EFFECT OF CIGARETTE SMOKE ON FREQUENCY OF ARRIVAL DISEASE IN

CHILDREN AT PUSKESMAS KEDUNG BANTENG BANYUMAS

Reni Riyanto 1, Anis Kusumawati 1

1 Lecturer at the Faculty of Medicine, Muhammadiyah University of Purwokerto

Email: Dokteranis@yahoo.co.id

ABSTRACT

Background: Acute Respiratory Infection (ARI) is one of the causes of morbidity and mortality in children under five. The incidence of
Acute Respiratory Infection (ISPA) in children under five in Indonesia is still high, with cases of morbidity reaching 260,000 children
under five every year. At the end of 2000, ARI had reached six cases among 1000 babies and toddlers. In 2003, there were five out of
1000 under-five children under five in 1000 cases of ARI. In general, there are several factors that cause ARI, namely polluted
environmental factors such as cigarette smoke and smoke from burning fuel for cooking with high concentrations.

Research purposes: This study aims to determine the effect of cigarette smoke on the frequency of ARI disease in toddlers at
Kedung Banteng Banyumas Health Center.
Research methods: Subjects in this study amounted to 52 respondents using sampling techniques purpossive sampling. The
research instrument used a structured interview guide with an analytic observational design cross sectional. Data analysis using
statistical tests Somers'd.

Research result: From this study, it is known that 21 toddlers (40.38%) who are exposed to cigarette smoke ≤ 20 minutes per day
and suffer from ARI <3 times a year have a percentage (30.77%) of 16 toddlers, while under five children who are exposed to
cigarette smoke ≥ 20 minutes per day as many as 31 toddlers 59.62% as much. And suffering from ARI ≥ 3 times a year as many as
36 children (69.23%). The Somers'd analysis results obtained a value of ρ value of 0.007. These results indicate that there is a
positive influence between exposure to cigarette smoke on the frequency of ARI disease in children under five at Kedung Banteng
Banyumas Health Center.

Conclusion: Cigarette smoke has an effect on the frequency of ARI disease in children under five at Kedung Banteng Banyumas
Health Center.

Keywords: Effect of cigarette smoke, frequency of ARI disease

PRELIMINARY (Elizabeth, 2009). Usually the sufferer will experience fever,

ARI is a disease that most often causes death in children cough and recurring colds and anorexia. In the tonsillitis and

otitis media will show the presence of inflammation of the

toddler, so that ARI still tonsils or middle ear clearly. Acute infections in toddlers will

is a disease that causes quite high mortality (WHO, 2007).

Dead

the in part big resulting in stop

caused by pneumonia. Acute Respiratory Infections (ARI) are Respiratory while or apnea

infections caused by microorganisms. These infections are (Meadow, 2005).

limited to As a disease group, ARI is also the main cause of patient

visits to health facilities, namely as much as 40% - 60% of

structures channel breath treatment visits at puskesmas

including the nasal cavity, pharynx, and larynx

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and 15% - 30% of visits to hospital for treatment (MOH, Environmental factors include: indoor air pollution (cigarette

2002). Acute Respiratory Infection (ARI) is an acute infection smoke and smoke from burning fuel for cooking with high

that involves the organs of the upper respiratory tract and concentrations), home ventilation and occupancy density.

lower respiratory tract. This infection is caused by viruses, Individual child factors include: child's age, birth weight,

fungi and bacteria. ARI will attack nutritional status, vitamin A and immunization status.

Behavioral factors include behaviors to prevent and control

ARI

the host if the body's resistance (immunology) decreases.

Globally, the under-five mortality rate has decreased by 41%,

from an estimated rate of 87 deaths per 1000 live births in on baby or role active

1990 to 51 deaths per 1000 live births in the year. The family / community in dealing

estimated incidence of ARI in developing countries is 0.29% ARI (Prabu, 2009).

(151 million people) and industrialized countries 0.05% (5 The habit of parents smoking in the house can have a

million people). ISPA ranks first in the group of infants and negative impact on family members, especially toddlers.

toddlers in Indonesia. The prevalence of ARI in Indonesia is Smoke

cigarette that stick to and

leaving chemicals or residue on clothes, roofs, sofas,

curtains, and other places in the house. If smoking outdoors

or secondhand smoke is exposed to secondhand smoke,

25.5% with morbidity cigarette smoke can stick to clothes and skin. If smoking

pneumonia in infants is 2.2% and in infants 3%, while indoors, the residue can stick to curtains, sofas, roofs, and

mortality in infants is 23.8% and 15.5% in infants (Depkes RI, even children's toys. People who inhale cigarette smoke are

2008). In Indonesia, acute respiratory infections (ISPA) called third hand smoker ( Sulaiman, 2014). This is supported

by a study which states that toddlers who live in the same

occupy order first house with family members smoking is risky

causes death in infants and toddlers. The mortality survey

conducted by the sub-district ISPA in 2005 placed ISPA /

pneumonia as the biggest cause of infant mortality in

Indonesia with a percentage of 10-20% per year (Maryunani,

2011). Because babies under five years of age are a group 5,743 times more likely to suffer pneumonia than children

whose immune system is still vulnerable under five who share the same household with non-smoking

family members (Sugihartono, 2012).

Indonesia is a country with around 27.6% of active

to various disease smokers, with a total of 65 million smokers or 225 billion

(Probowo, 2012) cigarettes per year. 10,000 people per day in the world die

In general, there are three risk factors for ARI, namely from smoking and

environmental factors, individual child factors and behavioral

factors. 57,000 people per year in Indonesia

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died because smoke, with health services, both at the Puskesmas level and at the

The increase in cigarette consumption in Indonesia is the hospital level.

highest in the world at 44%. The prevalence of smoking in Based on the explanation above, the researcher wanted to

Indonesia from 1995 to 2001 among adults increased by examine the effect of cigarette smoke on the frequency of ARI

4.6% (Depkes RI, 2008). disease in children under five at Kedung Banteng Community

Health Center, Banyumas.

Cigarettes are poisonous objects that have a very

dangerous effect on active or passive smokers, especially METHOD

toddlers who are accidentally exposed to cigarette smoke. This study used an analytic observational design with an

Nicotine with thousands of other toxic hazards, cigarette approach

smoke gets into the baby's respiratory tract which can cause cross sectional to determine the effect of cigarette smoke on

the frequency of ARI disease in children under five. Cigarette

smoke as an independent variable and the frequency of ARI

Infection on channel as the dependent variable were seen and measured at the

respiration (Hidayat, 2005). Nicotine that is inhaled through same time (Budiarto, 2004).

the respiratory tract and into the body through the mother's

milk will accumulate This research was conducted at the Kedung Banteng

in body toddler and Banyumas Health Center from January to July 2015. The

endanger the health of these toddlers. population in this study was divided into

As a result of cigarette smoke disorders in infants,

including vomiting, diarrhea, colic (disorders of the baby's 2, namely the target population in this study were all toddlers

digestive tract), increased heart rate, respiratory problems in who suffer from ISPA in the working area of the Kedung

infants, lung infections and Banteng Banyumas Health Center and the actual population

in this study were toddlers diagnosed with ARI and came to

ear, distraction growth. the Kedung Banteng Banyumas Health Center for treatment.

Cigarette smoke exposure has an effect on the incidence of

ARI in toddlers, where toddlers who are exposed to cigarette

smoke have a greater risk of contracting ARI than toddlers Sample in research this 52

who are not exposed to cigarette smoke. respondents conducted by sampling technique purposive

sampling

Various efforts have been made by the government to namely sampling based on certain considerations made by

control ARI, starting in 1984 along with the initiation of ARI the researchers themselves, based on previously known

control at the global level (Ministry of Health RI, 2012). characteristics or characteristics of the population

However, until now, these efforts have not shown significant (Notoatmodjo, 2007). Analysis

results. ARI cases are still widely found

data in research this

using Univariate analysis and Brivat analysis.

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RESULTS

The results in this study are divided into two, namely:

1. Based on the Characteristics of Respondents

a. Based on Age

Table 1. Distribution of the frequency of respondents by age

No. Age Frequency Percentage (%)

1 12-23 months 25 48.08

2 24-35 months 10 19.23
3 36-47 months 7 13.46
4 48-60 months 10 19.23
Total 52 100
Source: Primary Data, 2015

Based on table 1. above can be seen age 12-23 month. Currently on

that group age The lowest percentage was 13.46% or as many as 7

respondents with the highest percentage of 48.08% or respondents were in the 36-47 month age group.

as many as 25 respondents were in the group

b. Based on Gender

Table.2 Distribution of frequency of respondents based on gender

No. Gender Frequency Percentage (%)

1 Male 20 38.46
2 Women 33 61.54
Total 52 100

Based on table 2 above, it can be seen that the male 38.46% or as many as 20 respondents,

number of ARI sufferers in this study was 52 children while respondents

under five, based on the gender of the respondent female 61.54% or as many as 33 respondents.

c. Based on Immunization Status

Table.3 Frequency distribution of respondents based on immunization status

No. Immunization Status Frequency Percentage (%)

1 Complete 50 96.15
2 Incomplete 2 3.85
Total 52 100

Based on table 3 above, it can be seen that the Complete immunization 96.15% or as many as 50

number of ARI sufferers in this study was 52 toddlers, respondents, while incomplete immunization 3.85% or

based on as many as 2 respondents.

status giving

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d. Based on nutritional status

Table.4 Frequency distribution of respondents based on nutritional status

No. Nutritional status Frequency Percentage (%)

1 Good nutrition 51 98.08

2 Malnutrition 1 1.92
Total 52 100

Based on table 4 above, it can be seen that with less nutrition as much as 1.92% or as much as 1 toddler.

children with ARI with good nutrition are 98.08% or as The nutritional status of children under five is calculated

many as 51 respondents, while children under five with based on weight / age.

ARI

e. Based on the status of giving Vitamin A

Table.5 Distribution of the frequency of respondents based on vitamin A

No. Vitamin A Frequency Percentage (%)

1 Granted 52 100
2 Not Given 0 0
Total 52 100

Based on table 5, it can be seen that the status the percentage is 100%, this indicates that all

of vitamin A in 52 respondents has respondents have received vitamin A.

f. Based on Birth Weight

Table.6 Frequency distribution of respondents based on birth weight

No. Birth Weight Frequency Percentage (%)

1 Normal 48 92.31
2 LBW 4 7.69
Total 52 100

Based on table 6 above, it can be seen that while that have LBW

children with ARI with normal birth weight have a as much as 7.69% or as many as 4 respondents.

percentage

92.31% or as many as 48 respondents,

g. Based on the frequency of exposure to cigarette smoke.

Table.7 Distribution of respondents based on length of exposure to cigarette smoke

No. Duration of exposure per day Frequency Percentage (%)

1 <20 minutes 21 40.38

2 ≥ 20 minutes 31 59.62
Total 52 100

Based on table 7 above, it can be seen that as many as 40.38% or as many as 21 respondents,

children with ARI are exposed to cigarette smoke <20 while exposed to cigarette smoke ≥ 20 minutes per

minutes per day day

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59.62% or as much as 31 respondents

2. Frequency of ARI

Table.8 Distribution of respondents based on the frequency of ARI incidence

No. ARI for 1 year Frequency Percentage (%)

1 <3 times 16 30.77

2 ≥ 3 times 36 69.23
Total 52 100

Based on table 8 above, it can be seen that those affected by ARI ≥ 3 times a year were 69.23% or

toddlers with ARI <3 times a year are 30.77% or as as many as 36 respondents.

many as 16 respondents, while

3. The Effect of Cigarette Smoke on the Frequency of Exposure to ISPA in Toddlers

Table 9 Distribution of respondents based on duration of exposure to cigarette smoke and frequency of ARI disease incidence in children under

five

No. Duration of exposure to smoke Frequency of ARI in a year Total

cigarette
<3 times ≥ 3 times
1 <20 minutes per day ≥ 20 11 10 21
2 minutes per day total 5 26 31
16 36 52

Based on table 9 above, it can be seen that times a year while 16 toddlers (30.77%) who were

69.23% 36 toddlers who are exposed to cigarette exposed to cigarette smoke <20 minutes per day rarely

smoke ≥ 20 minutes per day experience ARI more experienced ARI, namely <3 times a year.

frequently, namely ≥ 3

DISCUSSION in accordance with the results of previous research which

Acute Respiratory Infection or ARI is the main cause of states that children are under the age

morbidity and mortality in children under five. ARDs that are 2 year have a risk

not handled properly suffer from ARI 1.4 times greater than older children (Daulay,

will enter 1999). In Medan, this situation occurs because children under

lung tissue and causes pneumonia, which is an infectious the age of 2 have not yet perfect immunity and their airway

disease of the lungs which is the main cause of death in lumen is still narrow (Sahroni,

infants and toddlers (Depkes RI,

2008). 2012).

Based on the results of the study in table 1 shows that Table 2 shows that toddlers are suffering

the majority of children under five who suffer from ARI ARI mostly is

disease with a percentage of 48.08% as many as 25 toddlers women, namely with a percentage of 61.54% or as many as 33

in the 12-23 month age group. Bhasil this children under five. Because in general there is no incidence of

ARI as a result

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viruses or bacteria in men or women, Based on the length of exposure to cigarette smoke in table 7

but there is that shows that most of the children with ARI in this study were

suggested that the incidence of ARI is higher in boys over 6 exposed to cigarette smoke ≥ 20 minutes per day, namely

years of age. . Because as a whole in a developing country 59.62% or as many as 31 toddlers, while 40.38% or as many

like Indonesia, the problem of gender is not too bad as 21 toddlers were exposed to cigarette smoke ≥ 20 minutes

per day .. This is in accordance with previous research which

said that

be noticed, however Lots

research that shows a difference smoke cigarette could spoil

prevalence disease ARI pulmonary defense mechanism so that it will facilitate the

against gender (Hidayati, 2009). emergence of ARI. opinion

Most of the children with ARI who were respondents in Rahajoe (2008). The smoking behavior of parents and family

this study had received complete immunization, namely members who live in one house triggers the incidence of ARI

among children under five in the working area of Puskesmas

96.15% .Immunization expected Sempor II. Research by Winarni, et al (2010), In addition, a

can prevent the emergence of ARI disease. Because person who is not a smoker but who inhales cigarette smoke

immunization non-compliance can be the cause of the for at least 15 minutes a day for one week is categorized as a

increasing number of children under five who experience ARI passive smoker. Secondhand smoke is more dangerous for

disease. In this study, 3 children under five who did not passive smokers than active smokers.

receive complete immunization experienced ARI more

frequently, namely ≥ 3 times a year than under five who did

status immunization complete. Result research on table 8

Giving immunization show shows that most of the children under five had ARI ≥ 3 times

consistency in influencing the incidence of ARI. Based on in the last year (often), as many as 36 children under five

previous research which states that babies who do not

receive immunization are according to age (Sadono, 2005). 69.23% and 16 toddlers 30.77% experienced ISPA <3 times in

there is a risk of suffering from ARI and there is a significant the past year (rarely). Episode

relationship between immunization and the incidence of ARI ARI disease in children under five at

in children under five. Vitamin A too Indonesia is estimated to be 3-6 times per year (average 3

times per year). ARI is a disease that often occurs in children.

cough - colds in children under five in Indonesia are

essential to health and estimated to be 3 - 6 times per year. ARI is also a major

continuity life because could cause

increase body resistance to infectious diseases. Toddler with

giving visit patient in means

vitamin A that less health. As many as 40% - 60% of treatment visits at the

is a risk factor for ARI (Azad, 2009). Puskesmas and 15% - 30% of medical visits are in outpatient

Distribution frequency respondents and

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Hospitalization is caused by ISPA (Depkes RI, 2008). where no family member smokes. Infants and toddlers are at

greater risk because babies and toddlers have smaller lungs

Based on table 9, it shows that 26 toddlers 50% who than adults, their immune systems

were exposed to cigarette smoke ≥ 20 minutes per day

experienced ARI more often, namely ≥ 3 times a year, while 1

toddler 21.15% who were exposed to cigarette smoke <20 not yet awakened perfect,

minutes per day rarely experienced ARI, namely <3 times a consequently more susceptible to pneumonia.

year. This can be interpreted that the duration

Based on the results of the above research, it can be

proven that the hypothesis is accepted, namely that there is

exposed smoke cigarette could an effect of cigarette smoke on the frequency of ARI disease

increasing the frequency of ARI occurrences in children under in children under five at Kedung Banteng Banyumas Health

five. The longer the toddler is exposed to cigarette smoke every Center.

day, the higher the risk of the toddler being exposed to ARI

because cigarette smoke disrupts the respiratory defense

system. CONCLUSIONS AND SUGGESTIONS

The results of this study also obtained the level of Based on the results of the research that has been done,

closeness of the relationship between the two variables using it can be concluded that cigarette smoke has an effect on the

the test Somers'd with a value (r) of 0.372 which indicates that frequency of ARI disease in children under five at Kedung

the direction of the correlation is positive with weak correlation Banteng Banyumas Health Center.

strength. The strength of this weak correlation is due to

several other factors that influence the occurrence of ISP.

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