FACTORS INFLUENCING THE OCCURRENCE OF TYFOID FEVER INSULTAN ISKANDAR MUDA HOSPITAL, NAGAN RAYA DISTRICT 2022

Typhoid fever is a disease caused by Salmonella Typhi which is usually spread by consuming contaminated food or water. Cases of typhoid fever every year around the world reach 21 million cases and 128,000 to 161,000 deaths that occur each year. The research objective was to find a relationship between the independent variables and the dependent variable, which was intended to find a relationship between the factors that influence the occurrence of typhoid fever at Sultan Iskandar Muda Hospital, Nagan Raya Regency. The type of research used in this study was quantitative research. By using a cross sectional approach. The research was conducted at the Sultan Iskandar Muda Hospital in November 2022. The sample taken in this study was 60 out of 95 respondents. The sampling technique for this study was carried out using Simple Random Sampling. Based on the test, there was a relationship between gender (p=0.000), the relationship between eating habits outside (p=0.001), food processing at home (P=0.000), the relationship between waste management (0.000 ), there was no relationship between hand washing habits (p=0.789), no age relationship (0.195) to the occurrence of typhoid fever at Sultan Iskandar Muda Hospital. From these results it can be concluded that washing hands before eating and age do not affect typhoid fever while gender, eating habits outside the home, food processing at home, waste management have an influence relationship between waste management (0.000), no relationship between hand washing habits (p=0.789), no relationship between age (0.195) and the occurrence of typhoid fever at Sultan Iskandar Muda Hospital. From these results it can be concluded that washing hands before eating and age do not affect typhoid fever while gender, eating habits outside the home, food processing at home, waste management have an influence relationship between waste management (0.000), no relationship between hand washing habits (p=0.789), no relationship between age (0.195) and the occurrence of typhoid fever at Sultan Iskandar Muda Hospital. From these results it can be concluded that washing hands before eating and age do not affect typhoid fever while gender, eating habits outside the home, food processing at home, waste management have an influence

Based on the Indonesian Health Profile in 2018, 41,081 cases of typhoid and paratypoid fever were hospitalized in hospitals and 279 of them died (RI Ministry of Health, 2018).
Reservoirs forSalmonella Typhinamely humans with fecal-oral transmission which usually occurs through consuming food and water that has been contaminated with human feces (Radhakrishnan et al., 2018).The occurrence of transmission of typhoid fever is due to intermediaries from organisms based on snack habits, unclean food management, and behavior that does not meet individual hygiene requirements (Suprapto, 2022).From this aspect, the hygiene behavior of an individual is a very important aspect in maintaining the cleanliness of nails, hands, teeth, mouth, and hair so that there are no disease agents (Ardiaria, 2019).
Indonesia's health profile in 2018 there are 10 most common diseases that occur in hospitalized patients, typhoid fever is included in the category of the highest Case Fatality Rate of 0.57%.Typhoid fever, according to the characteristics of the respondents, spreads evenly according to age and evenly in adults, but the prevalence of typhoid fever is mostly found at the age of 5-19 years at 1.7% and the lowest is in infants, namely 0.6%.The highest spread of typhoid fever occurs in rural areas (Ministry of Health, Republic of Indonesia, 2016).From the provincial basic health research (RISKESDAS) data for 2017 the prevalence of typhoid fever cases in Aceh province is 3%, spread across all districts/cities with a vulnerability of 0.6% to 0.7% with the highest prevalence of typhoid in North Aceh with vulnerable 0.7%.
Data from the Sultan Iskandar Muda Hospital, Nagan Raya Regency, there are 10 large clusters of inpatient diseases in which typhoid fever has the highest percentage of other diseases.From the data taken from the Sultan Iskandar Muda Hospital, the number of inpatient cases diagnosed with typhoid fever has increased quite significantly, as can be seen from the percentage of cases of patients diagnosed with typhoid fever in 2022, from July there were 91 patient cases and in then in August there were 97 cases then in September cases of inpatients with a diagnosis of typhoid fever experienced an increase from previous months which were known as many as 163 cases of vulnerable productive age.

RESEARCH METHOD
The type of research used in this research is quantitative research.By using a cross sectional approach, which is a study conducted at one time and one time, there is no follow up, to find a relationship between the independent variables and the dependent variable, which is intended to find a relationship between the factors that influence the occurrence of typhoid fever in Sultan Hospital.Iskandar Muda, Nagan Raya Regency.The samples taken in this study were 60 of 95 respondents.The sampling technique for this research was carried out using Simple Random Sampling where the sample was taken randomly.The research was conducted at the Sultan Iskandar Muda Hospital in November 2022.The instrument used to collect research data was in the form of secondary data using the interview method.Independent variables are washing hands before eating, eating habits outside the home, health of food processing at home, behavior of waste processing at home.The dependent variable in this study is the occurrence of typhoid fever.

3.1.Univariate Analysis Age
The results of the research regarding the age of the respondents at the Sultan Iskandar Muda Hospital, Nagan Raya Regency in 2022 are explained in Table 3.1.1below.From Table 3.1.1 it is known that of the 60 respondents, there were most respondents aged >30 years with a total of 32 (53.3%)

Gender
The results of the research regarding the gender of the respondents at the Sultan Iskandar Muda Hospital in Nagan Raya Regency in 2022 are explained in Table 3.1.3below:  From Table 3.1.4it can be seen that 38 respondents (63.3%) had a bad habit of washing their hands before eating and 22 respondents (36.7%) had good eating habits outside the home.

Snacking Habits Outside the Home
Resultsresearch on the habit of washing hands before eating for respondents at Sultan Iskandar Muda Hospital, Nagan Raya Regency in 2022 is explained in Table 3.1.5below: From Table 3.1.5it can be seen that 36 respondents (60.0%) had a bad habit of washing their hands before eating and 24 respondents (40.0%) had good eating habits outside the home.

Food Processing At Home
Resultsresearch on eating habits outside the respondents' homes at Sultan Iskandar Muda Hospital, Nagan Raya Regency in 2022 is explained in Table 3.1.6below: From Table 3.1.6it can be seen that 42 respondents (70.0%) had poor food processing at home and 18 respondents (30.0%) had good food processing at home.

Waste Management at Home
Resultsresearch on waste management in respondents' homes at Sultan Iskandar Muda Hospital, Nagan Raya Regency in 2022 is explained in Table 3.1.7below: Based on Table 3.2.1 above, it can be seen that there were 19 respondents aged >30 years (59.4%)including the control group.Meanwhile, there were 13 respondents (40.6) aged >30 years, included in the case group and 11 (39.3) of respondents aged <30 years, including the control group, while 17 respondents (60 ,7) including the case group.The results of the chi-square test analysis of the relationship between the age of the respondent and the incidence of typhoid fever showed that the value of p = 0.196 was greater than = 0.05, it was known that the OR was 0.443, which protected the risk of an effect.So it can be concluded that statistically there is no relationship between the age of the respondent and the incidence of typhoid fever.

3.2.2
Relationship between Respondent's Gender and Typhoid Fever Incidence at Sultan Iskandar Muda Hospital, Nagan Raya Regency in 2022 Based on Table 3.2.2above, it can be seen that 26 male respondents (70.3%) belong to the control category, 11 male respondents (20.7) are included in the case category.Meanwhile, there were 4 female respondents (17.4%) belonging to the control category and 19 female respondents (82.6%) included in the case respondent category.The results of the chi square test analysis of the relationship between the gender of the respondent and the incidence of typhoid fever showed that the value of p = 0.000 was less than = 0.05.So it is concluded that there is a relationship between gender and the occurrence of typhoid fever.OR value = 11.227> 1, then statistically it can be concluded that respondents who have male sex are at risk of 11, 3.2.3The Relationship between the Habit of Washing Hands Before Eating Respondents and the Incidence of Typhoid Fever at the Sultan Iskandar Muda Hospital, Nagan Raya Regency in 2022 Based on Table 3.2.3above, it can be seen that there were 20 respondents (52.6) with the bad habit of washing their hands before eating in the control category and 18 people (47.4%) with the case category with the bad habit of washing their hands.While respondents with good hand washing habits before eating were 10 people (45.5%) in the control category and respondents with good hand washing habits before eating were 12 people (54.5%) in the category including case respondents.The results of the chi square test analysis of the relationship between the gender of the respondent and the incidence of typhoid fever showed that the value of p = 0.789 = 0.05 was known to be OR of 1.333 at risk of developing typhoid fever.So it was concluded that there was no relationship between the habit of washing hands before eating with the incidence of typhoid fever.
3.2.4The Relationship between Respondents' Habits of Snacking Outside the Home with the Incidence of Typhoid Fever at Sultan Iskandar Muda Hospital, Nagan Raya Regency in 2022 Based on Table 3.2.4above, it can be seen that respondents with unhealthy eating habits outside the home were 25 people (69.4%) in the control category and respondents with bad eating habits outside the home were 11 people (30.6%) included in the category control.While respondents with good eating habits outside the home were 5 people (20.8%) in the control category, then respondents with good eating habits outside the home were 19 people (79.2) included in the case category.The results of the chi square test analysis of the relationship between the sex of the respondent and the incidence of typhoid fever showed that the value of p = 0.001 was less than = 0.05.So it was concluded that statistically there was a relationship between eating habits outside the home and the incidence of typhoid fever.QR value = 8.636 > 1, 3.2.5The Relationship between Food Processing at Respondents' Homes and the Incidence of Typhoid Fever at Sultan Iskandar Muda Hospital, Nagan Raya Regency in 2022 Based on Table 3.2.5 above, it can be seen that respondents with food processing at home.Respondents with bad food processing were 28 people (66.7%) in the control category, respondents with bad food processing were 14 people (33.3%) in the case respondent category.While respondents with good food processing at home were 2 people (11.1%) in the casual category and respondents with good processing of 16 people (88.9) were included in the case category.The results of the chi square test analysis of the relationship between the gender of the respondent and the incidence of typhoid fever showed that the value of p = 0.000 was less than = 0.05.So it was concluded statistically that there was a relationship between the habit of eating snacks outside the home and the incidence of typhoid fever.QR value = 16.00 > 1, 3.2.6The Relationship between Waste Management at Respondents' Homes and Typhoid Fever Incidence at Sultan Iskandar Muda Hospital, Nagan Raya Regency in 2022 Based on table 3.2.6, it shows that waste management at home is based on respondents, respondents with poor waste management are 12 people (35.3%) including the control category, respondents with bad waste management are 22 people (64.7%) with the category case.While respondents with good waste management were 18 people (69.2%) in the control category and respondents with good waste management were 8 people (30.8%) including the case category.The results of the chi square test analysis of the relationship between the gender of the respondent and the incidence of typhoid fever showed that the value of p = 0.000 was less than = 0.05.So it can be concluded statistically that there is a relationship between waste management and the incidence of typhoid fever.QR value = 16.00 > 1,

DISCUSSION
Based on the results of the study, it was found that there was no relationship between age and the occurrence of typhoid fever at Sultan Iskandar Muda Hospital in 2022.The results of the Chi-square test obtained a p-value sig (0.195) > (0.05), which means that there is no relationship between the age of the respondent and the incidence of typhoid fever in the Sultan Iskandar Muda Hospital, Nagan Raya Regency.It is known that the OR is 0.196, meaning that at the age of <30 there are 17 people (60.7) respondents in the case category.This study shows that typhoid fever sufferers often occur at the age of <30 years, in line with Dewi's research (2018) where the most dominant typhoid fever patients are at the age of 25 years or also often referred to as early adulthood.These results are different where there are several factors that cause typhoid fever to occur at the age of 40-60 or in adulthood.continued (Jahja. 2011).Based on respondents Based on the results of the study, it was found that there was a relationship between gender and the occurrence of typhoid fever at Sultan Iskandar Muda Hospital in 2022.The results of the Chi square test analysis obtained a value of p = 0.000 less than = 0.05.OR value = 11.227> 1.According to Patattan (2017).Many cases of typhoid fever depend on gender because typhoid fever is often found attacking women.This was refuted by the results of Yulida's research (2009) in this study which stated that gender had no effect on the occurrence of typhoid fever, however, because typhoid fever is a contagious disease that can be transferred from one person to another and also typhoid fever has a cause of transmission by several other factors.
Based on the results of research on the relationship between washing hands before eating, there is no relationship between the occurrence of typhoid fever at Sultan Iskandar Muda Hospital.The results of the Chi-square test obtained a p-value sig (0.789) > (0.05) which means that there is no relationship between the behavior of washing hands before eating with the incidence of typhoid fever in Sultan Iskandar Muda Hospital, Nagan Raya Regency.It is known that the OR is 1.333.Although there is no relationship between the occurrence of typhoid fever and the habit of washing hands before eating, actually washing hands before eating is something that must be done because this is one of the requirements in maintaining health.Personal hygiene is a condition in which a person or individual fulfills the requirements in terms of health, both physical and individual.Hygiene is (Muhammad et al., 2020).
Based on the research results, it is known that there is a relationship between eating habits outside the home and the occurrence of typhoid fever at Sultan Iskandar Muda Hospital in 2022.The results of the Chi-square test obtained a p-value sig (0.001) > (0.05) at Sultan Iskandar Muda Hospital, Nagan Raya Regency it is known that the QR value = 8.636 > 1. Typhoid fever transmission can not only be through a person's hygiene but can also be through the form of food and where we get the food.In Addin's opinion (2017), states that typhoid fever can be transmitted anywhere and anytime and transmission of typhoid fever can occur when consuming food that comes from outside or roadsides that have not been guaranteed cleanliness or transmission can also be caused by the presence of typhoid fever sufferers who serves food like a cook in a restaurant.Apart from that, when eating outside, especially in public places, there are usually flies flying everywhere and even perching on food.These flies can transmit Salmonella typhi by means of flies that previously landed in the feces or vomit of typhoid fever sufferers and then landed on the food to be consumed (Padila, 2017).
Based on the research results, it is known that there is a relationship between waste management and the occurrence of typhoid fever at Sultan Iskandar Muda Hospital in 2022.The results of the Chi square test analysis obtained a value of p = 0.000 less than = 0.05.OR value = 16.227> 1. Waste management is a very influential thing to avoid and farthest from various diseases that are caused both to oneself and family members, so there is a relationship between the occurrence of typhoid fever and waste management at home.occurrence of typhoid fever.The results of the study are corroborated by Carles' theory (2017) which states that waste management is a waste management behavior that is not good will cause various diseases caused by flies which make sapah the most preferred breeding ground because it is in humid conditions and this will lead to the development of disease vectors such as flies.Flies like damp and foul-smelling places such as temporary shelters, the stench that is in the trash, possibly caused by organic waste.

CONCLUSION
Based on the results of the research and discussion that has been described regarding the Factors Influencing the Occurrence of Typhoid Fever in the Sultan Iskandar Muda Hospital, Nagan Raya Regency, 2022, the researcher can draw the following conclusions: 1.There is no relationship between age and the incidence of typhoid fever at the Sultan Iskandar Muda Hospital, Nagan Raya Regency 2. There is a relationship between the gender of the respondent and the incidence of typhoid fever at the Sultan Iskandar Muda Hospital, Nagan Raya Regency 3.There is no relationship between the habit of washing hands before eating with the incidence of typhoid fever at the Sultan Iskandar Muda Hospital, Nagan Raya Regency 4.There is a relationship between the habit of snacking outside the home with the incidence of typhoid fever at the Sultan Iskandar Muda Hospital, Nagan Raya Regency 5.There is a relationship between food processing at the respondent's house and the incidence of typhoid fever at the Sultan Iskandar Muda Hospital, Nagan Regency 6.There is a relationship between waste management at the respondent's house and the incidence of typhoid fever at the Sultan Iskandar Muda Hospital, Nagan Raya Regency

.4 The habit of washing hands before eating Resultsresearch on
the work of respondents at the Sultan Iskandar Muda Hospital in Nagan Raya Regency in 2022 is explained in Table3.1.4below:

Table 3 .2.2 Cross Tarbulation of the Relationship Between Gender of Respondents and the Incidence of Typhoid Fever at Sultan Iskandar Muda Hospital in 2022 Gender
E-ISSN: 2808-6635 |https://radjapublika.com/index.php/MORFAI