LAMPIRAN

KUESIONER PENELITIAN

BEBERAPA FAKTOR RESIKO YANG MEMPENGARUHI TINGGINYA

ANGKA KEJADIAN DEMAM BERDARAH DENGUE (DBD) BULAN
JANUARI – APRIL 2015 DESA SUMPUT KECAMATAN SIDOARJO
WILAYAH KERJA PUSKESMAS URANGAGUNG

A. KARAKTERISTIK RESPONDEN
1. Nomor :
2. Tanggal Penelitian :
3. Nama :
4. Jenis Kelamin :
1. Laki-laki 2. Perempuan
5. Umur : Tahun
6. Tingkat Pendidikan :
1. Tidak tamat SD
2. Tamat SD
3. Tamat SMP
4. Tamat SMA
5. Tamat D3/S1
7. Pekerjaan :
1. PNS/TNI/ABRI
2. Wiraswasta/Pengawai Swasta
3. Petani
4. Ibu Rumah Tangga
5. Pelajar
6. Belum sekolah.
8. Tingkat Sosial Ekonomi :
1. ≥ UMR Sidoarjo (Rp. 2.705.000,-)
2. < UMR Sidoarjo (Rp. 2.705.000,-)

1
B. SUMBER INFORMASI
Berikan checklist (√) dan pilihlah jawaban yang Anda anggap benar.

Kondisi Lingkungan

Indikator Lingkungan Ya Tidak

Menutup Tempat Penampungan
Air/Bak Mandi
Menguras Tempat Penampungan
Air/Bak Mandi 1 minggu sekali
Mengubur Barang bekas yang bisa
tergenang air
Mengunakan Obat Nyamuk di Rumah

Penyuluhan Kesehatan

a. Apakah ada penyuluhan kesehatan di Desa Anda tentang DBD yang

dilakukan oleh petugas kesehatan?

 Ada

 Tidak

b. Berapa kali dilakukan penyuluhan kesehatan yang Anda ikuti?

 Tidak pernah

 1 kali

 2 kali

 3 kali

2
 LAMPIRAN

CROSSTABS
/TABLES=Usia Pendidikan Pekerjaan Penghasilan Lingkungan Obat.Nyamuk Penyuluhan BY Penyakit
/FORMAT=AVALUE TABLES
/STATISTICS=RISK CMH(1)
/CELLS=COUNT

/COUNT ROUND CELL.

Crosstabs

Notes

Output Created 11-Jun-2015 23:07:30

Comments

Input Data C:\Users\7\Documents\spss awal.sav

Active Dataset DataSet1

Filter <none>

Weight <none>

Split File <none>

N of Rows in Working Data File 30

Missing Value Handling Definition of Missing User-defined missing values are treated as
missing.

Cases Used Statistics for each table are based on all the
cases with valid data in the specified
range(s) for all variables in each table.

Syntax CROSSTABS
/TABLES=Usia Pendidikan Pekerjaan
Penghasilan Lingkungan Obat.Nyamuk
Penyuluhan BY Penyakit
/FORMAT=AVALUE TABLES
/STATISTICS=RISK CMH(1)
/CELLS=COUNT
/COUNT ROUND CELL.

Resources Processor Time 00:00:00.110

Elapsed Time 00:00:00.224

Dimensions Requested 2

Cells Available 174762

[DataSet1] C:\Users\7\Documents\spss awal.sav

3
 Case Processing Summary

Cases

Valid Missing Total

N Percent N Percent N Percent

Usia * Penyakit 30 100.0% 0 .0% 30 100.0%

Pendidikan * Penyakit 30 100.0% 0 .0% 30 100.0%

Pekerjaan * Penyakit 30 100.0% 0 .0% 30 100.0%

Penghasilan * Penyakit 30 100.0% 0 .0% 30 100.0%

Lingkungan * Penyakit 30 100.0% 0 .0% 30 100.0%

Obat nyamuk * Penyakit 30 100.0% 0 .0% 30 100.0%

Penyuluhan * Penyakit 30 100.0% 0 .0% 30 100.0%

Usia * Penyakit

Crosstab

Count

Penyakit

DBD Tidak DBD Total

Usia <15 tahun 9 2 11

>15 tahun 6 13 19

Total 15 15 30

Risk Estimate

95% Confidence Interval

Value Lower Upper

Odds Ratio for Usia (<15 tahun

9.750 1.592 59.695
/ >15 tahun)

For cohort Penyakit = DBD 2.591 1.264 5.313

For cohort Penyakit = Tidak

.266 .073 .966
DBD

N of Valid Cases 30

4
 Tests of Homogeneity of the Odds Ratio

Asymp. Sig. (2-

Chi-Squared df sided)

Breslow-Day .000 0 .

Tarone's .000 0 .

Tests of Conditional Independence

Asymp. Sig. (2-

Chi-Squared df sided)

Cochran's 7.033 1 .008

Mantel-Haenszel 4.995 1 .025

Under the conditional independence assumption, Cochran's statistic is

asymptotically distributed as a 1 df chi-squared distribution, only if the
number of strata is fixed, while the Mantel-Haenszel statistic is always
asymptotically distributed as a 1 df chi-squared distribution. Note that the
continuity correction is removed from the Mantel-Haenszel statistic when
the sum of the differences between the observed and the expected is 0.

Mantel-Haenszel Common Odds Ratio Estimate

Estimate 9.750

ln(Estimate) 2.277

Std. Error of ln(Estimate) .925

Asymp. Sig. (2-sided) .014

Asymp. 95% Confidence Common Odds Ratio Lower Bound 1.592

Interval Upper Bound 59.695

ln(Common Odds Ratio) Lower Bound .465

Upper Bound 4.089

The Mantel-Haenszel common odds ratio estimate is asymptotically normally distributed under the common
odds ratio of 1,000 assumption. So is the natural log of the estimate.

5
Pendidikan * Penyakit

Crosstab

Count

Penyakit

DBD Tidak DBD Total

Pendidikan Rendah 9 2 11

Tinggi 6 13 19

Total 15 15 30

Risk Estimate

95% Confidence Interval

Value Lower Upper

Odds Ratio for Pendidikan

9.750 1.592 59.695
(Rendah / Tinggi)

For cohort Penyakit = DBD 2.591 1.264 5.313

For cohort Penyakit = Tidak

.266 .073 .966
DBD

N of Valid Cases 30

Tests of Homogeneity of the Odds Ratio

Asymp. Sig. (2-

Chi-Squared df sided)

Breslow-Day .000 0 .

Tarone's .000 0 .

Tests of Conditional Independence

Asymp. Sig. (2-

Chi-Squared df sided)

Cochran's 7.033 1 .008

Mantel-Haenszel 4.995 1 .025

6
 Tests of Conditional Independence

Asymp. Sig. (2-

Chi-Squared df sided)

Cochran's 7.033 1 .008

Mantel-Haenszel 4.995 1 .025

Under the conditional independence assumption, Cochran's statistic is

asymptotically distributed as a 1 df chi-squared distribution, only if the
number of strata is fixed, while the Mantel-Haenszel statistic is always
asymptotically distributed as a 1 df chi-squared distribution. Note that the
continuity correction is removed from the Mantel-Haenszel statistic when
the sum of the differences between the observed and the expected is 0.

Mantel-Haenszel Common Odds Ratio Estimate

Estimate 9.750

ln(Estimate) 2.277

Std. Error of ln(Estimate) .925

Asymp. Sig. (2-sided) .014

Asymp. 95% Confidence Common Odds Ratio Lower Bound 1.592

Interval Upper Bound 59.695

ln(Common Odds Ratio) Lower Bound .465

Upper Bound 4.089

The Mantel-Haenszel common odds ratio estimate is asymptotically normally distributed under the common
odds ratio of 1,000 assumption. So is the natural log of the estimate.

Pekerjaan * Penyakit
Crosstab

Count

Penyakit

DBD Tidak DBD Total

Pekerjaan Tidak Bekerja 8 6 14

Bekerja 7 9 16

Total 15 15 30

7
 Risk Estimate

95% Confidence Interval

Value Lower Upper

Odds Ratio for Pekerjaan (Tidak

1.714 .403 7.292
Bekerja / Bekerja)

For cohort Penyakit = DBD 1.306 .637 2.676

For cohort Penyakit = Tidak

.762 .362 1.602
DBD

N of Valid Cases 30

Tests of Homogeneity of the Odds Ratio

Asymp. Sig. (2-

Chi-Squared df sided)

Breslow-Day .000 0 .

Tarone's .000 0 .

Tests of Conditional Independence

Asymp. Sig. (2-

Chi-Squared df sided)

Cochran's .536 1 .464

Mantel-Haenszel .129 1 .719

Under the conditional independence assumption, Cochran's statistic is

asymptotically distributed as a 1 df chi-squared distribution, only if the
number of strata is fixed, while the Mantel-Haenszel statistic is always
asymptotically distributed as a 1 df chi-squared distribution. Note that the
continuity correction is removed from the Mantel-Haenszel statistic when
the sum of the differences between the observed and the expected is 0.

8
 Mantel-Haenszel Common Odds Ratio Estimate

Estimate 1.714

ln(Estimate) .539

Std. Error of ln(Estimate) .739

Asymp. Sig. (2-sided) .466

Asymp. 95% Confidence Common Odds Ratio Lower Bound .403

Interval Upper Bound 7.292

ln(Common Odds Ratio) Lower Bound -.909

Upper Bound 1.987

The Mantel-Haenszel common odds ratio estimate is asymptotically normally distributed under the common
odds ratio of 1,000 assumption. So is the natural log of the estimate.

Penghasilan * Penyakit
Crosstab

Count

Penyakit

DBD Tidak DBD Total

Penghasilan <UMR 2 11 13

> UMR 13 4 17

Total 15 15 30

Risk Estimate

95% Confidence Interval

Value Lower Upper

Odds Ratio for Penghasilan

.056 .009 .366
(<UMR / > UMR)

For cohort Penyakit = DBD .201 .055 .740

For cohort Penyakit = Tidak

3.596 1.480 8.738
DBD

N of Valid Cases 30

Tests of Homogeneity of the Odds Ratio

Asymp. Sig. (2-

Chi-Squared df sided)

Breslow-Day .000 0 .

9
 Tests of Homogeneity of the Odds Ratio

Asymp. Sig. (2-

Chi-Squared df sided)

Breslow-Day .000 0 .

Tarone's .000 0 .

Tests of Conditional Independence

Asymp. Sig. (2-

Chi-Squared df sided)

Cochran's 10.995 1 .001

Mantel-Haenszel 8.398 1 .004

Under the conditional independence assumption, Cochran's statistic is

asymptotically distributed as a 1 df chi-squared distribution, only if the
number of strata is fixed, while the Mantel-Haenszel statistic is always
asymptotically distributed as a 1 df chi-squared distribution. Note that the
continuity correction is removed from the Mantel-Haenszel statistic when
the sum of the differences between the observed and the expected is 0.

Mantel-Haenszel Common Odds Ratio Estimate

Estimate .056

ln(Estimate) -2.883

Std. Error of ln(Estimate) .958

Asymp. Sig. (2-sided) .003

Asymp. 95% Confidence Common Odds Ratio Lower Bound .009

Interval Upper Bound .366

ln(Common Odds Ratio) Lower Bound -4.761

Upper Bound -1.006

The Mantel-Haenszel common odds ratio estimate is asymptotically normally distributed under the common
odds ratio of 1,000 assumption. So is the natural log of the estimate.

10
Lingkungan * Penyakit
Crosstab

Count

Penyakit

DBD Tidak DBD Total

Lingkungan Tidak baik 12 7 19

Baik 3 8 11

Total 15 15 30

Risk Estimate

95% Confidence Interval

Value Lower Upper

Odds Ratio for Lingkungan

4.571 .903 23.137
(Tidak baik / Baik)

For cohort Penyakit = DBD 2.316 .831 6.450

For cohort Penyakit = Tidak

.507 .254 1.011
DBD

N of Valid Cases 30

Tests of Homogeneity of the Odds Ratio

Asymp. Sig. (2-

Chi-Squared df sided)

Breslow-Day .000 0 .

Tarone's .000 0 .

Tests of Conditional Independence

Asymp. Sig. (2-

Chi-Squared df sided)

Cochran's 3.589 1 .058

Mantel-Haenszel 2.220 1 .136

11
 Tests of Conditional Independence

Asymp. Sig. (2-

Chi-Squared df sided)

Cochran's 3.589 1 .058

Mantel-Haenszel 2.220 1 .136

Under the conditional independence assumption, Cochran's statistic is

asymptotically distributed as a 1 df chi-squared distribution, only if the
number of strata is fixed, while the Mantel-Haenszel statistic is always
asymptotically distributed as a 1 df chi-squared distribution. Note that the
continuity correction is removed from the Mantel-Haenszel statistic when
the sum of the differences between the observed and the expected is 0.

Mantel-Haenszel Common Odds Ratio Estimate

Estimate 4.571

ln(Estimate) 1.520

Std. Error of ln(Estimate) .827

Asymp. Sig. (2-sided) .066

Asymp. 95% Confidence Common Odds Ratio Lower Bound .903

Interval Upper Bound 23.137

ln(Common Odds Ratio) Lower Bound -.102

Upper Bound 3.141

The Mantel-Haenszel common odds ratio estimate is asymptotically normally distributed under the common
odds ratio of 1,000 assumption. So is the natural log of the estimate.

Obat nyamuk * Penyakit

Crosstab

Count

Penyakit

DBD Tidak DBD Total

Obat nyamuk Tidak 11 5 16

Iya 4 10 14

Total 15 15 30

12
 Risk Estimate

95% Confidence Interval

Value Lower Upper

Odds Ratio for Obat nyamuk

5.500 1.145 26.412
(Tidak / Iya)

For cohort Penyakit = DBD 2.406 .986 5.869

For cohort Penyakit = Tidak

.438 .197 .972
DBD

N of Valid Cases 30

Tests of Homogeneity of the Odds Ratio

Asymp. Sig. (2-

Chi-Squared df sided)

Breslow-Day .000 0 .

Tarone's .000 0 .

Tests of Conditional Independence

Asymp. Sig. (2-

Chi-Squared df sided)

Cochran's 4.821 1 .028

Mantel-Haenszel 3.237 1 .072

Under the conditional independence assumption, Cochran's statistic is

asymptotically distributed as a 1 df chi-squared distribution, only if the
number of strata is fixed, while the Mantel-Haenszel statistic is always
asymptotically distributed as a 1 df chi-squared distribution. Note that the
continuity correction is removed from the Mantel-Haenszel statistic when
the sum of the differences between the observed and the expected is 0.

13
 Mantel-Haenszel Common Odds Ratio Estimate

Estimate 5.500

ln(Estimate) 1.705

Std. Error of ln(Estimate) .801

Asymp. Sig. (2-sided) .033

Asymp. 95% Confidence Common Odds Ratio Lower Bound 1.145

Interval Upper Bound 26.412

ln(Common Odds Ratio) Lower Bound .136

Upper Bound 3.274

The Mantel-Haenszel common odds ratio estimate is asymptotically normally distributed under the common
odds ratio of 1,000 assumption. So is the natural log of the estimate.

Penyuluhan * Penyakit
Crosstab

Count

Penyakit

DBD Tidak DBD Total

Penyuluhan Tidak Pernah 14 6 20

Pernah 1 9 10

Total 15 15 30

Risk Estimate

95% Confidence Interval

Value Lower Upper

Odds Ratio for Penyuluhan

21.000 2.155 204.614
(Tidak Pernah / Pernah)

For cohort Penyakit = DBD 7.000 1.067 45.938

For cohort Penyakit = Tidak

.333 .165 .672
DBD

N of Valid Cases 30

Tests of Homogeneity of the Odds Ratio

Asymp. Sig. (2-

Chi-Squared df sided)

Breslow-Day .000 0 .

14
 Tests of Homogeneity of the Odds Ratio

Asymp. Sig. (2-

Chi-Squared df sided)

Breslow-Day .000 0 .

Tarone's .000 0 .

Tests of Conditional Independence

Asymp. Sig. (2-

Chi-Squared df sided)

Cochran's 9.600 1 .002

Mantel-Haenszel 7.105 1 .008

Under the conditional independence assumption, Cochran's statistic is

asymptotically distributed as a 1 df chi-squared distribution, only if the
number of strata is fixed, while the Mantel-Haenszel statistic is always
asymptotically distributed as a 1 df chi-squared distribution. Note that the
continuity correction is removed from the Mantel-Haenszel statistic when
the sum of the differences between the observed and the expected is 0.

Mantel-Haenszel Common Odds Ratio Estimate

Estimate 21.000

ln(Estimate) 3.045

Std. Error of ln(Estimate) 1.162

Asymp. Sig. (2-sided) .009

Asymp. 95% Confidence Common Odds Ratio Lower Bound 2.155

Interval Upper Bound 204.614

ln(Common Odds Ratio) Lower Bound .768

Upper Bound 5.321

The Mantel-Haenszel common odds ratio estimate is asymptotically normally distributed under the common
odds ratio of 1,000 assumption. So is the natural log of the estimate.

15
FREQUENCIES VARIABLES=Penyakit Usia Pendidikan Pekerjaan Penghasilan Lingkungan Obat.Nyamuk
Penyuluhan

/ORDER=ANALYSIS.

Frequencies
Notes

Output Created 11-Jun-2015 23:08:18

Comments

Input Data C:\Users\7\Documents\spss awal.sav

Active Dataset DataSet1

Filter <none>

Weight <none>

Split File <none>

N of Rows in Working Data File 30

Missing Value Handling Definition of Missing User-defined missing values are treated as
missing.

Cases Used Statistics are based on all cases with valid

data.

Syntax FREQUENCIES VARIABLES=Penyakit

Usia Pendidikan Pekerjaan Penghasilan
Lingkungan Obat.Nyamuk Penyuluhan
/ORDER=ANALYSIS.

Resources Processor Time 00:00:00.000

Elapsed Time 00:00:00.004

[DataSet1] C:\Users\7\Documents\spss awal.sav

Statistics

Penyakit Usia Pendidikan Pekerjaan Penghasilan Lingkungan Obat nyamuk Penyuluhan

N Valid 30 30 30 30 30 30 30 30

Missing 0 0 0 0 0 0 0 0

16
Frequency Table
Penyakit

Cumulative
Frequency Percent Valid Percent Percent

Valid DBD 15 50.0 50.0 50.0

Tidak DBD 15 50.0 50.0 100.0

Total 30 100.0 100.0

Usia

Cumulative
Frequency Percent Valid Percent Percent

Valid <15 tahun 11 36.7 36.7 36.7

>15 tahun 19 63.3 63.3 100.0

Total 30 100.0 100.0

Pendidikan

Cumulative
Frequency Percent Valid Percent Percent

Valid Rendah 11 36.7 36.7 36.7

Tinggi 19 63.3 63.3 100.0

Total 30 100.0 100.0

Pekerjaan

Cumulative
Frequency Percent Valid Percent Percent

Valid Tidak Bekerja 14 46.7 46.7 46.7

Bekerja 16 53.3 53.3 100.0

Total 30 100.0 100.0

17
 Penghasilan

Cumulative
Frequency Percent Valid Percent Percent

Valid <UMR 13 43.3 43.3 43.3

> UMR 17 56.7 56.7 100.0

Total 30 100.0 100.0

Lingkungan

Cumulative
Frequency Percent Valid Percent Percent

Valid Tidak baik 19 63.3 63.3 63.3

Baik 11 36.7 36.7 100.0

Total 30 100.0 100.0

Obat nyamuk

Cumulative
Frequency Percent Valid Percent Percent

Valid Tidak 16 53.3 53.3 53.3

Iya 14 46.7 46.7 100.0

Total 30 100.0 100.0

Penyuluhan

Cumulative
Frequency Percent Valid Percent Percent

Valid Tidak Pernah 20 66.7 66.7 66.7

Pernah 10 33.3 33.3 100.0

Total 30 100.0 100.0

18
 LAMPIRAN

SURAT PERSETUJUAN MENJADI RESPONDEN

(Informed Consent)

Setelah mendapat penjelasan dengan baik tentang tujuan dan manfaat

penelitian yang berjudul “Beberapa Faktor Resiko Yang Mempengaruhi
Tingginya Angka Kejadian Demam Berdarah Dengue (DBD) Bulan Januari –
April 2015 Desa Sumput Kecamatan Sidoarjo Wilayah Kerja Puskesmas
Urangagung”, saya mengerti bahwa saya diminta untuk mengisi kuesioner dan
menjawab pertanyaan tentang faktor-faktor resiko yang mempengaruhi tingginya
angka kejadian DBD di Desa Sumput Sidoarjo. Saya memerlukan waktu sekitar
10-15 menit sebagaimana yang telah dijelaskan sebelumnya. Saya memahami
bahwa penelitian ini tidak membawa risiko. Apabila ada pertanyaan yang
menimbulkan respon emosional, penelitian akan dihentikan dan peneliti akan
memberikan dukungan.
Saya mengerti bahwa catatan mengenai data penelitian akan dirahasiakan,
dan kerahasiaannya ini akan dijamin. Informasi mengenai identitas saya tidak
akan ditulis pada instrument penelitian dan akan tersimpan secara terpisah
ditempat yang aman.
Saya mengerti bahwa saya berhak menolak untuk berperan sebagai
responden atau mengundurkan diri setiap saat tanpa adanya sanksi atau
kehilangan hak-hak saya.
Saya telah diberi kesempatan untuk bertanya mengenai penelitian ini atau
mengenai keterlibatan saya dalam penelitian ini, dan telah dijawab dengan
memuaskan.
Secara sukarela saya sadar dan bersedia berperan dalam penelitian ini
dengan menandatangani Surat Persetujuan Menjadi Responden.

Surabaya, ....Juni 2015

Responden,

(…………………………)
Saksi:
1. ………………………..(tanda tangan)

(……………………..)

2. ………………………..(tanda tangan)

(……………………...)

19
 LAMPIRAN

PENGANTAR KUESIONER

Judul Penelitian : Beberapa Faktor Resiko Yang Mempengaruhi

Tingginya Angka Kejadian Demam Berdarah Dengue
(DBD) Bulan Januari – April 2015 Desa Sumput
Kecamatan Sidoarjo Wilayah Kerja Puskesmas
Urangagung.

Peneliti :
1. Wiwit Wulandari, S. Ked
2. Stepheny Puspa Wangi, S. Ked
3. Eny Wijayanti, S. Ked
4. Putu Gede Richard Arby I , S. Ked

Pembimbing : dr. Gembong Nuswanto, M.Sc

Bapak/ibu yang terhormat,

Saya adalah Dokter Muda Fakultas Kedokteran Universitas Wijaya
Kusuma Surabaya. Untuk menyelesaikan kepaniteraan klinik, saya bermaksud
untuk mengadakan penelitian dengan judul “Beberapa Faktor Resiko Yang
Mempengaruhi Tingginya Angka Kejadian Demam Berdarah Dengue (DBD)
Bulan Januari – April 2015 Desa Sumput Kecamatan Sidoarjo Wilayah Kerja
Puskesmas Urangagung.
Saya berkeyakinan bahwa penelitian ini memiliki manfaat yang sangat
berguna untuk mengurangi angka kejadian DBD di Sidoarjo khususnya di Desa
tersebut. Oleh sebab itu saya berharap kesediaan bapak/ ibu untuk menjadi
responden dalam penelitian ini.
Apabila bapak/ibu sekalian bersedia kami mohon kesediannya untuk
menandatangani persetujuan menjadi subyek penelitian.
Atas perhatian dan kerjasama bapak/ibu saya ucapkan terima kasih.

Surabaya, Juni 2015

Mengetahui : Peneliti,

(dr. Gembong Nuswanto, M.Sc.) (Dokter Muda PKM Urangagung)

20