THE DESCRIPTION OF LARVA FREE INDEX AS COMBI ( COMMUNICATION FOR BEHAVIORAL IMPACT ) DENGUE HEMORRHAGIC FEVER PREVENTION INDICATOR

Dengue hemorrhagic fever (DHF) has a high incidence rate, especially in the tropical and subtropical area. Various efforts have been made as an attempt to empower the community in PSN-dengue program, but has not yet reached the optimal result. COMBI (Communication for Behavioral Impact) is a dynamic team working to formulate and deliver the message, materials, and appropriate communication media for community problems found by way of a mutually agreed settlement of the problem.Quantitative research was done by cross sectional method to check the water storage containers inside the houses of the respondents. The number of the respondents were 990 male (38.1%), 1612 female (61.9%). Three (0.1%) respondents were aged <17 years, 249 (9.6%) were 17-25 years old, 526 (20.2%) were 26-35 years old, 706 (27.1%) were 36-45 years old, 602 (23.1%) were 46-55 years old, 348 (13.4%) were 56-65 years old, 173 (6.7%) were >65 years old. Most dominant level of education and employment statuses were 1107 (42.5%) high school and 858 (32.9%) were housewives. The average numbers of Larva Free Index in Sleman Regency, Bantul Regency and Yogyakarta municipality were 75.8%; 70.9%; and 77.3% respectively. The average CI in Yogyakarta municipality was 7.05%, Sleman Regency was 9.68%, and Bantul Regency was 20.86%. The average HI in Yogyakarta municipality was 22.7%, Sleman Regency was 24.13%, and Bantul Regency was 29.02%. This study suggested that the LFI, CI and HI were not in accordance with the target of the Ministry of Health.


Introduction
Dengue Hemorrhagic Fever (DHF) has a high incidence rate especially in the tropics and subtropics (Achmadi, 2010).Data from WHO (World Health Organization) estimated around 50-100 million dengue fever cases happens each year in nearly half of the world's population, and approximately 75% of cases occurs in Asia Pacific.Dengue hemorrhagic fever is one of the major public health problems in Indonesia.The number of dengue hemorrhagic fever patients and the wide spreading of the disease are increasing linearly with increasing mobility and population density (Achmadi, 2010;Suryanto, 2017).Kotamadya Yogyakarta, in 2015.
Observation of the presence of larvae assisted by local area Jumantik (Juru Monitoring Jentik).Evaluation of larva presence is done by observing water containers inside the respondent's house according to Technical Guidance of Eradicating Mosquitoes of Dengue Hemorrhagic Fever.Among others, places or vessels that can be a breeding ground for Aedes aegypti mosquitoes were examined (eyesight only) to know the presence of larvae.Examination of large water reservoirs such as tubs, jars, drums, and other water reservoirs, if at first sight any larvae was not found, wait approximately ½ -1 minute to ensure that larvae did not exist.Examination of small breeding places such as flower vases, potted plants, bottles with turbid water, often required the water in the shelter to be moved elsewhere.Examination of larvae in a dark place or turbid waters used a flashlight.
Demographic data of respondents including gender, age, education level, income, and information media are presented in the form of descriptive statistic (percentage, and the calculation of larvae was done by calculating the LFI (larvae free index) which is the comparison of number of houses that have no larvae compared to the number the overall houses under study, multiplied by 100% .The target of LFI from the Government is over 95%.

Results and Discussion
Characteristics of respondents showed the number of female respondents was (61.9%) more dominant than male (38.1%).Respondents were mostly 36-45 years old with 27.1%, with a dominant education level of high school (42.5%).The most dominant occupation was housewife by 858 (32.9%).
There was a significant relationship between knowledge and the behavior of eradicating dengue mosquito nest in Karangjati Village, where the behavior of mosquito eradication was good if the knowledge was also good.There was a positive relationship between education level and health level.One explanation that can be put forward is that with a good level of education, a healthy lifestyle will improve, due to increased knowledge about health behavior and health outcomes.There was a positive relationship between knowledge, by, for and with the community, by using appropriate social and cultural communication in place, to influence the environment so as to mobilize the community and enable them to carry out the control of PSN-DBD.The planning of COMBI's implementation consists of 15 steps, which are forming a multidisciplinary planner team, establishing initial behavioral objectives, planning and conducting formative research/survey/research, seeking feedback from formative research, analyzing and setting final behavioral goals, segmenting target audiences, developing strategy, previewing behavior, messages and materials, designing monitoring systems, strengthening staff skills, designing and establishing information governance systems, developing program structures, developing strategic execution plans, budgeting, pilot testing and revising strategic execution plans).COMBI aims to transforming the society from being ignorant to knowing, from knowing to willing, and from willing to being able to prevent Dengue Hemorrhagic Fever.The goal of the community empowerment is when they understand that DHF is a problem for themselves.
The LFI (Larvae Free Index) of 1994-2008 was still below the target even though some places had been given COMBI implementation interventions (Achmadi, 2010).Therefore it is necessary to evaluate the implementation of COMBI with parameters LFI, CI, and HI as one indicator of the success of mosquito nest eradication in Yogyakarta Special Region.

Methods
The research was conducted by cross sectional quantitative method to the respondents with cluster random sampling technique in Yogyakarta Special Region, covering Sleman, Bantul, and Yogyakarta Municipality.
The data collected from larvae were carried out on 2604 respondents in 13 subdistricts taken by accidental sampling, including Mlati sub-district, Gamping subdistrict, Kalasan sub-district, Godean subdistrict, Piyungan sub-district, Kasihan subdistrict, Sewon sub-district, Banguntapan sub-district (of the Bantul Regency), and Tegalrejo Sub-district, Wirobrajan Sub-District, Gondokusuman Sub-District, Mantrijeron Sub-District, Umbulharjo Sub-district, in behavior, and practice with significance of p <0.001.Work was not statistically related to community behavior in PSN-DBD (p = 0.260).Community behavior among the unemployed were better (63%) in PSN when compared to the working community (51.9%) (Hardayati, 2011).This is similar to that of Wong et al., 2015 which suggested that dengue prevention practices in a group of people with skilled job were poorer than the unemployed group (Wong, 2015).This might be caused by the respondents encountered in the study were mostly housewives who were not working and had more time at home and were responsible for house hygiene, and PSN may be included.On the other hand, working people may have less time in implementing DHF prevention (Wong, 2015).
The larvae free index of Sleman, Bantul and Municipality of Yogyakarta did not achieve the target according to the Ministry of Health (more than 95%).This showed that vector control and PSN-DHF had not been successful.Community hygiene behavior was also related to PSN-DHF activities.Most communities rely on the role of health workers in mosquito vector control.The role of society is more dominant in the prevention of DHF.The condition is influenced by the level of public awareness of the behavior of clean living is still low (Parida, 2012).
The highest LFI of the three regencies/ municipalities was found in Yogyakarta Municipality, and the lowest LFI was achieved by Bantul Regency.LFI values that were still far from the target indicated that the risk of the spread of dengue disease is high, and therefore the effort to prevent DHF by empowering the community through the 3M PSN Movement with COMBI approach needs to be improved.The low value of LFI also showed that community members did not understand that DHF is a threat to themselves/the level of awareness of the people is still low, so based on COMBI theory, the residents should understand that DHF is a threat to their health and even their life.
Surveys of Aedes aegypti density are important to determine the extent of vector spread and to prioritize areas and seasons for vector control.Another indicator for controlling the spread of vectors is the Container Index (CI).The CI value is obtained from the number of positive containers containing the larva divided by the number of containers examined multiplied by 100%.The average of CI results from the three research areas obtained value of more than 5% so that the potential for breeding of Aedes aegypti mosquitoes.
Based on survey results, it is known that Bantul is the region with the most positive number of larvae containers compared to Sleman and Yogyakarta.Based on population The highest positive type of larvae containers were bathtubs and buckets.From several surveys conducted in several cities in Indonesia showed that the highest potential for breeding spots were containers used for daily necessities such as drums, jars, bathtubs, toilet tubs, buckets , and the like (Yudhastuti, 2005).
The presence of containers plays an important role in the density of Aedes larvae, as the more containers present will make more crowded mosquito density and will become more populous of Aedes mosquitoes (Raude, 2012).The more densely populated the Aedes mosquitoes, the higher the risk of dengue virus infection with faster spreading time therefore resulting in the number of cases of dengue fever to rapidly increase which eventually resulted in the outbreak of dengue disease (Sitio, 2008).
Value House Index (HI) is one of the indicators for the spread of DHF vectors, namely Aedes aegypti mosquitoes.HI obtained from the number of positive houses where larvae were found divided by the number of houses examined multiplied by 100%.
Researchers examined 200 houses in each subdistrict presented in Table 4.
Based on the survey results, it is known that the average HI of the three regions is more than 20%.The HI indicator for the risk of dengue hemorrhagic outbreaks based on theory is ≥10%.Pan American Health Organization established 3 (three) levels of risk of dengue transmission, with low risk is achieved by HI <0.1%, medium risk is if HI value is 0.1% -5%, high risk is if HI> 5%.Therefore, the three research areas were categorized as high risk for breeding and spreading of Aedes aegypti mosquitoes.
Bantul Regency is the region with the highest HI value of 29.02% (Table 4).This is in line with the results of CI Bantul region which also showed the highest value (Table 3).This caused the potential spread of DHF vectors in Bantul region to be the highest among the cities The discovery of many larvae in the houses showed that the PHBS culture (Clean and Healthy Behavior) in the society still needs to be improved.Mosquito is a vector of diseases that can fly to various areas with a maximum distance of 100 meters, unless carried by the wind.This caused the risk of spreading vectors from one home to another, increasing the risk of DHF outbreaks.
The eradication of vectors is still the best choice to reduce the number of people with DHF.The vector eradication strategy principally is the same as the general strategy advocated by WHO by making adjustments on the ecology of disease vectors in Indonesia.The strategy consists of individual protection, vector eradication in outbreaks and vector eradication for epidemic prevention, and prevention of the spread of DHF (Sitio, 2008).
Implementation of mosquito nest eradication is an important action to break the chain of DHF mosquito spreading.This is supported by Hasan (2007) study which stated that the habit of doing PSN was related to the incidence of DHF, individuals who did not implement 3M were at risk of 5.85 fold greater (95% CI: 2.86-11.99)for dengue than individuals who did implement the 2M or 3M.
Control of DHF through PSN is possible only through community movements, which is impossible without increased knowledge and behavioral changes.The success of several countries controlling DHF was accomplished by continuously changing societal behavior with the COMBI method.Through routine monthly meetings to create a DHF control activity plan can sharply decrease the CI, HI, and BI (Hasan, 2007).
Based on the results of this study it is known that the value of free numbers of larvae, CI and HI still had not reached the standard set to reduce the incidence of DHF, so it can be stated that the implementation of COMBI especially for Bantul, Yogyakarta and Sleman has not reached the expected target in the control of DHF vector.The growth of public awareness as well as the active involvement of all sectors in PSN is very important to control the vector of dengue mosquitoes.

Conclusion
The results of this study indicated that the value of LFI in Yogyakarta province had not met the target of Ministry of Health (target> 95%), with 75.9% in Sleman Regency, 70.98% in Bantul Regency and 77.3% Municipality of Yogyakarta.The average CI (target <5%) in Yogyakarta Municipality was 7.05%, Sleman Regency was 9.68%, and in Bantul regency was 20.86%.The average HI (target <5%) in Yogyakarta Municipality was 22.7%, Sleman Regency was 24.13% and Bantul Regency was 29.02% .CI and HI were not in accordance with the targets set by the Ministry of Health Republic of Indonesia, so that vector control in the Special Region of Yogyakarta was not successful.

Table 2 .
Larvae Free Index of Sleman, Bantul and Municipality of Yogyakarta in 2015

Table 4 .
Value of House Index in Sleman, Bantul dan Kotamadya Yogyakarta in 2015