PREFACE

Thanks to Allah SWT for helping and give uschance to finish this Scenario
C tutorial report on the XXII bloktimely. Shalawat and salamalways be with our
prophet Muhammad SAW and his family, friends, and followers until the end of
time.

We recognize that this tutorial report is far from perfect. Therefore we

expect constructive criticism and suggestions, in order to refine the next tasks.

In completing this tutorial task, we got a lot of help, guidance and advice.
On this occasion we would like to express our respect and gratitude to:

1. Dr. Kamalia Layal, M.Biomed as tutor of group 3

2. All of the members who involved in the making of this report

May Allah SWT give a reward for all the charity given to all those who
have supported us and hopefully this tutorial report, useful for us and the
development of science. May we always be in the protection of Allah SWT.
Amen.

Palembang, November 8st, 2017

Author

1
 TABLE OF CONTENT

PREFACE ..................................................................................................................1

TABLE OF CONTENT .............................................................................................2

CHAPTER I INTRODUCTION

1.1 Issue Background ..........................................................................................3

1.2 Purpose and Objectives .................................................................................3

BAB II DISCUSSION

2.1 Tutorial Data .................................................................................................4

2.2 Case Scenario ................................................................................................4

2.3 Clarification of Terms ...................................................................................5

2.4 Identification of Problem ..............................................................................6

2.5 Analysis and Synthesis of Problem...............................................................6

2.6 Knot...............................................................................................................23

2.7 Conceptual Framework .................................................................................23

Conceptual Framework .......................................................................................23

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 CHAPTER I
INTRODUCTION

1.1 Issue Background

Community medical science and public healthis the XXII blok in the
seven semester of Competency Based Curriculum of Medical Education
Faculty of Medicine, Muhammadiyah University of Palembang.
In this occasion already implemented tutorial with case C Dr. Beny
just worked for 6 months at the Puskesmas Beringin Jaya. He got a report
from his surveillance staff that this month there was an increase in cases of
diarrhea, acute respiratory infections (ARI) significantly. Beringin Jaya has
been village with endemic diarrhea and ARI. Puskesmas located is Beringin
Jaya village with population of 20.000. Beringin Jaya village is located on the
river bank where the river is used by residents for bathing, washing and
defecating.

Purpose and Objectives

The purpose and objectives of this case study tutorial, namely:

1. As a report task group tutorial that is part of KBK learning system at the
Faculty of Medicine, Muhammadiyah University of Palembang.
2. Can solve the case given in the scenario with the method of analysis and
learning group discussion.
3. Achieving the objectives of the tutorial learning method.

3
 CHAPTER II

DISCUSSION

2.1 Tutorial Data

Tutor : Dr. Kamalia Layal, M.Biomed
Moderator : Okta Permata Putri
Secretary : Rati Permata Sari
Notulis : Nabilah Tamara
Day and date : Tuesday, November 7th, 2017
(13.00 am -14.30 pm)
Thursday, November 9th, 2017
(13.00 am – 14.30 pm)
Rule of tutorial : 1. Gadget should be nonactive or in silent mode.
2. Everyone in the group should express their opinion.
3. ask for permission if want to go outside.
4. Eating and drinking are not allowed in the room.

2.2 Case Scenario

Dr. Beny just worked for 6 months at the Puskesmas Beringin Jaya. He
got a report from his surveillance staff that this month there was an increase in
cases of diarrhea, acute respiratory infections (ARI) significantly. Beringin
Jaya has been village with endemic diarrhea and ARI.

Puskesmas located is Beringin Jaya village with population of 20.000.

Beringin Jaya village is located on the river bank where the river is used by
residents for bathing, washing and defecating.

At the base of the river there is a rubber processing plant, where

factory wate is directly flowed into the river without prior treament.

The work of general population is as a forest encroachment farmer,

where to open their land to burn forest. Some of the population work as labors

4
 in rubber processing plant, generally they work not using personal protective
equipment.

Dr. Beni plan to investigate outbreaks to prevent transmission and to

the seek the source of disease transmission, he will also provide public
education to prevent transmission of the disease.

2.3 Clarification of Terms

1 Surveillance Collecting analizing data continously and
systematicaly then disseminated to responsible
for diseuse prevention and other health problem
2 Endemic Total case of a certain desease that appeur at
certaintime and certain area in a apopulation
3 Diarrhea The condition of having at least 3 loose of liquid
bowel movement each day

4 ARI Acute respiratory infection is infection that

interfered with the respiratory process for some
of people caised log virus, or bactery that attacks
nose, trachea or lungs
5 Population Group of people or resident in spesific area
6 Encroachment Unlawful entering (gradually and whitout
permission) upon the land, property, other
posessions, or the right for another
7 Personal The equipment that must be use when working
protective in the area that have a potential risk and in a
equipment danger area to maintain the safety of workers and
those around them
8 Outbreak A sudden occcurance of something unwelcome
such as war or disease

5
 9 Public education Giving a knowledge and ability of person
through learning practice technique or
instruction for the purpose of changing or
affecting individual human behaviour groups and
communities for can be more independent in
achieving healthy life goals

2.4 Identification of Problem

1. Dr. Beny just worked for 6 months at the Puskesmas Beringin Jaya. He got
a report from his surveillance staff that this month there was an increase in
cases of diarrhea, acute respiratory infections (ARI) significantly. Beringin
Jaya has been village with endemic diarrhea and ARI.
2. Puskesmas located is Beringin Jaya village with population of 20.000.
Beringin Jaya village is located on the river bank where the river is used
by residents for bathing, washing and defecating.
3. At the base of the river there is a rubber processing plant, where factory
wate is directly flowed into the river without prior treament.
4. The work of general population is as a forest encroachment farmer, where
to open their land to burn forest. Some of the population work as labors in
rubber processing plant, generally they work not using personal protective
equipment.
5. Dr. Beni plan to investigate outbreaks to prevent transmission and to the
seek the source of disease transmission, he will also provide public
education to prevent transmission of the disease.

2.5 Analysis of Problem

1. Dr. Beny just worked for 6 months at the Puskesmas Beringin Jaya. He got
a report from his surveillance staff that this month there was an increase in
cases of diarrhea, acute respiratory infections (ARI) significantly. Beringin
Jaya has been village with endemic diarrhea and ARI.
a. What are the tasks of surveillance staff?
Answer:

6
 Based on the Decree of the Minister of Health No. 1479 /
Menkes / SK / X / 2003 on Guidelines on the Implementation of
Epidemiology Surveillance System for Infectious Diseases and
Non Communicable Diseases, the role of surveillance of
puskesmas is:

1. Data Collection and Processing

The Puskesmas surveillance unit collects and processes STP
Puskesmas data from the outpatient registers & inpatient registers
at Puskesmas and Puskesmas Pembantu, excluding data from non-
Puskesmas service units and health cadres. The collection and
processing of data is utilized for analysis materials and
recommendations for follow-up as well as data distribution.

2. Follow-up Analysis and Recommendation

The Puskesmas surveillance unit conducts monthly analysis of
potential outbreak diseases in its area in the form of a table
according to the village / kelurahan and the weekly disease trend
graph, then informs the results to the Puskesmas Head, as the
implementation of local area monitoring (PWS) or early awareness
system of potential outbreak diseases at the Puskesmas. If there is a
tendency to increase the number of potential disease outbreaks, the
Head of Puskesmas will conduct an epidemiological investigation
and inform the District Health Office. The Puskesmas surveillance
unit conducts an annual analysis of disease progression and links it
to risk factors, environmental changes, and program planning and
success. Puskesmas utilize the results as an annual profile material,
Puskesmas planning materials, program and sector related
information and District / Municipal Health Office.

3. Feedback

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 Puskesmas surveillance unit sent monthly report attendance
and data recovery request to Puskesmas Pembantu in its working
area.

4. Reports
Every week, Puskesmas send PWS data of potential disease of
KLB PWS KLB (attached form 3). Every month, Puskesmas sends
STP Puskesmas data to District / City Health Office with the type
of disease and its variables as form STP. EFA (attached form 4). In
the PWS data of potential outbreaks and STP data, this Puskesmas
does not include data on non-health service units and health cadres
data Each week, non-Puskesmas Service Units send PWS data of
potential outbreaks to District Health Offices.
(KMK RI, 2003)

b. What is the purposes of surveillance?

Answers:
a. Provide an information about the situation, disease trends,
and risk factors and also health problems in a community
and the factorswhich influenced it as a decision-making
material;
b. The implementation of early awareness to the possibility
of occurrenceOutbreaks and their effects
c. The implementation of investigation and control of
outbreaks/epidemic
d. As the funfamental to give a health information to the
parties concerned with health considerations.
(Permenkes, 2014)

c. What are the steps of surveillance?

Answer:

8
 The decree of minister of health of the republic number
1116/ menkes/sk/VIII/2003 concering guidelines for implementing
epidemiology surveillance system. Health epidemiological
surveillance activities are activities that are carried out
continuously and systematically with the working mechanism as
follows:
1. Identification of cases and health problems as well as other
relevant information
2. Recording, reporting, and data processing
3. Analysis and interpretation of data
4. Epidemiological studies
5. Dissemination of information to units that need it
6. Make recommendations and follow-up alternatives
7. Feedback

d. What are the requirements to be a surveillance staff?

Answer:
Epidemiological human resources, namely:
a. Epidemiologists (S1, S2, S3)
b. Epidemiologic surveillance officers trained field
epidemiologic assistants and trained puskesmas officers
c. Health department managers who have an epidemiological
orientation
d. Position of epidemiological function
e. Trained human resources of puskesmas
f. Human resources related
(Ministry of Health RI, 2003)

e. What is the meaning of endemic disease?

Answer:
The amount of a particular disease that is usually present in
a community is referred to as the baseline or endemic level of the

9
 disease. Endemic refers to the constant presence and/or usual
prevalence of a disease or infectious agent in a population within a
geographic area (CDC,2012).
1. Endemic: persistent disease in a particular place, population
and community (minimum 3 years in a row. For example:
DHF
2. Epidemic (epidemic): an increase of disease beyond normal
(2 x fold before) in the community. Example: filariasis
3. Pandemic: epidemics that occur in a very wide area
(worldwide). Example: H1N1 2009 (Swine flu)
4. Sporadic: the incident that lasted briefly took place in some
places and at the time of observation of each incident is not
interconnected for example in the process of spreading. For
example: NE disease

f. What is the meaning of an increase in cases of diarrhea ARI

significantly?
Answers:
The meaning of an increase in case of diarrhea and ARI
significantly is an outbreak. According to Pasal 1 in Permenkes
Number 1501 (2010), Outbreaks is the occurrence or increase of a
disease or mortality significantly within an area in a certain time
and the condition that can lead become an epidemic.

g. How does disease travel naturally and transmisinya? (diarrhea and

ARI)
Answer:
Diarrhea:
Transmission of infectious germs that cause diarrhea is
transmitted through Face-Oral germs can be transmitted when
entered into the mouth through food, drink or contaminated objects
with feces, such as fingers, food containers or drinking places to be

10
 washed with contaminated water. People who are covered by clean
water supply have a lower risk of diarrhea than people who do not
get clean water. Communities can reduce the risk of diarrhea by
using clean water and protecting the water from contamination
from the source to storage at home (Soepardi, 2011).

ARI:
Transmission of infectious agents through airborne is disease
transmission caused by spreading droplet nuclei that remain
infectious when flying in the air in long distances and long periods
of time. Transmission through the air can be further categorized
into "obligate" or "preferential" transmission (Soepardi, 2011).

2. Puskesmas located is Beringin Jaya village with population of 20.000.

Beringin Jaya village is located on the river bank where the river is used
by residents for bathing, washing and defecating.
a. What is the correlation between the location of the village and case
of diarrhea?
Answer:
The correlation between the location of the village and case
of diarrhea is because of the village near from the source of the
water, which is the river, so the villager use the water from the
river for their daily life, such us for bathing, washing and
defecating. Their bad habits (use the river for bathing, washing and
defecating) made the hygiene in their village low. The low hygiene
in the village can be the risk factor of the increase in case of
diarrhea.

b. What are the impact of using the river for bathing, washing and
defecating?
Answer:
According to (Workie, Amare, Melake Demena et al. 2003)
which includes wateborne disease are:

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Categories of Diseases Causes Caused Transmission
agents organisms route of disease

Bacterial Shigellosis Shigella. Sp Man-Feces-water-

food and drink-
human

Thyphoid Salmonella thypi Man-Feces-water-

dan salmonella food and drink-
parathypi human

Cholera Vibrio Cholera Man-Feces-water-

food and drink-
human

Acute E. coli Man-feces-water-

Gastroenteritis human

Viral Infectious hepatitis Hepatitis A virus Man-feces-water-

food and drink-
Hepatitis E Virus
human

Poliomyelitis Polio virus Man-feces-water-

human

Acute Gastroentritis Rota Virus Man-feces-water-

human

Protozoal Amebiasis Entamoeba Man-feces-water-

Hystolitica food and drink-
human

Giardiasis Giardia lamblia Man-feces-water-

food and drink-
human

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Helminths Dracunculiasis Drancunculus Man-water-human
(Guinea Worm) medinesis

c. What is good water source criteria?

Answer:
There are 3 requirements for good water, they are:

a. Physical requirement
The physical requirements for good water are no color, no
taste, and the temperature are must be lower than the
temperature of the environtment around the water.
b. Bacteriological requirement
The water must be free from any kind of bacteri especially the
pathogen one. It can be checked from the sample of the water.
If it contains less than 4 E. Coli bacteri per 100 cc of water,
then the water is safe to consume.
Chemical requirements
The water are acceptable if it contains certain substances but in
a certain amount too.
Substance Acceptable level
Flour (F) 1-1,5
Chlor (C) 250
Arsenic (Ar) 0,05
Cuprum (Cu) 1,0
Iron (Fe) 0,3
Organic substance 10
Acidity 6,5-9,0
Carbon dioxide 0
(Notoatmodjo, 2011)

13
d. What are the type on latrine?
Answer:
1. Cemplung toilet, latrine (pit latrine)
Inside the pit latrine ranged between 1.53 meters. In accordance
with the rural areas, the latrine can be made from bamboo, bamboo
walls, and the roof of coconut leaves or rice leaves. The distance
from drinking water sources is at least 15 meters away.

2. Ventilated cistern (ventilated improved pit latrine = VIP latrine)

This toilet is almost the same as the cemplung latrine, the
difference is more complete, that is using the pipe vent. For rural
areas, these ventilation pipes can be made with bamboo.

3. Toast pond (fishpond latrine)

These latrines are built on fish ponds.

4. Fertilizer toilet (the compost privy)

In principle, these latrines are like a cemplung latrine, only more
shallow excavations. In addition, the latrine is also to dispose of
animal waste and waste, and leaves.

5. Septic tank
This type of septic tank latrine is the most eligible way, therefore,
the recommended disposal of these stools. Septic tanks consist of a
watertight sedimentary tank, in which faeces and waste water enter
and decompose. In this tank, the stool will be for several days.
During this time, the stool will have 2 processes:
a) Chemical process
b) Biological processes
(Notoadmodjo, 2011)

14
 e. What are the criteria of a good latrine?
Answer:
According Notoadmojo (2011) A toilet called healthy for
rural areas must meet the following requirements:
1. Does not pollute the surface of the soil around the latrine
2. Do not contaminate surface water around it
3. Not pollute the surrounding groundwater
4. Unaffordable by insects especially flies and cockroaches
and other animals
5. Does not cause odor
6. Easy to use and maintain (maintenance)
7. Simple design
8. Cheap
9. Can be accepted by the wearer.

3. At the base of the river there is a rubber processing plant, where factory
wate is directly flowed into the river without prior treament.
a. What is the impact of factory waste directly flowed into the river
without prior treatment?
Answer :
Wastewater treatment methods:
Wastewater treatment is intended to protect the environment
against waste water pollution.Some simple ways of waste water
treatment include:
a. Dilution
The wastewater is diluted until it reaches a sufficiently low
concentration, then is discharged into water bodies.
b. Oxidation ponds (oxidation ponds)
In principle, this way of processing is the utilization of
sunlight, algae, batteries and oxygen in the process of
natural cleansing. Wastewater is flowed into a large
rectangular pool with a depth of between 1-2 meters. The

15
 walls and bottom of the pond need not be lined with
anything. The location of the pond should be far from
residential areas, and in open areas, thus allowing good
wind circulation.
c. Irrigation
Wastewater is poured into open trenches dug, and water
will seep into the ground through the base of the trench
walls.
(Notoatmodjo, 2012)
4. The work of general population is as a forest encroachment farmer, where
to open their land to burn forest. Some of the population work as labors in
rubber processing plant, generally they work not using personal protective
equipment.
a. What diseases are likely to be experienced by farmers encroaching
forests and laborers factory?
Answer:
- Diseases of the forest planters
Respiratory diseases: ARI, Pneumonia.

- Disease on factory workers:

Chemical trauma, ARI.

b. What is the law that regulates about K3?

Answer:
a. Laws governing the OSH implementation system: a. In the
Law of the Republic of Indonesia Number 13 Year 2003 on
Employment Article 87.
 Every company must implement a safety and health
management system integrated with the company's
management system.
 Provisions concerning the application of occupational
safety and health management systems as referred to in

16
 paragraph (1) shall be regulated by a Government
Regulation.
b. In Government Regulation No. 50 of 2012 on the
implementation of occupational safety and health
management system of article 10-13.

c. What kind of personal protective equipment that suitable for the

labors in rubber processing plant?
Answer:
According to the Regulation of the Minister of Manpower and
Transmigration of the Republic of Indonesia No. PER.08 / MEN /
VII / 2010 concerning Personal Protective Equipment, Article 3
Paragraph (1)
PPE includes:
1. Head protectors
Types of head protection devices consist of safety helmet,
hat or head hood, cover or hair safety, and others.
2. Eye and face protection
Types of eye and face protection devices consist of
spectacles, goggles, face shields, diving masks, face shields
and safety goggles (full face masks).
3. Ear shield
This type of ear protector consists of ear plugs and earplugs
(ear muffs).
4. Respiratory protection and equipment
Types of respiratory protective equipment and equipment
consisting of a mask, respirator, katrit, kanister, Re-
breather, Airline respirator, Continues Air Supply Machine
or Air Hose Mask Respirator, diving tank and regulator

17
 (Self-Contained Underwater Breathing Apparatus /
SCUBA), Self- Contained Breathing Apparatus (SCBA),
and emergency breathing apparatus.
5. Hand protection
This type of hand protection consists of gloves made of
metal, leather, canvas, fabric or coated fabrics, rubber, and
chemical resistant gloves.
6. Foot protector
Type of foot protector in the form of safety shoes at work
of smelting, metal casting, industry, construction of
buildings, work of potentially explosive hazards, electrical
hazards, wet or slippery workplaces, chemicals and
microorganisms, and / or animal hazards and others.
Article 3 paragraph (2), in addition to the PPE as referred to in
paragraph (1), there are also additional PPE, namely:
a) Protective clothing
This type of protective clothing consists of vests, aprons
(Apron / Coveralls), Jackets and protective clothing that
cover part or all of the body parts.
b) Personal protective equipment falling
This type of personal protective equipment consists of
harness, karabiner, lanyard, safety rope, rope clamp,
decender, mobile fall arresters), and others.
c) Buoy
The buoy type consists of a life jacket, a life vest, a
Bouyancy Control Device.

d. What are the type of occupational disease?

Answer:
According to the International Labor Organization (ILO),
occupational accidents are classified by 4 kinds:
1) Classification by accident type

18
 a) Fall
b) Wrapped objects
c) Pounded or exposed to objects
d) Squashed by objects
e) Movements beyond ability
f) High temperature effect
g) Exposed to electric current
h) Contact of hazardous materials or radiation
2) Classification by cause
a) Machines, such as power generation machines, sawmills,
and so on.
b) conveyance, land transport, air and water transport
equipment.
c) Other equipment, such as burner and heating kitchens,
refrigeration installations, electrical appliances, and so on.
d) Materials, substances, and radiation, such as explosives,
gases, chemicals, and so on.
e) Work environment (outside buildings, inside buildings,
andbelow ground)
f) Other causes
3) Classification by nature of injury or abnormality
a) Fracture
b) Dislocation
c) Strain muscles
d) Bruises and other deep wounds
e) Amputation
f) Wounds on the surface
g) Concussion and crumbling
h) Burns
i) Sudden poisoning
j) Influence of radiation
k) And others

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 4) Classification according to location of abnormalities or injuries
in the body
a) Head
b) Neck
c) Agency
d) Top member
e) Lower member
f) Plenty of places
g) Other location
(Notoadmojo, 2011)

e. How to prevent the occupational disease?

Answer:
To prevent occupational diseases can be made between various
efforts other:
a. Periodic Medical Examination.
b. Special Health Checkup.
c. Health Services.
d. Provision of Facilities and Infrastructure and more convenient
workplace improvements.

5. Dr. Beni plan to investigate outbreaks to prevent transmission and to the

seek the source of disease transmission, he will also provide public
education to prevent transmission of the disease.
a. How is the plan to prevent the outbreaks in this case?
Answer:
Pasal 13 Ayat 2 in the Regulation of the Minister of Health
of the Republic of Indonesia Number
Answer:
1501 / MENKES / PER / X / 2010, Countermeasures of outbreaks
outbreaks:
a) Epidemiological investigations

20
 b) Management of the patient which includes the examination,
treatment, care and treatment of the patient, including
quarantine measures
c) Prevention and thickening
d) Destruction of the disease
e) Treatment of the corpse due to the epidemic
f) Counseling to the community
g) Other countermeasures.
Pasal 13 Ayat 3: Other mitigation measures referred to in
paragraph (2) letter g include temporarily dismissing the school,
temporarily closing public facilities, conducting intensive
surveillance / surveillance during outbreaks and evaluating overall
countermeasures .

b. What are the steps to investigate the outbreaks?

Answer:
According to Regulation of the Minister of Health of the
Republic of Indonesia No 949 / MENKES / SK / VIII / 2004,
Investigation of alleged outbreaks by:
1. In the Health Service Unit, the health worker asks every
visitor of the Health Service Unit about the possibility of an
increase in the number of people suspected of the outbreak
at a particular location.
2. In the Health Services Unit, the health worker checks the
inpatient and outpatient registers of any possible increase in
suspected cases at a particular location based on the
patient's address, age, and gender or other characteristics.
3. The health worker interviewed the village head, the head of
the dormitory and everyone who knows the state of the
community about the increase of the suspected disease of
the outbreak.

21
 4. Opening of service post at the location of suspected
outbreak and analyzing patient data of treatment to know
the possibility of existence of increase of suspected disease.
5. Visiting suspected persons home or home-to-house visits to
all residents depending on the choice of investigation team.

c. What is the process transmission disease in this case?

Answer:
1. Primary prevention.
Primary prevention is the effort to modify risk
factors or prevent the development of risk factors, before
the start of pathological changes, performed at the stage of
suseptibel and disease induction, with the aim of preventing
or delaying the occurrence of new cases of disease.
2. Secondary prevention.
Secondary prevention is a preventive effort in the
asymptomatic disease phase, precisely at the preclinical
stage, on the incidence of clinical disease symptoms
through early detection (early detection).
3. Terertial prevention.
Tertiary prevention is the prevention of disease
progression in the direction of the consequences of worse
disease, with the aim of improving the quality of life of
patients. Tertiary prevention is usually done by doctors and
a number of other health professions (eg, physiotherapists)
(Depkes RI, 1994).

6. What is the islamic value in this case?

Answer:
The Word of Allah SWT in Q.S. Ar-Ruum, 30: 41:

22
 Meaning: "It has been seen that the damage on land and at sea is due to
the deeds of human hands; God wants them to feel some of the (result) of
their deeds due to) their deeds, in order that they return to the right path”.

2.6 Conclusion
Beringin Jaya Village occurred outbreaks of diarrhea and acute respiratory
infection (ARI) caused by water borne disease due to poor sanitation due to
occupational disease.

2.7 Conceptual Framework

Poor sanitation and

waste disposal into Forest burning
the river

Water borne disease Air pollution

ARI
Diarrhea

Outbreaks

Investigation of
outbreak and
prevention

23
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Menteri Kesehatan Republik Indonesia. 2003. Keputusan Menteri Kesehatan RI Nomor

1116 tahun 2003 Pedoman Penyelenggaraan Sistem Survelilans Epidemiologi
Kesehatan. Jakarta: Departemen Kesehatan

Noor, N. 2008. Epidemiologi. Jakarta: Rineka Cipta

Notoatmodjo, Soekidjo. 2011. Kesehatan Masyarakat: Ilmu dan Seni. Rineka Cipta,
Jakarta, Indonesia.

Pedoman Surveilans Epidemiologi Penyakit Menular. Departemen Kesehatan

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Imunisasi. 1994. Jakarta

Permenkes RI nomor 1501 Tahun 2010 tentang Jenis Penyakit Menular Tertentu yang
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Priyanto, Dwi. 2011. Peran Air dalam Penyebaran Penyakit. BALABA, 7 (1), pp 27-28.

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Soepardi, Jane. 2011. Situasi Diare di Indonesia. Buletin Data Kementerian Kesehatan
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kerja. Surakarta: Harapan Press. 2008

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