ANALYSIS RISK FACTORS RELATED TO

ACUTE RESPIRATORY INFECTION (ARI)

IN PUSKESMAS SUNGAI BESAR BANJARBARU

Ayi Sunarsih, Berson, Dwi Daravita Pertiwi, Lea, Merrylinda Permata, Minati Widiya
Astuti, Normahayati, Rahmanuddin1
College Student of Public Health, Medical Faculty, Lambung Mangkurat University

Email : klmpk2.Aj@yahoo.com

ABSTRACT
Based on the Prevalenceof ARI in 2016 in Indonesia has reached 25% with the range of
events that is about 17.5% - 41.4% with 16 provinces of which have a Prevalenceabove the
national rate. Peatlands are spread in Sumatra, Kalimantan and Irian Jaya (Papua); This area
rePrensentase(%)sents 60% of the total peat in the tropics. The land is at risk of a fire that
causes smoke haze. Puskesmas Sungai Besar is one of the work areas with the highest
incidence of ARI in Banjarbaru City of South Kalimantan. From 2017 shows that the
incidence of ARI to be the number 1 case in the top 10 diseases suffered by people who seek
treatment at the Puskesmas Sungai Besar with the number of visits as many as 3448 people or
21.08%. This is what underlies us to examine the risk factors that affect the incidence of ARI
in the Puskesmas Sungai Besar. The purpose of this research is to analyze the risk factors
associated with the incidence of ARI in the Area of Puskesmas Sungai Besar Banjarbaru
City. This research uses cross sectional research design, which is an analytic survey study.
Cross sectional observation is the research of Prevalenceof disease and also the Prevalenceof
cause or risk factor. The population of this research is all people suffering from ARI who
have visited to Puskesmas Sungai Besar in Banjarbaru are 428 people in 2018 samples taken
are 84 people.
Keywords : ARI, Risk Factors, Smoke Haze.

INTRODUCTION
Health is a human right and an investment for the success of nation building. For that
purpose, the development of health is comprehensive and sustainable. Acute respiratory
infection (ARI) is known as one of the leading causes of death in infants, and children under
five in developing countries. Nearly all ARI deaths in infants and toddlers are generally
caused by lower respiratory tract infections (pneumonia). The World Health Organization

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(WHO) estimates the incidence of Acute Respiratory Infections (ARI) in developing
countries with under-five mortality rates of over 40 per 1000 live births of 15% -20% per
year at toddlers. In Indonesia, Acute Respiratory Infection (ARI) always ranks first in the
cause of death in infants and toddlers. Based on the Prevalence of ARI in 2016 in Indonesia
has reached 25% with the range of events that is about 17.5% - 41.4% with 16 provinces of
which have a Prevalence above the national rate.
In addition, ARI is also often on the list of 10 most diseases in the hospital. The
mortality survey conducted by the ARI Sub-Directorate in 2016 puts ARI / ARI as the
biggest cause of infant mortality in Indonesia with a percentage of 32.10% of all under-five
mortality. Air is an important factor in life, but with the increasing physical development of
cities and industrial centers, air quality has changed. Air pollution in Banjarbaru City is partly
caused by the smoke pollution of vehicles caused by the rapid growth of vehicles, like
motorcycle and car, etc. in Banjarbaru or in South Kalimantan. Banjarbaru is the main route
through which the motor vehicle passes either to the provincial capital in Banjarmasin or out
of the area to the city in the area of South Kalimantan. Besides, the cause of air pollution in
Banjarbaru City is caused by the smoke haze arising from forest and land fires that usually
occur in the dry season1.
The term acute respiratory infection (ARI) contains three elements: infection, respiratory
tract, and acute. Infection is the incidence and multiplication of microorganisms (agents) in
the host body, whereas infectious diseases are clinical manifestations in the event of tissue
damage and / or function when the host inflammatory reaction is called. Respiratory tract is
an organ that starts from the nose to the alveoli and its organ adnexanya (sinuses, middle ear
and pleural cavity), while the acute infection is an infection that lasts up to 14 days, although
some diseases that can be classified in the ARI can last more than 14 day, such as pertussis.
ARI is a respiratory tract infection that can last up to 14 days, where clinically an acute sign
and symptom of infection occurs in each respiratory tract with no more than 14 days2.
Air pollution in Banjarbaru, among others, caused by the smoke pollution kendaraaan
caused by the rapid growth of the number of vehicles in Banjarbaru city or South Kalimantan.
Banjarbaru is the main route through which the motor vehicle passes to the provincial capital
in Banjarmasin and out of the area to the city in the area of South Kalimantan. Besides, the
cause of air pollution in Banjarbaru is caused by the smoke haze arising from forest and land
fires that usually occur in the dry season1.
Air is an important factor in life, but with the increasing physical development of cities
and industrial centers, air quality has changed. Air pollution in Banjarbaru is caused, among
others, by the smoke pollution of vehicles caused by the rapid growth of vehicles in South

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Kalimantan include Banjarbaru. Peatlands are in Sumatra, Kalimantan and Irian Jaya
(Papua); This area represence 60% of the total peat in the tropics. The land is at risk of
experiencing a fire that causes smoke haze 3.
Smoke disorders are also very negative impact on public health such as the emergence
of respiratory disorders4. Hendrik L. Blum suggests that environmental and behavioral factors
have a major impact on health status, in addition to health and hereditary factors. Puskesmas
Sungai Besar is one of the work areas with the highest incidence of ARI in Banjarbaru City,
South Kalimantan. In 2017 shows that the incidence of ARI to be the number 1 case in the
top 10 diseases suffered by people who seek treatment at the Puskesmas Sungai Besar with
the number of visits as many as 3448 people or 21.08%. This is what underlies us to examine
the risk factors that affect the incidence of ARI in the area of the Puskesmas Sungai Besar.
The general objective to be achieved in this research is to analyze the risk factors related to
the incidence of ARI at Puskesmas Sungai Besar in Banjarbaru City of South Borneo.

MATERIALS AND METHODS

The research use cross sectional research design, that is an analytic survey research. This
study aims to examine the relationship between risk factors for the consequences that occur in
the form of a disease or state (status) of a particular health at the same time. Cross sectional is
a study to study the dynamics of correlation between risk factors with effects, by approach,
observation, or data collection at one time (Point time approach). Cross sectional research
design has advantages such as easy to implement, simple, economical, in terms of time, and
results can be obtained quickly. Besides, at the same time can collect many variables, both
risk and effect variables5.
Research Locations Conducted At Puskesmas Sungai Besar. The study was conducted in
May 2018. The population of this study is patients with ARI visiting the Puskesmas, by
filling out questionnaires and interviews.
The data obtained by the researchers through interviews on the patient visits at the
Puskesmas Sungai Besar as respondents by holding a questionnaire that has been prepared
previously. Data analysis in this study using Univariate. Analysis is to obtain the frequency
distribution of all research variables by using computerized program. Then using Bivariate
Analysis to know the relation between independent variable with dependen, by using Chi-
Square test, with degree of trust / CI 90% and α = 0,05.

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 RESULTS AND DISCUSSION
From the results of the study obtained a description of respondents data consisting of
age, education, occupation, knowledge. ARI that can be seen in the distribution of the
following table:
Table 1. Frequency Distribution of Respondents by Age at Puskesmas Sungai Besar 2018
No Age Frequency Prensentase(%)
1 Old 27 32,11
2 Young 57 67,89
Total 84 100
From the above table it can be seen that more respondents aged <40 years or young age
that is as many as 57 respondents (67.89%) and a little with age ≥ 40 years as many as 27
respondents (32.11%).
Table 2. Frequency Distribution of Respondents by Education at Puskesmas Sungai
Besar 2018.
No Education Frequency Prensentase(%)
1 High 14 16,67
2 Middle 17 20,22
3 Low 53 63,11

Total 84 100
Based on the above table it can be seen the highest number of respondents with low
education level as much as 53 respondents (63.11%) and the least with high education level
as many as 14 respondents (16.67%).
Tabel 3. Frequency Distribution of Respondents by Occupation at Puskesmas Sungai
Besar 2018.
No Ocupation Frequency Prensentase(%)
1 Work 57 67,89
2 Not Work 27 32,11
Total 84 100

Based on the above table it can be seen that the most respondents are working the most
are 57 respondents (67.89%) and the few are not working ie 27 respondents (32.11%).

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 Tabel 4. Frequency Distribution of Respondents by Knowledge at Puskesmas Sungai Besar 2018.
No Knowledge Frequency Prensentase(%)
1 Good 18 21,44
2 Not Good 66 78,56
Total 84 100
Based on the above table it is known that respondents who have good knowledge level as
many as 18 respondents (21.44%) and who have a level of knowledge less good as much as
66 respondents (78.56%).
Table 5. Frequency Distribution of Respondents Based on Acute Respiratory Infection (ARI) Disease at
Puskesmas Sungai Besar 2018.
No ARI Frequency Prensentase(%)
1 Pneumonia 56 66,67
2 Not Pneumonia 28 33,33
Total 84 100
Based on the above table it can be seen that respondents who are pneumonia as many as
56 respondents (66.67%) who are not pneumonia as much as 28 respondents (33.33%).
a. Age Relation To Acute Respiratory Infection (ARI) Disease.
Table 6 Distribution of Respondent Age Relation With Acute Respiratory Infection (ARI) In Puskesmas
Sungai Besar 2018.

Age ARI Total P OR (95%CI)

Pneumonia(%) Not Pneumonia(%) (%) (Value)
Old 18 (66,67) 19 (33,33) 27 (100,0) 0,010 2,000 (0,379-
Young 38 (66,67) 9 (33,33) 57 (100,0) 2,642)

Total 56 (66,67) 28 (33,33) 84 (100,0)

Based on the above table shows that respondents who are old and suffering from
Acute Respiratory Infection (ARI) are 18 people (66.67%) and non-Pneumonia (19.33%),
Acute Respiratory Infection (ARI) diseases are 38 people (66.67%) and non-Pneumonia
(33.33%).
Chi-Square test shows that there is a significant correlation between age with Acute
Respiratory Infection (ARI) with p value (0,010), p value <α = 0,05 means that there is
correlation between respondent age with Acute Respiratory Infection (ARI). And the OR
value is 2,000, meaning that respondents with older age are 2 times more likely to avoid
Acute Respiratory Infection (ARI) disease than younger age.

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b. Education Relation to Acute Respiratory Infection (ARI).
Table 7 Distribution of Respondent Education Relation With Acute Respiratory Infection (ARI)
Disease In Puskesmas Sungai Besar 2018.
Education ARI Total P OR (95%CI)
Pneumonia(%) Not Pneumonia(%) (%) (Value)
High 9 (64,33) 5 (35,67) 14 (100,0) 0,032 2,855 (0,032-
Middle 7 (41,22) 10 (58,78) 17 (100,0) 0,037)
Low 40 (75,55) 13 (24,45) 53 (100,0)

Total 56 (66,67) 28 (33,33) 84 (100,0)

From the table above shows that respondents who are highly educated and suffering
from Acute Respiratory Infection (ARI) are 9 people (64.33%) and non-pneumonia (5)
(35.67%), while those with middle and suffering education Acute Respiratory Tract Infection
(ARI) of Pneumonia 7 (41,22%) and non pneumonia as many as 10 people (58,78%) and low
educated and suffering from Acute Respiratory Infection (ARI) disease that is 40 pneumonia
people (75.55%) and non-pneumonia as many as 13 people (24.45%).
The result of Chi-Square test showed a significant correlation between education with
acute respiratory tract infections with p value (0,032), p value <α = 0,05 means there is
correlation between respondent education with acute respiratory tract disease ARI). And the
value of OR is 2.855, meaning that respondents with low education have 2 times chance of
suffering from Acute Respiratory Infection (ARI).
c. Occupation Relation To Acute Respiratory Infection (ARI) Disease.
Table 6 Distribution of Respondent Occupation Relation With Acute Respiratory Infection (ARI) In
Puskesmas Sungai Besar 2018.

Occupation ARI jumlah P OR (95%CI)

Pneumonia(%) Not Pneumonia(%) (%) (Value)
Work 37 (64,89) 20 (35,11) 57 (100,0) 0,043 2,779 (0,290-
Not Work 19 (70,44) 8 (29,56) 27 (100,0) 2,094)

Total 56 (66,67) 28 (33,33) 84 (100,0)

From the table above shows that the respondents who work and suffer from Acute
Respiratory Infection (ARI) diseases are Pneumonia as many as 37 people (64.89%) and non-

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pneumonia as many as 20 people (35.11%), while those who do not work and suffer from
disease Acute Respiratory Infection (ARI), 19 people (70.44%) and non-pneumonia
(29.56%).
Chi-Square test results showed a significant relationship between the work with acute
respiratory tract infections with p value (0.043), then p value <α = 0.05 means there is a
relationship between the work of respondents with acute respiratory tract infections ARI).
And the value of OR is 2.779, meaning that respondents working a chance 2 times suffering
from Acute Respiratory Infection (ARI).
d. Knowledge Relations of Acute Respiratory Infection (ARI) Disease.
Table 9 Distribution of Knowledge Relations of Respondents With Acute Respiratory Infection Infections
(ARI) At Puskesmas Sungai Besar 2018.

Knowledge ARI jumlah P OR (95%CI)

Pneumonia(%) Not Pneumonia(%) (%) (Value)
Good 9 (50,00) 9 (50,00) 18 (100,0) 0,048 2,404 (0,139-
Not Good 47 (71,22) 19 (28,78) 66 (100,0) 1,175)

Total 56 (66,67) 28 (33,33) 84 (100,0)

From the table above shows that the respondents who are well knowledge and suffer
from Acute Respiratory Infection (ARI) are 9 people (50.00%) and 9 non-pneumonia
(50.00%), while those with less knowledge and suffering Acute Respiratory Infection (ARI)
disease was 47 people (71.22%) and non-pneumonia (19.68%).
Chi-Square test results showed a significant relationship between knowledge with acute
respiratory tract infections with p value (0.048), then p value <α = 0.05 means there is a
relationship between knowledge of respondents with acute respiratory tract infections ARI).
And the value of OR is 2.404, meaning that respondents with knowledge less likely 2 times
suffering from Acute Respiratory Infection (ARI).

1. Relation of Respondent Age Against Acute Respiratory Infection Disease (ARI).

Chi-Square test shows that there is a significant correlation between age with Acute
Respiratory Infection (ARI) disease with p value (0,010), p value <α = 0,05 means there is
correlation between respondent age with Acute Respiratory Infection (ARI). And the OR
value is 2,000, meaning that respondents with older age are 2 times more likely to avoid
Acute Respiratory Infection (ARI) disease than younger age.

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 This is in line with research conducted by Sarbi (2008) on factors affecting Acute
Respiratory Infection (ARI), the results showed that the age of respondents had a significant
influence on ARI, where young age had 12 times chance of ARI disease compared with old
age.
This means that age can directly affect one's knowledge. This is in line with the theory
developed by Notoatmodjo (2003) which states that age affects the capability and mindset of
a person. The more aged will be the more developed the ability to catch and the mindset, so
that knowledge gained better. At a young age, individuals will play a more active role in
society and social life and more to prepare for the success of adjusting to old age, other than
that young people will spend more time to read. Intellectual abilities, problem solving, and
verbal skills are reported almost no decrease in this age. Two traditional attitudes about the
course of development during life6.
The older the wiser, the more information it encounters and the more things it does to
increase its knowledge. Can not teach new intelligence to an elderly person due to a decline
both physically and mentally. It can be expected that IQ will decrease with age, especially in
some other capabilities such as vocabulary and general knowledge. Some theories argue that
one's IQ will decrease quite rapidly with age.
2. Respondent Education Relations Against Acute Respiratory Infection Disease (ARI).
Chi-Square test results showed a significant relationship between education with acute
respiratory tract infections with p value (0,032), p value <α = 0,05 means that there is
correlation between respondent education with acute respiratory tract disease ARI). And the
value of OR is 2.855, meaning that respondents with low education have 2 times chance of
suffering from Acute Respiratory Infection (ARI).
This is in line with the theory of Notoatmodjo (2003) education is an attempt to develop
personality and abilities in and out of school and lasts a lifetime. Education affects the
learning process, the higher a person's education the easier the person is to receive
information. With higher education then someone will tend to get information, either from
other people or from mass media. The more information that goes in the more knowledge
gained about health. Knowledge is closely related to education where it is expected that
someone with higher education, then the person will be wider knowledge. It should be
emphasized, however, that a lowly educated person is by no means an absolute
understatement6.
Increased knowledge is not absolutely obtained in formal education, but also can be
obtained in non-formal education. A person's knowledge of an object also contains two
aspects: positive and negative aspects. These two aspects will ultimately determine a person's

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attitude toward a particular object. The more positive aspects of a known object, the more
positive the attitude toward the object will grow.
3. Respondent Employment Relations Against Acute Respiratory Infection Disease
(ARI).
Chi-Square test results showed a significant relationship between the work with acute
respiratory tract infections with p value (0.043), then p value <α = 0.05 means there is a
relationship between the work of respondents with acute respiratory tract infections ARI).
And the OR value is 2,779, meaning that the respondent working has 2 times chance to suffer
from Acute Respiratory Infection (ARI).
According Notoatmodjo (2003) Environment is everything that is around the individual,
both physical, biological, and social environment. The environment affects the process of
entry of knowledge into the individuals residing within the environment. This happens
because of the interaction of reciprocity or not that will be responded as knowledge by each
individual6.
4. Relation of Knowledge of Respondent to Acute Respiratory Infection (ARI) Disease.
Chi-Square test results showed a significant relationship between knowledge with acute
respiratory tract infections with p value (0.048), then p value <α = 0.05 means there is a
relationship between knowledge of respondents with acute respiratory tract infections ARI).
And the value of OR is 2.404, meaning that respondents with knowledge less likely 2 times
suffering from Acute Respiratory Infection (ARI).
This is in line with research conducted by Sarbi (2008) on factors influencing Acute
Respiratory Infection (ARI), the results showed that the knowledge of the respondents had a
significant influence on ARI, where less than 12 times had ARI with good knowledge.
This is incompatible with Azwar's (2006) theory of knowledge can affect one's
behavior. Knowledge is the result of knowing and this happens after people have sensed an
object. Knowledge is the result obtained from the results of the process, in addition to the
results obtained from the senses that have their own values7.
From the results of studies conducted by the WHO and health education experts, it was
revealed that people's knowledge about waste is good, but practice in handling waste is still
very low. Changes or improvements in community knowledge are not matched by an
improvement or change in behavior.
Knowledge is an insight into what people know about attitudes and actions taken. The
high knowledge of one's behavior will improve, otherwise if someone's knowledge is less
then it can be less reasonable behavior. So the decisions made often lead to failure or error 8.

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 The factors that affect one's risk of ARI, namely environmental factors, individual
characteristics and worker behavior. Environmental factors include air pollution (tobacco
smoke, air pollution from industrial products and fuel burning fumes for high concentrations
of cooking). Individual factors such as age, gender and educational level may also affect the
risk of exposure to ARDs. Worker behavior includes smoking and mask use 9.
The level of knowledge affects the anticipation of respondents to anticipate ARI disease such
as ignorance to use the mask. Exposure to dust can cause acute or chronic respiratory distress.
Dust particles that can cause acute respiratory disturbance one of them are industrial
products that can contaminate the air such as coal dust, cement, cotton, asbestos, chemicals,
poisonous gas, dust on rice milling (organic dust) and others. Various 3 factors affect the
occurrence of disease or interference with the airway due to dust. Factors that include dust
factor which includes the particle, shape, concentration, solubility and chemical properties
and long exposure. Individual factors include pulmonary defense mechanisms, anatomy and
respiratory physiology 10.

CONCLUTIONS
Factors that may affect the occurrence of Acute Respiratory Infection (ARI) as follows:
1. Age of respondent to disease of Acute Respiratory Infection (ARI) by using Chi-Square
test at p value 0,010 <α = 0,05
2. Respondent's education on Acute Respiratory Infection (ARI) by using Chi-Square test
in p value 0,032 <α = 0,05.
3. Respondent's work on Acute Respiratory Infection (ARI) by using Chi-Square test in p
value 0,043 <α = 0,05.
4. Knowledge of responder to disease of Acute Respiratory Infection (ARI) by using Chi-
Square test in p value 0,048 <α = 0,05.

SUGESTIONS
Based on the research done get som suggestions as follows:
1. It is expected that health workers should be regularly held health education
2. Preferably the government prioritizes the health of the village at least often provide
counseling and add health facilities.
3. It is expected that the public to get used to clean and sanitary life to avoid disease

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10. Cahyana A. Djajakusli R. Rahim MR. 2012. Faktor yang berhubungan dengan
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Mandiri Kaltim Tahun 2012. FKM Unhas

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