formulir-formulir yang digunakan di semua tingkatan, dokumen lainnya, serta laporan. Temuan studi menunjukkan adanya kelemahan-kelemahan SIK dalam semua tingkatan. Karena kompleksnya, sistem menghasilkan data dan informasi yang tidak akurat, dengan tingkat penggunaan yang rendah. Valid data and information are critical for any health programs, in particular for planning, monitoring and evaluation purposes. District Health Information System is designed to produce routine data on process and output type of indicators at district level. This study, taking place at Deli Serdang and Sumedang districts, has its objectives as to learn about the current practice of DHIS, specifically looking at its process and the availability, quality and utilization of the data. Methods of data collection include in-depth interview with stakeholders at village, health facility and district levels, examination of existing forms at all levels as well as other documents and reports. Findings suggest that weaknesses of DHIS prevail at each level of the system. Complexity of the system has produced inaccurate and suboptimal the use of generated data and information.
Determinan Abortus di Indonesia Kuntari, Titik; Wilopo, Siswanto Agus; Emilia, Ova
Kesmas Vol. 4, No. 5
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Abortus menjadi masalah yang penting dalam kesehatan masyarakat karena berpengaruh terhadap morbiditas dan mortalitas maternal. Di Indonesia, belum ada data yang komprehensif tentang kejadian abortus, berbagai data yang ada sebelumnya berdasarkan survei dengan cakupan yang relatif terbatas. Abortus yang tidak aman bertanggung jawab terhadap 11% kematian ibu di Indonesia. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan kejadian abortus di Indonesia. Penelitian ini dilaksanakan dengan metode observasional menggunakan disain studi cross sectional. Data penelitian diperoleh dari data Survei Demografi dan Kesehatan Indonesia 2002-2003. Analisis data dilakukan secara bertahap yaitu: analisis univariat, analisis bivariat dan analisis multivariat dengan regresi logistik. Hasil menunjukkan bahwa risiko abortus meningkat seiring dengan peningkatan usia ibu. Wanita dengan paritas 0-2 berisiko lebih tinggi untuk mengalami abortus dibandingkan wanita dengan paritas 3 atau lebih (OR=5,2, IK 95%=3,49-7,89). Wanita yang bekerja berisiko 2,7 kali lebih tinggi untuk mengalami aborsi daripada wanita yang tidak bekerja (OR= 2,7 , IK 95%= 2,10-3,58). Selain itu, risiko abortus meningkat pada wanita yang menikah pada usia 30 tahun atau lebih (OR=1,8, IK95%= 1,30-2,48). Risiko abortus tidak berhubungan bermakna dengan riwayat abortus sebelumnya, tingkat pendidikan dan tingkat sosial ekonomi. Abortion has become a main problem in public health because of its impact on maternal morbidity and mortality. There is no comprehensive data on abortion in Indonesia. So far, data were based on survey with limited coverage. Unsafe abortion is responsible to 11 percent of maternal mortality in Indonesia. This research objective is to determine factors related to abortion in Indonesia. The study was an observational method with cross sectional design. These data are gathered from Indonesian Demography and Health Survey 2002–2003. Data analysis used univariate, bivariate and multivariate analysis with logistic regression. The risk of an abortion increased in line with the increasing of maternal age. Women with 0-2 parity have higher risk than multiparity (OR=5.2, IK95%=3.49-7.89). Employed women have higher risk than unemployed (OR=2.7, IK95%=2.10-3.58). The risk of abortion increased among women married at 30 years old or over (OR=1.8, IK95%=1.30-2.48). There is no significant association between history of abortion, education, socioeconomic and risk of abortion.
Keracunan Pestisida dan Hipotiroidisme pada Wanita Usia Subur di Daerah Pertanian Suhartono, Suhartono; Dharminto, Dharminto
Kesmas Vol. 4, No. 5
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Wanita bermukim di daerah pertanian berisiko terpajan pestisida yang dapat berakibat hipotiroidisme yang pada kehamilan dapat menyebabkan gangguan tumbuh-kembang janin. Tujuan penelitian ini adalah mengetahui angka kejadian keracunan pestisida dan hipotiroidisme pada wanita usia subur di daerah pertanian. Penelitian ini menggunakan disain penelitian cross-sectional dan 26 WUS terpilih sebagai subjek secara acak. Semua subjek dilakukan pengukuran kadar TSH, fT4 dan enzim kolinesterase, sementara kadar T3, UEI, dan Pb darah diukur pada sub-sampel. Penderita dinyatakan keracunan pestisida apabila ditemukan kadar enzim kolinesterase 4,5 μIU/L. Penelitian ini menemukan rerata kadar kolinesterase adalah 7,26 (±1,28) dengan kisaran nilai 5,33-9,39 μg/L; rerata kadar TSH adalah 5,09 (±6,14), dengan kisaran nilai 0,47-31,73μIU/L; rerata kadar fT4 adalah 15,18 (±2,09), dengan kisaran nilai 8,73-18,87 pmol/L; rerata kadar T3 adalah 1,75 (±0,51), dengan kisaran nilai 1,24-2,95 pmol/L. Prevalensi keracunan pestisida pada WUS 0,0% dan prevalensi hipotiroidisme 46,2%. Women lived in agricultural areas are risk to suffer various disorders due to pesticides exposure such as hypothyroidism. Hypothyroidism causes growth and development disorders of fetus. The aim of the study is to find out the prevalence of pesticide poisoning and hypothyroidism in women of childbearing age in agricultural areas. Cross-sectional study was conducted and 26 women of childbearing age were selected randomly. TSH, fT4 and cholinesterase enzyme levels were measured in all subjects, while levels of T3, UEI and blood Pb were measured in the sub-sample. Pesticide poisoning is determined if the levels of enzymes cholinesterase 4.5 μIU/L. This study showed that mean of cholinesterase levels was 7.26 (± 1.28), range of values 5.33-9.39 μg/L; mean of TSH levels was 5.09 (± 6.14), range of values 0.47-31.73 μIU/L; mean of fT4 level was 15.18 (± 2.09), range of values 8.73-18.87 pmol/L; mean of T3 levels was 1.75 (±0.51), range of values 1.24-2.95 pmol/L. The prevalence of pesticide poisoning in childbearing women was 0.0% and prevalence of hypothyroidism was 46.2%.
Perbandingan Dua Metode Estimasi Pajanan Pestisida di Tempat Kerja Prihartono, Nurhayati
Kesmas Vol. 4, No. 5
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Informasi yang valid tentang pajanan masa lalu mungkin sulit didapat dari wawancara individu. Peran ahli seperti higiene industri atau pertanian dalam mengestimasi pajanan pestisida dengan menggunakan jenis pekerjaan dapat meningkatkan validitas data pajanan. Penelitian ini bertujuan membandingkan pajanan pestisida di tempat kerja yang ditentukan berdasarkan laporan individu dan ahli, serta mempelajari pola perbedaan tingkat pajanan dari kedua metode tersebut. Laporan individu berasal dari studi kasus kontrol tentang anemia aplastik di Thailand. Estimasi ahli digunakan untuk menentukan tingkat pajanan terhadap 4 jenis pestisida pada setiap 476 jenis pekerjaan. Instrumen standar dibuat berdasarkan probabilitas pajanan, frekuensi, intensitas dan keyakinan diri dalam menentukan pajanan. Penelitian ini menemukan kesesuaian yang buruk tentang pajanan yang ditentukan oleh kedua metode. Petani padi merupakan kelompok pekerja terbesar yang dinyatakan terpajan ke empat pestisida oleh ahli, tetapi hampir semua petani padi tidak melaporkan keterpajanan tersebut. Ada perbedaan dalam melaporkan pajanan: kelompok kasus, pria, usia muda, dan pekerja yang mempunyai penghasilan tinggi cenderung melaporkan pajanan. Dengan ketidakyakinan estimasi pajanan dari kedua metode ini, maka gabungan pajanan yang berasal dari ahli dan laporan individu akan meningkatkan kegunaan kedua metode dan meningkatkan validitas pajanan. Obtaining valid information on past exposures from personal interview may be difficult. The role of experts such as industrial hygienists or agronomists in estimating pesticide exposures could improve the validity of data. The aims of this study are to compare occupational pesticides exposures determined by self-reports and experts, and to examine the discrepancies patterns of exposure ratings obtained by two methods. Self-report exposure information was derived from a case-control study of aplastic anemia in Thailand. Expert judgments were used to assign levels of exposure toward 4 different pesticides among 476 job titles. A standardized instrument was developed based on exposure probability, frequency, intensity and confidence rating. There was a poor appropriateness on pesticide exposure ratings obtained by two methods. Expert cited that grain farmers were the most exposed group among job titles from four pesticides; however, almost grain farmers denied the exposures. There was a discrepancy in reporting the exposure; case groups, youth, male and higher incomes were more likely to report the exposures. Due to the uncertainty of exposure estimation from the two methods, combining estimation both of expert and self-report may enhance the utility of both methods and improve the validity of exposure estimation.
Kesehatan Jiwa di Indonesia dari Deinstitusionalisasi sampai Desentralisasi Idaiani, Sri
Kesmas Vol. 4, No. 5
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Deinstitusionalisasi adalah kebijakan di bidang kesehatan jiwa yang dimulai di negara-negara maju sekitar tahun 1950. Kebijakan tersebut telah dilakukan di Indonesia, meskipun informasi tentang keberhasilan dan kegagalan masih terbatas pada pendapat profesional di kalangan psikiatri. Disaat program ini belum sepenuhnya berhasil, Indonesia mengalami perubahan politik yang mengantarkan pada kebijakan desentralisasi. Pada saat yang bersamaan, muncul masalah kekurangan tenaga dokter spesialis psikiater. Tujuan analisis ini adalah untuk melakukan kajian terhadap berbagai masalah yang berkaitan dengan psikiater dan deinstitusionalisasi pada era desentralisasi. Dalam artikel ini disajikan beberapa kondisi yang terjadi di negara lain serta kajian terhadap kebijakan yang ada di Indonesia. Berdasarkan informasi yang dikumpulkan dapat disimpulkan bahwa di Indonesia terjadi kekurangan tenaga psikiater, masalah deinstitusionalisasi terkait erat dengan pembiayaan bidang kesehatan. Perlu kajian lebih mendalam tentang dampak dan model yang sesuai untuk Indonesia melalui penelitian terapan, riset operasional khususnya di bidang kesehatan jiwa masyarakat. Desentralisasi akan berhasil meningkatkan pembangunan kesehatan jiwa apabila ada perkuatan dukungan lintas sektor khususnya legislatif. Deinstitutionalization is an international mental health policy started in 1950 by developed countries. This policy has implemented in Indonesia, even though there were no evaluation related to the policy. The opinion is still limited by professional judgment. While the program has not finished, Indonesia had political reformation. Decentralization was a part of reformation program. Besides, there was lack of psychiatrist in Indonesia. The aim of this study is to assess problems related to psychiatrist, deinstitutionalization and decentralization. Several policies and conditions in other country were informed. The conclusion of this study mentioned that there was lack of psychiatrist in Indonesia at present; the deinstitutionalization was influenced by national health financial. It needs further studies of effectiveness of community mental health programs through applied or operational research. Decentralization will succeed to improve mental health development if there is support from all sectors including the legislative.
Pemanfaatan Tanaman Obat Keluarga di Kelurahan Tanah 600, Medan Karo-Karo, Ulina
Kesmas Vol. 4, No. 5
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Pemanfaatan Tanaman Obat Keluarga (TOGA) tidak hanya sebagai bumbu masakan dan obat, tetapi jika ditekuni dengan sepenuh hati akan memberi nilai kepuasan, bahkan sebagai penopang kehidupan. Penelitian kualitatif dengan metode ‘Individual’s life history’ pada satu keluarga yang telah memanfaatkan tanaman obat sejak lama di Tanah 600 Kecamatan Medan Marelan. Tujuan penelitian untuk mengetahui pengalaman satu keluarga yang berhasil memanfaatkan tanaman obat keluarga sebagai sumber pendapatan keluarga. Pengumpulan data dilakukan dengan teknik pengamatan dan wawancara mendalam. Penelitian dilakukan pada periode Februari-April 2009. Informan adalah Mak Intan, dilengkapi dengan keterangan suami, anak, menantu dan orang lain yang mengenal Mak Intan. Analisis data dilakukan dengan teknik ‘on going analysis’. Hasil penelitian menunjukkan bahwa pemanfaatan TOGA memerlukan pengetahuan, perjuangan untuk mengembangkan TOGA dan keinginan-keinginan. Pengetahuan diperoleh tidak hanya dari warisan keluarga dan membaca tetapi dapat ditingkatkan dengan adanya pujian dan jalinan kerja, baik dengan Dinas Kesehatan atau teman seprofesi. Perjuangan pengembangan TOGA dimulai dengan tahap jamu gendong, mengikuti pameran, dan pembuatan jamu instan. Pemanfaatan TOGA akan memberikan nilai ekonomis, nilai keindahan, dan nilai kepuasan. Family Crops Medicine (TOGA) is used as culinary spices and medicine, at present it also can be utilized as earnings. If learned seriously, it also gives a satisfactory value. This study is a qualitative research using ‘individual’s life history’ method. Family utilized TOGA for long time in tanah 600 District Marelan Medan was selected. The aim of this study is to know the experience of a family that successfully utilized TOGA as a health treatment and family earnings. Data was collected by observation and in-depth interviews. Research was conducted during February to April 2009. Informant is an old woman called mak Intan. Information from her husband, son in law and anyone knowing mak Intan were also obtained. Data was analyzed by “ongoing analysis” technique. The result indicates that TOGA utilization requires knowledge and strong willingness to develop TOGA. The knowledge is not only obtained from family legacy and readings, but also cooperated with health district office or colleagues. The struggle to develop TOGA is started from backpacking herbal medicine, attending exhibition and making instant herbal medicine. Utilization of TOGA will provide economic, esthetic and satisfactory values.
Identifikasi Penyebab Diare di Kabupaten Karangasem, Bali Sujaya, I N.; Aryantini, N.P. Desy; Nursini, N.W.; Purnama, S.G.; Dwipayanti, N.M.U.; Artawan, I G.; Sutarga, I M.
Kesmas Vol. 4, No. 4
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Abstract

Pada Februari hingga Maret 2008 terjadi kejadian luar biasa muntah berak (diare) di Kabupaten Karangasem Bali. Tercatat sekitar 600 orang mengalami muntaber dan 5 orang meninggal dunia. Ini merupakan kejadian KLB muntaber pertama kali di Bali serta belum diketahui patogen penyebab diare tersebut. Tujuan penelitian ini adalah mengidentifikasi penyebab diare di Karangasem serta kemungkinan rantai penularannya. Penelusuran penyebab KLB dilakukan dengan menganalisis sampel air yang diambil dari sumber air umum, cubang/sumur penduduk, bahan makanan, serta rectal swab penderita dengan kombinasi teknik pemupukan kuman dan PCR spesifik dengan target gen pembentuk toksin pada Escherichia coli. Dengan melakukan kultur pada sampel makanan diperoleh bahwa 11 dari 21 sampel makanan positif mengandung E. coli. Dari sampel yang positif E. coli, 2 sampel yang diambil di rumah penderita muntaber terdeteksi gen pembentuk shiga like toxin tipe I dan II pada E. coli. Deteksi gen pengkode shiga like toxin tipe I juga terdeteksi pada penderita dan beberapa sampel air dari cubang penduduk. Hal ini menunjukkan bahwa E. coli pembentuk shiga ike toxin tipe I merupakan penyebab KLB di Karangasem. Lebih lanjut diperoleh bahwa pita shiga like toxin tipe I dan tipe II. E. coli strain Karangasem berbeda dengan strain EHEC sehingga strain Karangasem ini kemungkinan merupakan strain E. coli patogen baru yang terjadi akibat perubahan genetik pada E. coli pembentuk shiga like toxin yang ditemukan di Bali. In February to March 2008, Bali was shocked by the outbreak of diarrhea in Karangasem District, Bali. It was recorded that 600 people were having diarrhea and 5 people were died due to the disease. This outbreak was the first time happened in Bali and the causing pathogen was not yet identified. The aim of this study was to identify the causing pathogen of diarrhea in the outbreak case in Karangasem, as well as to identify the possible transmitting pathway. The tracking of outbreak cause was carried out by analyzing water sample taken from communal clean water source, private clean water reservoir, food sample, as well as rectal swab of the patient with the combination of pathogen enrichment technique and specific PCR with Escherichia coli as the target of toxin forming agent. Based on the culture growth from food samples, it was found that 11 from 21 samples were E. colipositive. From samples that E. colipositive, 2 sam-ples that were taken from patient’s house were detected a shiga like toxic forming gene, type I and II on the E. coli. The similar shiga like toxin forming gene type I was also detected on samples from patient and samples from water of private family cubang. This shows that E. colithat forms shiga like toxin type I was the diarrhea causing pathogen in this particular outbreak in Karangasem. Furthermore, it was found out that the ribbon formed by shiga like toxin type I and II differ from the strain of EHEC. Thus, it is possible that the strain found in Karangasem was a new strain of E. colipathogen due to genetic transformation on shiga like toxin forming E. coli that was found in Bali.

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