1 1.1 Background
Environment-based disease is a disease phenomenon that occurs within a community group, which is related, rooted, or has a close correlation with one or more environmental components in a space where the community lives or is active for a certain period of time. Skin disease is a type of environmental-based infectious disease. One of the skin diseases caused by parasites is scabies. This disease will make the sufferer experience itching and discomfort in the integrity of the skin, causing a desire to scratch or what is called pruritus. Itching or pruritus is an uncomfortable sensation that encourages someone to scratch. Pruritus is an important problem because it can cause a decrease in the patient's quality of life and often recurs, especially if it is chronic (occurs for 6 weeks or more (Stander, 2016).
Pruritus (itching) is the most common skin symptom, seen in many skin complaints that cause discomfort and changes in skin integrity when the patient responds to scratching. It is an uncomfortable feeling on the skin and sometimes interferes with the patient's quality of life. Currently, the specific mechanism of pruritus remains unclear. However, the itch receptors are unmyelinated, possessing brush-like nerve endings (penicillates) that are found only in the skin, mucous membranes, and cornea. Pruritus is also a severe skin irritation that is characteristic of several types of jaundice, allergic disorders and malignancies that make the sufferer experience an irritating skin sensation and cause stimulation to be scratched (Rupert et al., 2022).
The most common skin symptom is pruritus (itching), which causes discomfort and changes in skin integrity if the patient responds to
scratching. This causes an unpleasant sensation on the skin and can reduce the patient's quality of life. Currently, the exact mechanism of pruritus is unknown. Itch receptors, on the other hand, are unmyelinated, brush-like nerve endings (penicillates) that are found only in the skin, mucous membranes, and cornea. Pruritus is a severe skin irritation associated with various types of jaundice, allergic disease, and malignancy, causing the victim to experience an itchy and stimulated scratching sensation. Itching or pruritus can also be defined as an uncomfortable sensation that gives rise to a desire to scratch, which adversely affects the psychological and physical elements of life. This is the most common symptom of skin disease, and can sometimes be mild or severe (Song et al., 2018).
Pruritus may be present continuously or infrequently. The location can be local or public. Itching is mostly associated with free teleneurons, which are found in the superficial layers of the epidermis. Contact dermatitis, eczema, urticaria, neurodermatitis, prurigo, and skin pruritus are the most common itch-related skin diseases. In addition, pruritus can develop as a result of systemic diseases such as inflammatory diseases, metabolic diseases, infections, nervous disorders, endocrine diseases, mental disorders, and cancer. Pruritus results from a complex interaction between the skin, the immune system, and the nervous system. Pruritogen binds to receptors on the free ends of unmyelinated C nerve fibers in the skin. 4 The sensation of itching is induced through activation by pruritogen at the G protein-coupled receptor (GPCR) ( Yosipovitch et al., 2018 ). GPCRs that are known to contribute to pruritus are histamine receptor-1, protease-activated receptor (PAR)-2 and PAR-4, mas-associated G protein-coupled receptors (mrgpR), and so on. The bond between pruritogen and GPCR can activate various ion channels, namely transient receptor potential vanilloid 1 (TRPV1), transient receptor potential ankyrin 1 (TRPA1), and voltage-gated sodium channel (Nav). CMIA and is activated by histamine (Stander et al., 2019).
Meanwhile, non-histaminergic pruritic signaling pathways are found in
CMH and are activated by proteases, cytokines, chemokines and amines (Golpanian et al., 2020). Various cytokines that play a role in pruritus, for example interleukin (IL)-4, IL-13, IL-31, IL-17, and thymic stromal lymphopoietin (TSLP). 5 Histamine-1 receptors are expressed in CMIA, whereas in CMH there are various other receptors (Stander et al., 2019). In acute pruritus, histamine plays an important role as a mediator of itching.
Histamine is released mainly by mast cells, but can also be released by basophil cells. Histamine binds to histamine receptors in nerves and activates TRPV1 resulting in an action potential (Yosipovitch et al., 2018).
The action potential causes the release of neuropeptides (substance P and calcitonin gene-associated protein), then triggers neurogenic inflammation.
Substance P, belonging to the tachykinin family, is a neuropeptide released by peptidergic neurons and has a high affinity for the neurokinin-1 (NK-1) receptor. In chronic pruritus, activation of GPCRs by nonhistamine pruritogens triggers the opening of TRPV1 and TRPA1 ion channels via the phospholipase or kinase system. Next, Nav activation occurs and triggers an action potential. The itching sensation that is transmitted by C nerve fiber synapses in the spinal cord is then transmitted via the spinothalamic tract to the brain (Golpanian et al., 2020).
The International Forum for the Study of Itch (IFSI) in 2007 classified pruritus into three clinical categories, namely group I in skin diseases; group II without skin disease; and group III due to chronic scratching lesions.
Pruritus can be further categorized according to the underlying disease, namely dermatological disease (category I), systemic disease (category II), neurological disease (category III), psychogenic (category IV), mixed (category V), and others (category VI). ) (Fowler et al., 2020).
Based on dermatological etiology, pruritus can be caused by allergic or irritant contact dermatitis, atopic dermatitis, bullous pemphigoid, skin T-cell
lymphoma (mycosis fungoides), dermatitis herpetiformis, dermatophyte infection, folliculitis, lichen planus, lichen simplex chronicus, pediculosis (lice infestation), psoriasis, sunburn, urticaria (hives), xerosis and scabies (Rupert et al., 2022).
Scabies is often neglected because it is considered a non-life-threatening disease, so the priority for treatment is low. In fact, if left untreated, chronic scabies can cause dangerous complications. A student who has a skin disease caused by scabies can appear symptoms of redness, pus, and symptoms of scaly skin to sores, this can cause feelings of discomfort, lack of confidence, and feelings of embarrassment, as well as cause more serious disorders. namely negative self-image. Especially female students, because female students are of course very concerned about their appearance.
Women tend to prioritize their physical appearance, they think about physical aspects, appearance, attractiveness and beauty (Tarbawi et al., 2018). Based on research from (Fitria Dwinanda, 2016), respondents based on gender showed that female respondents had a higher body image value than male respondents.
Lesions caused by individuals will cause symptoms of spots on the infected part of the skin, these spots in some infected individuals will cause feelings of discomfort so that adolescents experience a lack of confidence and can cause impaired self-image (Prayitno et al., 2022).
Female students who live in Islamic boarding schools have a high prevalence of scabies. This is due to crowded living quarters and physical interaction or contact between residents and poor personal hygiene, which contribute to the transmission of scabies mites . Scabies is generally found in densely populated areas, such as Islamic boarding schools. So that activities through direct contact (touching) or indirect contact with scabies sufferers use tools and materials that contain scabies such as soap, gloves,
or towels) so that scabies is easily infected. Impact Scabies causes unbearable itching (Pruritus). Itching (pruritus) which is scratched will cause lesions. Lesions caused by individuals will show symptoms of infected skin patches. So that these spots become scars or scar tissue.
Scabies is quite concerning, because from the start of the occurrence of scabies to becoming scars it will have an impact on a lack of self-confidence and become a disturbance of self-image related to female student psychology, and it is feared that it will have an impact on daily life (Ihtiartyas et al., 2019) .
Female students who suffer from scabies will complain of itching (pruritus), especially at night. Itching (pruritus) mainly occurs between the fingers, waist, around the elbows, breasts, wrists and others, so that there will be embarrassment because it will greatly affect their appearance. Itching (pruritus) that is scratched will cause lesions and eventually become scars or scar tissue due to wound healing. Scar tissue dramatically affects the quality of life of patients with skin wounds , one of which is poor personal hygiene (Lebonvallet et al., 2018) .
Personal hygiene is one of the factors that influence the incident scabies, someone with poor personal hygiene through direct contact (touching) or indirect contact with scabies sufferers using tools and materials affected by scabies, such as soap, gloves, or towels) and rarely cleans the bed, such as drying the mattress, changing pillowcases and sheets, as well as poor hygiene, so that people with scabies are easily infected (Puspita et al., 2018).
WHO stated that the incidence of scabies in 2014 was 130 million people in the world. Scabies is a skin disease with an estimated number of cases of more than 300 million annually in the world, the incidence varies greatly between countries or between regions within a country ranging from 0.3- 46% (Srisantyorini & Cahyaningsih, 2019).
According to the Ministry of Health of the Republic of Indonesia (MOH RI) based on data from Puskesmas throughout Indonesia in 2018 it was 5.6% - 12.95% and was ranked third out of the 12 most skin diseases.
In South Kalimantan, scabies ranks sixth out of ten diseases. Scurvy also ranks 13th in Banjar district. A high prevalence of scabies is generally found in environments with high population density and interpersonal contact such as prisons, orphanages and Islamic boarding schools (Kustantie &
Rachmawati, 2016).
There are 27,722 Islamic boarding schools in all provinces in Indonesia with a total of 4,172,615 students (pdppkemenag, 2019). Darul Hijrah Islamic Boarding School Puteri Martapura in 2018 recorded 43 female students affected by scabies.
Some efforts to prevent scabies in Islamic boarding schools are: do not borrow items such as towels and clothes, change them often pillow cases, bolsters and sheets, shower 2 times a day, avoid taking a shower directly contact with scabies sufferers, and provide counseling and related counseling against scabies ( Egeten et al. , 2019). One The part that plays a major role in preventing scabies in Islamic boarding schools is the Islamic Boarding School Health Service Post as referred to in the Regulation of the Minister of Health Number 1 of 2013 concerning this Implementation Guideline. Implementation of Islamic Boarding School Guidance (Ministry of Health RI, 2013) .
Posyandu Islamic boarding schools play a major role in controlling and preventing scabies in Islamic boarding schools. Several efforts have been made by the Posyandu Islamic Boarding School to prevent scabies, including promotive, preventive, curative, and rehabilitative. The
government hopes that with the existence of Islamic Boarding School Health Services, recording of health status at Islamic boarding schools can improve and be able to reduce and minimize health problems for Islamic boarding school residents, especially female students. In addition, the Poskesmas Dormitory can provide information on how to prevent it, signs and symptoms and provide treatment for a disease. This is one part of efforts to provide promotive and preventive health services (Hulaila, Musthofa, Kusumawati, & Nugraha, 2021; Imartha et al., 2017).
Research conducted by Indriati, Setyowati, & Abidin, (2019) stated that the results of interviews with Community Health Centers at three Islamic Boarding Schools (IBS) in Blora City District showed that 75% to 90% of female students had been exposed to scabies. So that female students need to get an understanding of scabies and pruritis which cause inflammation to cause a response of wanting to scratch. Knowledge is basically something that is known by humans related to health, disease or health and curiosity through sensory processes, especially in the eyes and ears towards certain objects. From the journal search results it was found that lack of knowledge makes a person less concerned about the importance of personal hygiene and the role of poor hygiene in the spread of infectious diseases. Self- knowledge, namely efforts to prevent pruritus in scabies including understanding, causes, signs and symptoms and handling related to pruritus by doing skin prevention in scabies. Most of a person's knowledge is obtained through the sense of hearing and sense of sight. A person's knowledge of objects has different intensities or levels, by itself at the time of sensing to produce this knowledge is strongly influenced by the intensity of attention and perception of the object.
Meanwhile, to minimize pruritus by preventing injury to the skin in scabies, attitude is needed. A person's attitude influences the person to take an action so that a desire arises to understand some information which will have an
impact on the stimuli that will be displayed in the form of behavior patterns, tendencies or anticipatory readiness to adapt (Wiratmo, Karim and Purwayuningsih, 2021).
Attitudes that can be taken to minimize pruritus can be differentiated into pharmacological or non-pharmacological treatment which consists of using skin care, namely using moisturizers, increasing awareness of the importance of personal hygiene such as washing, bathing every day, bathing, removing sweat and dirt. However, avoid scrubbing the skin intensely. When using soap and shampoo, avoid using products that have strong detergency. Rinse the soap and shampoo thoroughly to remove residue completely. Avoid hot water that causes itching. avoiding bath materials and bath powders that cause a burning sensation, avoiding using nylon or hard towels, keeping the room clean and maintaining the appropriate temperature and humidity, washing new underwear in water before use, rinsing detergent thoroughly, trimming fingernails and trying not to scratch skin when itchy but uses gloves or bandages for protection (Satoh et al., 2021; Andardewi et al., 2022).
Based on the results of a preliminary study conducted at the Darul Hijrah Puteri Martapura Islamic Boarding School, it was found that out of 10 female students, 8 of them had experienced itching in the skin area and did not know about pruritus, 8 of them said. experienced a decrease in self- confidence so that 6 people used a moisturizer to reduce itching and 2 people had to take medicine from a doctor and 5 people experienced a decrease in itching intensity after using a moisturizer and 1 person had to go for a check- up. to the doctor because the itching does not decrease.
In this study, it is possible that there are still many female students who do not know and understand about pruritus and how to minimize it by preventing scabies scars on the skin. Based on these problems, the authors
are interested in researching "The Correlation between the Level of Understanding and Behavior with the Level of Pruritus in Scabies Disease at Darul Hijrah Puteri Islamic Boarding School".
1.2 Problem Statement
From the background that the researcher described, the problem formulation obtained from this study was " The correlation between the level of understanding and behavior with the level of pruritus in scabies at the Darul Hijrah Puteri Islamic Boarding School ?"
1.3 Research Purposes 1.3.1 General purpose
Identify the correlation between the level of understanding and behavior with the level of pruritus in scabies at Darul Hijrah Puteri Islamic Boarding School.
1.3.2 Special purpose
The specific objectives of the research are as follows:
1.3.2.1 Identifying the level of understanding of female students on scabies at the Darul Hijrah Puteri Islamic Boarding School.
1.3.2.2 Identifying the behavior of female students with pruritus levels in scabies at the Darul Hijrah Puteri Islamic Boarding School.
1.3.2.3 Analyzing the correlation between the level of understanding with the level of pruritus at the Darul Hijrah Puteri Islamic Boarding School.
1.3.2.4 Analyzing the correlation between behavior and the level of pruritus at Darul Hijrah Puteri Islamic Boarding School.
1.3.2.5 Analyzing the correlation between the level of understanding and behavior with the level of pruritus in scabies at Darul Hijrah Puteri Islamic Boarding School.
1.4 Benefits of Research 1.4.1 Theoretical Benefits
The results of this study can be used as a reference source for similar research in nursing science to reduce pruritus in preventing skin scarring in Scabies.
1.4.2 Benefits for Further Research
It is hoped that the results of this study can be used as additional reference material for future researchers who have an interest in the correlation between the level of understanding of minimizing pruritus and the attitude of preventing skin scars in scabies at Darul Islamic Boarding School Puteri Hijrah Martapura.
1.4.3 Benefits of Boarding Schools
This research can contribute so that it can be used as material for consideration and correction for Islamic boarding schools to see the frequency of scabies that occurs in students and become a consideration for creating a healthier culture and providing further guidance.
1.4.4 Benefits for Santriwati
This research is expected to contribute knowledge to female students at the Darul Hijrah Putri Martapura Islamic Boarding School so that they can maintain a healthy environment to prevent and minimize the occurrence of scabies transmission.
1.5 Related Research
Several studies that have been carried out by other researchers are as follows:
1.5.1 The Correlation between Personal Hygiene and the Incidence of Scabies in Santri at Islamic Boarding Schools (Rizal Efendi et al., 2020). This study aims to analyze the correlation between personal hygiene and the incidence of scabies at Amanatul Islamic Boarding School Umat Surabaya. The sample in this study was 100 students
consisting of 51 male students and 49 female students. The research method in this study was a quantitative observational study using analytic survey research with a cross sectional approach and the sampling method using stratified random sampling. The results of this study indicated that most of the female students had poor personal hygiene (53%), had experienced scabies (56%) and there was a correlation between the personal hygiene of female students and the incidence of scabies (p=0.000) at the school. Amanatul Islamic Boarding School for the People of Surabaya. It can be concluded that the less good a person's personal hygiene is, the more students will experience scabies.
1.5.2 Prevalence of scabies and impetigo in school-age children in Timor- Leste by Alexander Matthews, Brandon Le, Salvador Amara, Paul Arkell, Merita Monteiro, Naomi Clarke, Terlinda Barros, Joaquim de Jesus Mendonça, Sonia Maria Exposto Gusmão, Leonia Maria dos Reis Seixas, João Henrique Araújo da Piedade , Daniel Engelman , Andrew C. Steer, Nicholas SS Fancourt , Jennifer Yan, John Kaldor , Joshua R. Francis, and Susana Vaz Nery (Matthews et al., 2021). This study aims to conduct a baseline assessment of scabies and impetigo to better understand local epidemiology and contribute to future surveys assessing the impact of the Mass Drug Administration (MDA). The samples in this study were all infants, children and adolescents <19 years from families who attended school, totaling 801 samples. The study was conducted in six primary schools in a semi- urban (Dili) and two rural areas (Ermera and Manufahi). This study used a cross-sectional survey using cluster sampling in sampling. The results of this study the overall prevalence of scabies was 30.6%.
Children in rural Manufahi were more likely to develop scabies than children in semi-urban Dili (53.6% vs 28.2%, adjusted odds ratio [AOR] 3.5). Most cases of scabies are mild (3 to 10 lesions), and the lesions are usually spread over more than one part of the body. The
prevalence of scabies was lower between ages 10 and 14 years compared with ages 5 to 9 years. In conclusion, the prevalence of scabies and impetigo in Timor-Leste is among the highest reported globally, especially in rural areas. Scabies infestations are strongly linked to impetigo. A comprehensive control strategy is urgently needed in Timor-Leste.
1.5.3 Body distribution of scabies skin lesions by Millicent H. Osti, Oliver Sokana Susanna Lake, Margot J. Whitfield, Dickson Boara Titus Nasi, Sean Dauer, Michael Marks, |Lucia Romani, John M. Kaldor, Andrew C. Steer, Daniel Engelman (Osti et al., 2022). This research is located in the Western Province of the Solomon Islands. This study aims to investigate the distribution of scabies lesional bodies in detail and to explore the accuracy of a simplified and focused examination approach. The samples in this study amounted to 467 samples from all ages. This research method is a cross-sectional study. The research results show A total of 467 individuals were enrolled (mean age: 9 years [range: 0–86]; female: 54.6%) of whom 269 (57.6%) participants had typical scabies lesions. The most common sites for scabies lesions were the dorsal fingers (65.7% of participants with scabies lesions), the dorsal finger clefts (62.1%), and the backs of the hands (61.7%).
