The effect of knowledge on attitude of pregnant women in prevention of worm infections

The effect of knowledge on attitude of pregnant women in prevention of worm infections Sulastri1*, Diah Ayu Agus Triana2 Introduction: Helminthiasis is an endemic and chronic disease caused by parasitic worms with a high prevalence rate and is non-fatal, but it affects the health of the human body by reducing the absorption of nutrients and proteins in infected individuals and reducing blood levels in the human body so that if it occurs in pregnant women, it can affect pregnancy and childbirth. This study aimed to examine the influence of findings on attitudes of pregnant women towards the prevention of helminthiasis in the work area of the Gatak Health Center, Sukoharjo. Methods: This study used a descriptive observational research method with a cross-sectional approach with 144 samples taken with an all-sampling technique. Results: Statistical test shows that the value of p 0.000 is less than alpha 0.05, which means there is a relationship between the knowledge the Pregnant women and the attitude of pregnant women insist the mother in preventing the occurrence of worms. Conclusion: The pregnant woman’s posture is classified as functional because it influences the mother in the prevention and treatment of helminthiasis and affects her state of health.


INTRODUCTION
Worm infections, especially intestinal worm infections, are environmental diseases that remain a problem in Indonesia. The infected worms can inhibit nutrient uptake and the occurrence of bleeding to reduce patient productivity. All age groups range from 40% to 60%, and up to 195 million people live in endemic areas of the world. 1 Results from studies in several other countries showed that at Kasoa Polyclinic, Ghana, 300 pregnant women whose stool samples were examined with the direct wet preparation technique and the concentration of ether former, 43 (14.3%) of them had intestinal parasites. 2 The results of a study in Ethiopia that the prevalence of intestinal helminth infections in pregnant women in 5 areas studied was 277 (37.3%). 3 Infection with intestinal worms has negative effects. This disease can weaken the patient's health, nutrition, intelligence, and performance, for which it causes many economic losses, as it causes loss of carbohydrates and proteins and blood loss (anemia). 4 Worm infection is one factor that makes anemia worse because as the number of worms in the intestine increases, so makes blood loss, which disrupts the iron balance as more iron is released than the iron supplied. 5 Earthworm species from the group of soilborne helminths are still a health problem, namely Ascaris lumbricoides, Trichuris trichiura, Strongyloides stercoralis, and hookworms (Necator americanus and Ancylostoma sp). 6 Mouth up to the mucous membrane of the small intestine. Hookworms ingest blood and travel from site to site in the lining of the intestine, leaving minimal bleeding and injury. 7 Worm infections can be transmitted through food contaminated with worm eggs because they are not washed properly. The ingested water contains worm eggs.
Infections are also caused by economic and environmental factors and poor personal hygiene. 2 Based on the health profile data in Sukoharjo in 2019 regarding environmental conditions, it was found that there were still some house buildings that still had dirty floors, especially the kitchen, there was no sewage, so there were still puddles in the house and household garbage. It had not been properly administered to provide access to drinking water. There is still water that does not meet the requirements for consumption because Coli bacteria are found, the water source may be contaminated with feces, or there is a leak in the mains. 8 Worm infections can be controlled by regularly administering anthelmintics, improving hygiene, improving personal hygiene, and providing health education to vulnerable groups. 9 One of the factors that cause helminthiasis is the knowledge of pregnant women about helminthiasis. The better the pregnant woman's knowledge, the better the mother will behave in preventing helminthiasis. Based on the previous problem, this study aimed to investigate pregnant women's knowledge and attitudes towards helminthiasis in the work area of the Gatak Health Center, Sukoharjo.

METHODS
The present study is a cross-sectional descriptive observational study conducted in January-February 2021; the study was conducted on pregnant women in the work area of Gatak Health Center, Sukoharjo Regency, Central Java, Indonesia. The study sample consisted of 144 pregnant women with pregnancy. Age in the first to third trimesters was recorded using a total sampling technique. The inclusion criteria in this study were pregnant women who could communicate well and were willing to become participants, while the exclusion criteria this study were pregnant women. who did not collect research questionnaires, the variables this study were the characteristics of pregnant women (age, gestational age, education, occupation and when they last took antiparasitic drugs) as independent variables and the level of knowledge and attitudes of women pregnant as the dependent variable.
The data collection technique used primary data obtained by completing questionnaires by pregnant women. The questionnaire consisted of 12 questions about the mother's knowledge of helminthiasis and 17 questions about the mother's attitude towards the prevention of helminthiasis, and then the data were evaluated using univariate and bivariate analysis; A univariate analysis was carried out, which describes the frequency and representation of the characteristics of the pregnant woman, which are represented by a frequency distribution table. Diverse analysis was conducted to determine the relationship between the characteristics and knowledge, and attitudes of pregnant women about helminthiasis in each prevalence using the SPSS application by chi-square analysis.

Characteristics of Respondents
The results of the study of 144 respondents gave the distribution of the characteristics of the respondents in Table 1 with the age of the respondents at the productive age of 20-35 years, namely 114 respondents (79.2%) and 30 respondents (20.8%) were of risk age. Most of the respondents were in the second trimester of pregnancy, up to 76 respondents (52.7%), 48 respondents (33.3%) in the third trimester, and 20 respondents (14.0%) in the first trimester. Ninety-two respondents (64%) already

Level of Knowledge and Attitude of Respondents
Of the 144 test samples, the level of knowledge and the attitudes in Table  2 with the level of knowledge of the pregnant woman about the infection with intestinal parasites, 90 respondents ORIGINAL ARTICLE   , there is no influence between work and knowledge. The variable taking medication has a p-value of 0.320, which means no effect exists between the last use of medication and knowledge.

The Effect of Characteristics on Attitude
The following table shows the results of the statistical tests that show the influence of the characteristic variables of pregnant women on attitudes with the results of the age sub-variable with a p-value of 0.120 > of alpha 0.05; there is no influence between the mother's age in the settings. Variable gestational age with a p-value of 0.062 > alpha 0.05 means that maternal gestational age does not influence attitudes. Education variable with p-value 0.00 < alpha 0.05, which means that there is an influence between education and attitudes of the pregnant woman. Working variable with a p-value of 0.000 < from alpha, which means that there is an influence between the work and the attitude of the pregnant woman and the variable intake of drugs with a p-value of 0.440, which means that there is no effect between the last drug intake and the attitude of the pregnant woman at the prevention of worms. Table 5 shows that pregnant women who are good at preventing helminthiasis are set at the level of those with good knowledge up to 68. Statistical test results show that the p-value of 0.000 is less than alpha 0.05 between the knowledge of pregnant women and the mother's attitude to preventing worms from occurring.

DISCUSSION
Of the 144 pregnant women surveyed who were willing to fill out the Gatak Health Center work area questionnaire, Sukoharjo was dominated by mothers of productive age (20-35 years). Most of them were housewives and had an average high school education. Results 10 showed that hookworm prevalence was more common among younger age groups, less than seven years of education, and farmers. The study also found that the majority of 118 respondents (81.9%) had never taken anti-parasitic drugs before and did not know if they were adults; they also had to take anti-parasitic medicines. To combat intestinal parasites in pregnant women, the Indonesian government has implemented a program for the administration, detection, and treatment of Fe tablets from the second and third trimesters under medical supervision. 1 An attempt to control and eradicate helminth infections to prevent anemia, low birth weight, and the risk of infant death. 11 Table 2 shows that 90 respondents (63%) had a good level of knowledge, and 86 respondents (59%) had a good attitude towards helminthiasis prevention in pregnant women. Various factors that can influence knowledge, such as education, information/media, socio-cultural and economic, environment, experience, age, and attitudes, influence factors such as personal or other experiences, the influence of culture and media, education and religion, and emotional factors. 12 Although the results of the study in Tables 3 and 4 results from the characteristics of the respondents such as age, gestational age, education, occupation, and time of the last drug intake, nothing influenced the level of knowledge that the statistical test p-value >0.05 can do caused by other factors not examined in this study, such as information, socio-cultural and economic information, environment and experience of the pregnant woman, but similar results were found in the study where education and work influence attitudes of the pregnant woman.
Good knowledge will lead mothers to understand helminth infections, and mothers 'understanding of helminth infections will influence mothers' attitudes. Based on the research results carried out 13 , the better the knowledge, the better the behavior to avoid helminthiasis. In the results of the study, there is a coincidence that of the respondents with a good level of knowledge, up to 68 respondents have a good attitude. Still, not all have a good attitude. This can be influenced by several factors such as personal experience or other people, and the missing information to get where Never take anti-drug worms.
A lack of information can affect health, and poor personal hygiene can increase the risk of worm infection. 11 same source as in animals 10 , open stool, the habit of washing hands with soap before eating and after defecation, the habit of cutting nails, and washing vegetables before processing. 3,14, 15 Infectious worms can cause malnutrition and bleed up to anemia. Hookworms, in particular, can absorb nutrients from the food intake of the host (humans) so that they experience malabsorption and lose the body's nutrients. Hookworms also swallow blood by attaching it to the lining of the upper small intestine, which can lead to digestive tract bleeding and chronic anemia during pregnancy. 16 Many studies 17-20 have shown that helminth infections affect pregnancy and childbirth. Worm screening is necessary. Pregnant women during prenatal care visits and offer training on personal hygiene and environmental cleanliness, household waste disposal, and housekeeping to change attitudes in prenatal care. Helminthiasis ventilation in pregnant women.
The limitation of this study is that not all pregnant women in the working area of the Gatak Health Center can participate. Some pregnant women do not dare to do antenatal care in health services for fear ORIGINAL ARTICLE of contracting COVID-19. This results in the number of respondents not being maximal.

CONCLUSION
The level of knowledge and attitudes of pregnant women about helminthiasis in the work area of Gatak Health Center Sukoharjo are mostly good. However, there are still pregnant women who have a fairly good level of knowledge and attitude, even not good. What affects mothers' differences in knowledge and attitudes is the personal experience that creates behavioral habits. There is a need to improve pregnant women's health education to prevent and control intestinal worms and their effects on pregnancy and childbirth.