JURNAL TEKNIK LINGKUNGAN ITB
E-ISSN: 27146715
JTL. Vol. 29 No. 2, 2023. Hal 6-10 - https://doi.org/10.5614/j.tl.2023.29.2.2 https://journals.itb.ac.id/index.php/jtl/index
Risks Factors of Scabies Incidence in Islamic Boarding School in Eastern Java Faktor Risiko Insiden Skabies di Pesantren in Jawa Timur
M. Faza Azmi Nasrullah, Anindrya Nastiti, Dwina Roosmini
Faculty of Civil and Environmental Engineering, Institut Teknologi Bandung, Jl Ganesa 10 Bandung 40132, Indonesia
*corresponding e-mail: [email protected]
Abstrak INFO ARTIKEL
With the highest Muslim population in the world, Indonesia has more than 26,000 Islamic boarding schools. Studies have found that scabies incidence is high in these schools. This study aims to identify factors affecting scabies incidence among 90 students in Islamic boarding schools in Eastern Java.
Knowledge, personal hygiene, and residential sanitation are significantly associated with the scabies incidence. Students who have poor knowledge, have poor personal hygiene, and live in poor sanitation condition are more likely to suffer from scabies at 12.02 times, 8 times, and 4.34 times, respectively, compared to students who have good knowledge, good personal hygiene, and good sanitation. Moreover, more female students have good personal hygiene compared to male students. We suggest strengthening education and hygiene behaviour change strategies involving kyai, school administrators, and peer examples in Islamic boarding schools.
Kata Kunci: skabies, pesantren, Indonesia, higiene, sanitasi
Sitasi: Nasrullah, M.F.A., Nastiti, A., & Roosmini, D. 2023. Risks Factors of Scabies Incidence in Islamic Boarding School in Eastern Java.
Jurnal Teknik Lingkungan 29 (2), 6- 10.
Article History:
Received 27 Juni 2023 Revised 15 Oktober 2023 Accepted 22 Oktober 2023 Available online 28 Oktober 2023
Jurnal Teknik Lingkungan Institut Teknologi Bandung is licensed under a Creative Commons Attribution- NoDerivatives 4.0 International License. Based on a work at www.itb.ac.id
Abstract
Sebagai negara dengan penduduk Muslim terbanyak di dunia, Indonesia memiliki lebih dari 26.000 pesantren. Studi telah menemukan bahwa terdapat tingkat insidensi skabies yang tinggi di pesantren. Penelitian ini bertujuan untuk mengidentifikasi faktor-faktor yang mempengaruhi insiden skabies pada 90 santri di pondok pesantren di Jawa Timur. Pengetahuan, higiene perorangan dan sanitasi tempat tinggal memiliki hubungan yang signifikan dengan kejadian skabies. Siswa yang memiliki pengetahuan buruk, memiliki tingkat higiene perorangan yang buruk, dan kondisi sanitasi tempat tinggal yang buruk lebih besar kemungkinannya untuk menderita skabies masing- masing sebesar 12,02 kali, 8 kali, dan 4,34 kali dibandingkan dengan siswa yang memiliki pengetahuan baik, higiene perorangan yang baik, serta sanitasi tempat tinggal yang baik. Selain itu, siswa perempuan cenderung memiliki higiene perorangan yang lebih baik dibandingkan dengan siswa laki-laki.
Penelitian ini menyarankan untuk memperkuat pendidikan dan strategi perubahan perilaku hidup bersih yang melibatkan kyai, pengurus sekolah, dan contoh teman sebaya di pesantren.
Keywords: scabies, Islamic boarding school, Indonesia, hygiene, sanitation
1. Introduction
A common problem worldwide, scabies is an infectious disease that affects the skin caused by the Sarcoptes scabiei (Heukelbach et al., 2005; Ryan et al., 2010). The World Health Organization states that scabies is one of the skin epidermal parasitic diseases with the most considerable incidence globally (WHO, 2020). This disease is characterized by the onset of itching, especially at night, and abnormalities in the skin in the form of papules, vesicles, urticaria, and cristae. Transmission of scabies occurs due to direct contact with the patient and through clothes, towels, sheets, and other items used by patients (Walton & Currie, 2007).
The prevalence of scabies in Indonesia was 6% per 2017 in Indonesia (Trasia, 2020). Scabies ranks third out of the twelve most frequent skin diseases (Azizah & Setiyowati, 2011). This study specifically focuses on scabies in Islamic boarding schools in Indonesia. In these schools, students (santri) study and live together in dormitories under the guidance of religious leaders (kyai). As a country with the highest Muslim population in the world, Indonesia has 26,975 Islamic boarding schools with high prevalence scabies rate. In some cases, the prevalence rate can reach to 64% to 69% (Ma’rufi et al., 2005; Nurmansyah et al., 2019). The high
https://doi.org/10.5614/j.tl.2023.29.2.2 page. 7 of 10 interactions or physical contacts between individuals in high-density settings such as Islamic boarding schools facilitate the transmission and infestation of Sarcoptes scabiei.
Although it is not life-threatening, scabies needs attention because of its high transmission level and its ability to interfere with the quality of life and academic performance of santri. Intense itching and secondary infections lead to a decrease in santri's academic achievements. For example, Muzakir (2008) suggested that the report card scores of 15.5% of students suffering from scabies decreased.
Several studies have tried to identify factors that influence the incidence of scabies in various situations. A study in Padang shows a relationship between individual hygiene and the incidence of scabies (Akmal et al., 2013). A study in Ethiopia identifies factors affecting scabies among schoolchildren: studying at a rural school, parents’ illiteracy, being grade level 1–4 low bathing frequency, contact with a person with itching symptom and a family member with itchy symptoms, not using soap for hand washing (Dagne et al., 2019).
Sungkar (1997) states that the scabies incidence among boarding school students with poor hygiene can reach 78.7%, but the rate decreases to 3.8% among student groups with better hygiene. Gender and knowledge level are also indicated to affect scabies incidence. Factors that play a significant role in the transmission of scabies are large family size and bed sharing (Azene et al., 2020). This diseases also more prominent among those living in rural areas, male, and having a poor hygiene (Karaca Ural et al., 2022).
Considering the impacts of scabies on productivity and quality of life of santri, it is essential to identify environmental and behavioural factors that affect the incidence of scabies. The findings will help design effective interventions to prevent scabies in Islamic boarding schools in Indonesia. Using the case of two Islamic boarding schools in Banyuwangi Regency and Jember Regency, East Java Province, this study aims to determine the effect of knowledge, individual hygiene, residential sanitation, and residential density on the incidence of scabies in Islamic boarding schools.
2. Methods
The research was conducted from June to July 2021 at two Islamic boarding schools in East Java Province:
boarding school D and boarding school T. Boarding school D was selected due to the high incidence of scabies, while boarding school T was selected due to the low incidence of scabies. This study was designed as a case-control study. A 'case' is a student in boarding school D who had been diagnosed with scabies and proven by a clinician certificate. Meanwhile, a 'control' is a student in boarding school T who had not been diagnosed with scabies or had no prior history of scabies.
In total, 90 santri participated in this research (45 from the case groups and 45 from the control groups). The inclusion criteria in this research are as follows: (1) Registered as a student at boarding school D or T; (2) agreed to participate in the research by signing the consent form; (3) for the case groups, had been diagnosed with scabies, proven by a clinician certificate, and for the control group, has no prior history of scabies. Meanwhile, students with clinical symptoms of other skin diseases and students with severe illnesses were excluded. Participants were asked to fill out a validated questionnaire, which consists of four elements:
(1) Knowledge on the causes, symptoms, transmission, prevention, and treatment of scabies.
(2) Personal hygiene (cleanliness of clothes, towels, and praying mats; regular washing of clothes, towels and praying mats with detergents; the frequency of sun-drying mattresses, pillows, and bolsters; clothes, towels, and praying mats sharing; regular use of personal antiseptic or soap; bathing frequency).
(3) Residential sanitation (cleanliness, air circulation, and room lighting; cleanliness of mattresses, bed linen and blankets; bathroom cleanliness; sufficient clean water; waste water management; solid waste management).
(4) Residential density evaluated using the standard regulated by the Decree of the Minister of Health No.
829/Menkes/SK/VII/1999, where a person should at least occupy an area of 8 m2.
Scores were assigned to participants’ responses on personal hygiene, knowledge, and residential sanitation.
For example: “Have you ever worn a towel alternately with friends?” Never = 5 points; Rarely = 4 points;
Sometimes = 3 points; Often = 2 points; Always = 1 point. Meanwhile, density was calculated by dividing the area of a dwelling with the number of students occupying it. For knowledge variable, the scores of each participant were summed from all five items (median value=3).
The participants were then classified as having “poor” knowledge if the sum of the scores from all knowledge items ≤ 3, while those with scores of > 3 were classified as having “good” knowledge. This was also applied for personal hygiene variables. The scores of each participant were summed from all seven items (median value= 4.2). The participants were then classified as having “poor” personal hygiene level if the sum of the scores from all personal hygiene items ≤ 4, while those with scores of > 4 were classified as having “good” personal hygiene.
https://doi.org/10.5614/j.tl.2023.29.2.2 page. 8 of 10 For sanitation, the participants were classified as having “poor” dwelling sanitation if the sum of the scores from all nine sanitation items ≤ 4, while those with scores of > 4 were classified as having “good” dwelling sanitation. In addition, the self-administered survey also recorded participants' demographic data, including age, gender, and education level.
During the survey, all the participants were accompanied by the school administrators. Informed consent, consisting of the purpose, risks, benefits and procedures for filling out the questionnaire, were explained.
Participants were free to choose not to participate or quit anytime without any consequences. In average, the survey took around 30 minutes. To triangulate the data, observations to the dormitories and interviews with students and school administrators were also conducted. This study was approved by the Research Ethics Commission of Padjadjaran University (Ethical Clearance Number 388/UN6.KEP/EC/2021).
Descriptive statistics, chi square analysis, odd ratio (OR), and multiple regression analysis were conducted to describe the data and to understand the relationships between knowledge (X1), personal hygiene (X2), residential sanitation (X3), and scabies incidence (Y). All statistical analyses were conducted with Microsoft Excel and IBM SPSS ver. 25.
3. Results
In total, this study involved 90 students. Table 1 shows gender, age, and education level of the participants.
Meanwhile, Table 2 shows that the percentage of students with good knowledge level, good personal hygiene level, and who live in better sanitation conditions are higher in the control group than in the case group, indicating the effect of these three aspects to the incidence of scabies. The numbers of male and female students with good and poor knowledge levels are almost similar. However, more female students have good personal hygiene compared to male students. All participants in both case and control group live in densely populated buildings that violate the standard of ≥ 8 m2/person. Thus, building density will be excluded from further analyses.
Table 1. Participants’ Characteristics
Case (n=45) Control (n=45)
Attribute Total (%) Attribute Total (%)
Male 23 (51.11) Male 23 (51.11)
Age Age
14-17 11 (24.4) 14-17 0 (0)
18-23 29(64.4) 18-23 45 (100)
>23 5 (11.1) >23 0 (0)
Education Education
Junior High School 7 (15.56) Junior High School 0 (0) Senior High School 20 (44.44) Senior High School 0 (0)
Undergraduate 18 (40.0) Undergraduate 45 (100)
Table 2. Knowledge, Personal Hygiene, and Sanitation among Case and Control Groups
Case (n=45), total (%) Control (n=45), total (%)
Variable Total Male Female Variable Total Male Female
Knowledge Knowledge
Good 7 (15.56) 4 (17.4) 3 (13.6) Good 31 (68.89) 17 (73.9) 14 (63.6) Poor 38 (84.44) 19 (82.6) 19 (86.4) Poor 14 (31.11) 6 (26.1) 8 (36.4)
Personal Hygiene Personal Hygiene
Good 15 (33.33) 2 (8.7) 13 (59.1) Good 36 (80.00) 16 (69.6) 20 (90.9) Poor 30 (66.67) 21 (81.3) 9 (40.9) Poor 9 (20.00) 7 (30.4) 2 (9.1)
Sanitation Sanitation
Good 25 (55.56) Good 38 (84.44)
Poor 20 (44.44) Poor 7 (15.56)
Next, bivariate analyses with chi square tests and odd ratio (OR) were used to find a relationship between independent and dependent variables (Table 3). Based on chi-square tests, knowledge (p=0.00), personal hygiene (p=0.00), and dwelling sanitation (p=0.003) had significant correlations with the scabies incidence.
https://doi.org/10.5614/j.tl.2023.29.2.2 page. 9 of 10 Based the OR values, students who have poor knowledge, have poor personal hygiene, and live in poor sanitation condition more likely to suffer from scabies at 12.02 times, 8 times, and 4.34 times, respectively, compared to students who have good knowledge, good personal hygiene, and good sanitation. Spearman- Rank correlation tests also suggest that sanitation (r=-0.595, personal hygiene (r= -0.583), and knowledge (r=-0.462) are also associated with the incidence of scabies.
A multiple linear regression also indicates a very strong relationship between all independent variables and the incidence of scabies (R=0.91). Meanwhile, the R2 of 0.828 indicates that the incidence of scabies was 82.8%
explained by the independent variables in this study. The remaining 17.2% is contributed by other factors.
Table 3. Bivariate Analyses
Variables Chi Square Test Odds Ratio Test
Significance Note OR Value Note
Knowledge 0.00 Significant 12.02 At risk
Personal Hygiene 0.00 Significant 8 At risk
Dwelling Sanitation 0.003 Significant 4.34 At risk
* Significant at p <0.05
** OR > 1 indicates an association while if the OR < 1, no associations were found.
4. Discussion
The results indicated that male students tend to be more vulnerable to scabies infections. This is in line with Ahmed et al. (2019) who indicate that men had much higher risks to be infected with scabies. This is perhaps driven by the evidence that women in general have better health and hygiene behaviors than men (Deeks et al., 2009; Dwipayanti et al., 2021). However, some studies, such as Muzakir (2008) showed that there was no meaningful relationship between sexes and the incidence of scabies.
Damayanti et al. (2021) suggests that there is a meaningful relationship between a person's level of knowledge and scabies incidence. Knowledge is often affected by the level of education; people with higher education levels tend to have more knowledge on how to prevent scabies and good personal hygiene. This will in turn affect their hygiene and health behaviour, which lower the risks of being infected with scabies.
This study also indicates personal hygiene is associated with scabies incidence. This is in line with a study in Ethiophia that shows personal hygiene, such as rarely changing clothes, rarely washing cloth, using only water to wash hands, significantly affect scabies incidence among school children (Misganaw et al., 2022).
The limitations of this study includes: (1) the difference in age and education level between control and age group, which may serve as confounders; (2) the limited access to female students’ dormitories; (3) COVID- 19 pandemic situation that limits observation time.
5. Conclusion
Using a case-control approach, this epidemiologic study investigated factors affecting scabies incidences in Islamic boarding schools in East Java, Indonesia. The results suggest that students with poor knowledge level, poor personal hygiene level, and poor sanitation have much higher risks to be infected by scabies.
Correlation and multiple regression analysis also indicates the strong effect of these factors to the incidence of scabies. It is advised that the school board should pay great attention to the density inside the dormitories, the availability of ventilations and air circulation in the rooms, access to sufficient water, sanitation, quarantine and health facilities for students who are infected by scabies, and hygiene facilities proportional to the number of students, and other facilities (clothes washing and drying facilities, etc.).
Education and behaviour change strategies to Islamic boarding school students are also proposed. Kyai, school administrators, and peer examples will play a significant role in promoting hygiene and health behaviours and thus reducing the incidence of scabies in this population.
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