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GlobalIlluminators FULL PAPER PROCEEDING

Multidisciplinary Studies

Full Paper Proceeding ITMAR -2014, Vol. 1, 448-461

ISBN: 978-969-9948-24-4

ITMAR-14

Exposure to Environmental Factors with Acute Respiratory Infection (ARI)

Among Children Under Five Years at Hamlet 1 of Ciampea Village, Ciampea
Sub District, Bogor District 2013

Astrid Citra Padmita 1* & Ririn Arminsih Wulandari 2

Department of Environmental Health, Faculty of Public Health, University of Indonesia, Depok 16424,
Indonesia
Abstract
Acute Respiratory Infection (ARI) is a major cause of acute illness in the worldwide. Bogor district is one of
region in West Java with high ARI case. Hamlet 1 of Ciampea Village is both settlement location and limestone
processing industry location. The existence of limestone processing industry around the settlement area is
source of air pollution that can affect peoples health. This study aims to determine the relationship between
environmental factors (ambient PM10, distance from house to limestone processing plant, temperature and
humidity of house, house ventilation, residential density of house, whether or not the family members at home
who got ARI, whether or not a family member at home who smoke, use of mosquito repellent, type of cooking
fuel, location of kitchen) with the occurrence of ARI. This study uses cross-sectional study design with sample
of 106 toddlers. Result shows that environmental factors which significantly associated with ARI among
children under five years are ambient air PM10 (7.40; 2.02-27.10) and residential density of house (3.39; 1.39-
8.32). The most dominant factor associated with the occurrence of ARI among children under five years is
ambient air PM10 (12.52; 2.57-61.08). Cross-sectoral cooperation is needed to reduce the number of ARI.
2014 The Authors. Published by Global Illuminators . This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/)
Peer-review under responsibility of the Scientific & Review committee of ITMAR-2014.

Keywords: Environmental factors, acute respiratory infection (ARI), children under five years
Introduction

Industrial development in many countries causes some environmental problems, one

of them in the form of air pollution. Health problems caused by air pollution, namely
respiratory disorders, eye health problems such as eye irritation and decreased visibility, and
heart function disorder (Koren and Herman 2003). One of respiratory disorders due to air
pollution is acute respiratory infections (ARI). ARI is a disease that is known as a major
cause of acute illness in the worldwide. ARI is still a major cause of infant mortality and
children and took first place among the causes of disability-adjusted-life-years (DALYs) in
some developing countries (World Health Organization 2009).
In Indonesia, the highest prevalence of ARI is in the group of children under five
years (> 35%) and the lowest is in the group of 15-24 years. Bogor Regency is one of the
area in West Java with a high ARI cases in which the prevalence of ARI through symptoms
diagnosis is 30.9% (Kementerian Kesehatan Republik Indonesia 2007). ARI was a disease
with the highest number of people in all age groups for outpatient cases in health centers of

*All correspondence related to this article should be directed to Astrid Citra Padmita, Department of Environmental Health, Faculty of
Public Health, University of Indonesia, Depok 16424, Indonesia

Email: astridcitra@gmail.com

2014 The Authors. Published by Global Illuminators. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/)
Peer-review under responsibility of the Scientific & Review committee of ITMAR-2014.
 Astrid Citra Padmita /ITMAR-2014/Full Paper Proceeding/vol-1,448-461

Bogor District on 2011, and was a disease with the highest number of people in the age group
0 - <5 years for outpatient cases at a hospital in the district of Bogor on 2011 (Dinas
Kesehatan Kabupaten Bogor 2012). Meanwhile, on 2012, ARI fitted into 10 major disease
patterns in health centers and hospitals in the district Bogor (Dinas Kesehatan Kabupaten
Bogor 2013).
Risk factors of ARI can be derived from outdoor pollution or indoor pollution.
Sources of outdoor air pollution consist of combustion for heating, factories, transportation,
or human activities in outdoors. The source of indoor air pollution such as combustion of
some fuels used in homes for cooking, gases that are toxic released into the rooms of the
house, pesticides or insecticides, tobacco smoke, also microorganisms include fungi and
bacteria (Kusnoputranto, Haryoto 2000).
Air pollution produces many kinds of pollutants, such as particulate matter (PM). It is
solid or liquid particles that existed in the air (United States Environmental Protection
Agency 2013). Particulate consists of PM10 and PM2,5. PM10 is solid or liquid particulate that
has a diameter larger than 2.5 m and smaller than 10 m.8 The impact of PM10 when inhaled
can affect the function of the heart, lungs, and cause other serious health effects. The main
health effects of exposure to PM10 include respiratory system disorders, disorders of the lung
tissue, cancer, and premature death (United States Environmental Protection Agency 2013).
Ciampea is a village located in the Ciampea Sub District, Bogor District. In this area,
there is a limestone processing industry with a total of 22 furnaces of limestone processing
located at Hamlet 1 of Ciampea Village and 4 other furnaces of limestone processing located
at Hamlet 6 of Ciampea Village (Heryanto 2013). In addition to pollutants such as gases
emitted from furnaces, PM is the only major pollutants of limestone processing industry
(United States Environmental Protection Agency 2013). Children under five years ( toddlers)
is one of the population at risk for ARI (World Health Organization 2009). Toddlers who
lives in the village Ciampea have a high risk for ARI due to combustion from activity at
limestone processing industry which emit PM to the air, so it is possible that toddlers will be
exposed to PM. However, limestone processing industry is a source of livelihood for the
people living in this area. Although limestone processing industry activities have a negative
impact on the health of the surrounding community, but the presence of limestone processing
industry will support the local economy.
In the working area of Health Center of Ciampea Sub District on 2011, ARI was a
disease with many cases which the number of cases of non pneumonia for the age group < 1
year amounted to 1,223 cases, the age group 1 year to < 5 years amounted to 3,304 cases, the
age group > 5 years amounted to 7,166 cases. In addition , there were 2 cases of severe
pneumonia in the age group 1 year to < 5 years (UPT Puskesmas Ciampea 2011). On 2012,
ARI was the most disease from the top ten diseases that exist in the working area of health
center of Ciampea Sub District where the proportion of ARI incidence in the age group 0-4
years is equal to 23 , 66 % (UPT Puskesmas Ciampea 2012). Furthermore, on 2013 through
October , ARI of non pneumonia cases in the age group < 1 year amounted to 963 cases , the
age group of 1 year to < 5 years amounted to 2,778 cases , and the age group > 5 years
amounted to 4945 cases (UPT Puskesmas Ciampea 2013).
This research was conducted at Hamlet1 of Ciampea Village because in the region
there are 22 limestone furnaces. This study aims to determine the relationship between

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environmental factors with the occurrence of ARI among children under five years who live
near a limestone processing industry at Hamlet1 of Ciampea Village on 2013.
Methods
Study Design
Study design of this research is cross - sectional, where the data of independent
variable (environmental factors) and dependent variable are collected simultaneously. Data
collected in the form of the presence or absence of ARI occurrence in children under five
years, environmental factors which are composed of outdoor environmental factors (ambient
air PM10 concentrations and the distance of toddlers house with the limestone processing
industry) and the physical environment factors of house (ventilation , residential density ,
temperature and humidity in home, kitchen layout , and sources of pollution such as cigarette
smoke in the home , use insect repellent , type of cooking fuel , and the presence or absence
of respiratory patients at home) , also the individual characteristics of toddlers (age,
immunization history, gender) . This study was conducted for one week on December 2013.
Study population was all toddlers aged 0-59 months who lived at Hamlet 1, Ciampea village,
Bogor District on 2013. Hamlet 1 of Ciampea Village consists of six neighborhoods where
the whole toddlers in these six neighborhoods are study population numbering 144 people.
The inclusion criteria are toddlers aged 0-59 months at the time of the interview and stay in
the Hamlet 1 of Ciampea Village, Ciampea Subdistrict, Bogor District on December 2013,
and the mother or the person caring for a toddler who is willing to be respondents in the
study. The number of samples taken at least derived from the following formula,14

n=Z21-/2.P(1-P)

d2

with
n = number of samples
Z21-/2 = 1.96 at the 95% confident interval
d = Precision (0.1)
P = Proportion of ARI Occurrence in toddlers (40%)15
Based on the formula above, the minimum number of samples obtained is 92 people.
However, in anticipation of an error in data collection, the number of samples plus 10% of
the minimum sample size is 102, so the number of samples needed in the study of 102 people
which subsequently fulfilled to 106 people.
Data Collection
The data collection of independent variable for the concentration of ambient air PM10
is done by using a tool, that is Haz - Dust EPAM 5000 which operated by a staff of Balai
Besar Teknis Kesehatan Lingkungan (BBTKL) Jakarta, Ministy of Health of Republik
Indonesia. This tool uses the method of laser analyzer in measuring particulate either in
outdoor or in indoor. The location of ambient air PM10 measurement adjusted based on the
provisions of ISO 19-7119.6-2005 about determining the location of test sampling ambient
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air quality monitoring. From these guidelines, defined 6 sampling points in an open area,
which are at the dominant wind direction, ambient air quality monitoring site minimum a two
points by emphasizing on residential areas or specific places, and at least one point at other
wind direction. Each point will represent the location of the data collection that has
determined.16 Data collection of the distance of toddlers house with the limestone
processing industry using tool that is Global Positioning System (GPS). Data collection for
temperature and humidity in home using digital thermo hygrometer with model Corona GL-
99. Ventilation and residential density of home is measured by using meter and
questionnaire. The measurement of other independent variables is done by using
questionnaire. The data collection of ARI occurrence among children under five years based
on the result of physical examination from health professional (general physician of Sentra
Medika Hospital, Cibinong.

Data Analysis

Data analysis consists of univariate analysis, bivariate analysis, and multivariate

analysis. Univariate analysis was conducted to determine the frequency distribution and the
proportion overview of each of the independent variables and the dependent variable.
Bivariate analysis is used to determine the relationship between the dependent variable with
the independent variables. In bivariate analysis, the test consisted of chi-square test and odds
ratio (OR). Multivariate analysis using multiple logistic regression test. Multivariate analysis
is conducted to determine the most dominant risk factor in relationship between the
dependent and independentv vvariables.dependent and independent variables.risk factor in
relationship between the dependent and independent variables.is conducted to determine the
most dominant risk factor in relationship between the dependent and independent variables.
In bivariate analysis, the test consisted of chi-square test and odds ratio (OR). Multivariate
analysis using multiple logistic regression test. Multivariate analysis is conducted to
determine the most dominant risk factor in relationship between the dependent and
independent variables.
Results
Data Normality Test

Data normality test performed on numerical data using Skewness value and standard
error. The data are normally distributed if Skewness value divided standard error produces
numbers 2, so that the standards used is mean value. However, if the data are not normally
distributed, the standard used is the median value. In the variable of the distance of toddlers
house with the limestone processing industry and toddler age are known that the data are
normally distributed, so that the standard used is the mean value. The mean value of the
distance of toddlers house with the limestone processing industry is at 409.42 meters, while
in the toddler age is 24.99 months which subsequently fulfilled to 25 months
ARI among Children Under Five Years
The results of physical examination by physician at Hamlet 1 of Ciampea Village on
December of 2013 showed that as many as 28 people (26.4%) suffered from ARI. Based on
the results of the mapping with Geographical Information Systems (GIS), indicated that
toddlers who get ARI stay more at home with a location adjacent to the limestone processing
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plant and ambient PM10 sampling points. The figure below shows Here is a the distribution
of ARI occurrence among children under five years at Hamlet 1 of Ciampea Village,
Ciampea Sub District, Bogor District on 2013. Limestone processing plant is indicated by
blue dots. The location of ambient air PM10 sampling points indicated by black dots. House
with a toddler affected by ARI shown in red dots, while homes with toddlers who are not
affected by ARI

Figure 1: Map of ARI Occurrence Distribution among Children Under Five Years at Hamlet
1 of Ciampea Village, Ciampe Sub District, Bogor District on 2013.

Relation between Environmental Factors with the Occurrence of ARI among Children under
Five Years.
Environmental factors that have a significant relationship with the occurrence of ARI
in children under five years are ambient air PM10 and residential density of house. Toddlers
who live in locations with ambient air PM10 concentration which not eligible risk 7.4 times
greater of ARI compared with toddlers who live in locations with ambient air PM 10 which
eligible. While, toddlers who live in the house with residential density ineligible 3.39 times
greater risk of ARI compared with toddlers living in homes with eligible residential densities
(Table 1).
Table 1:
Relation between Environmental Factors with ARI Occurrence among Children under Five
Years at Hamlet 1 of Ciampea Village, Ciampea Sub District, Bogor District on 2013
ARI p-
Variables Total 95% CI
No Yes OR Value

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N % N % %
N
Ambient Air
PM10
- 150 g/m3 7 78, 2 88, - - -
- > 150 g/m3 4 7 0 21,3 94 7 7,40 (2,02- 0,002
33. 11, 27,10)
4 3 8 66,7 12 3
Distance from
house to
limestone
processing
plant 4 79, 1 55, - - -
- 409,42 7 7 2 20,3 59 7 2,02 (0,84- 0,126
meters 3 66, 1 44, 4,85)
- <409,42 1 0 6 34,0 47 3
meters
House
Temperature
- 180-300C 3 76, 36, - - -
- <180 or 0 9 9 23,1 39 8 1,32 (0,53- 0,650
>300C 4 71, 1 63, 3,29)
8 6 9 28,4 67 2
House
Humidity
- 40%-60% 50, - - -
- <40% or 2 0 2 50,0 4 3,8 0,34 (0,05- 0,284
>60% 7 74, 2 10 96, 2,55)
6 5 6 25,5 2 2
House
Ventilation
- 10% of 0,0 1 100, 0,9 - - -
floor area 0 0 1
- <10% of 74, 2 99, 3,89 (2,81- 0,264
floor area 7 3 7 10 1 5,38)
8 25,7 5
Residential
density of
house 5 82, 1 64, - - -
- 8m2 per 6 4 2 17,6 68 1 3,39 (1,39- 0,011
people 2 57, 1 35, 8,32)
- <8m2 per 2 9 6 42,1 38 9
people
Family
Member Who
Got ARI 4 75, 1 60, - - -
- No 8 0 6 25,0 64 4 1,20 (0,50- 0,822
- Yes 3 71, 1 39, 2,88)
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0 4 2 28,6 42 6
Family
Member Who
Smoke 1 83, 11, - - -
- No 0 3 2 16,7 12 3 1,91 (0,39- 0,510
- Yes 6 72, 2 88, 9,32)
8 3 6 27,7 94 7
Use of
Mosquito
Repellent 4 72, 1 54, - - -
- No 2 4 6 27,6 58 7 0,88 (0,37- 0,827
- Yes 3 75, 1 45, 2,09)
6 0 2 25,0 48 3
Type of
Cooking Fuel
- Eligible 7 72, 2 92, - - -
- Not Eligible 1 4 7 27,6 98 5 0,38 (0,04- 0,678
87, 3,20)
7 5 1 12,5 8 7,5

Continuation of Table 1:

ISPA
Total
Variabel Tidak Ya OR 95% CI Nilai-p
N % N % N %
Location of
Kitchen
- Separated 3 77, 11 22, 4 46, - - -
- Not 8 6 17 4 9 2 1,47 (0,61- 0,508
Separated 4 70, 29, 5 53, 3,53)
0 2 8 7 8

Relationship between Individual Characteristics with the Occurrence of ARI among Children
Under Five Years
The results of the analysis for the toddler age variable with occurrence of ARI in
children under five years shows that there is no significant correlation between age with the
occurrence of ARI. There is also no significant relationship between the history of
immunization with ARI occurrence among children under five years. Meanwhile, for toddler
sex with ARI incidence occurrence among children under five years, the results of the
analysis showed the p-value of 0.045 and OR value of 2.61 (95% CI = 1.08 to 6.34), so that
there is a significant association between the sex of toddlers with ARI occurrence. Female
toddlers are at risk of ARI 2.61 times greater than male toddlers (Table 2).

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Table 2:
Relationship between Individual Characteristics with the Occurrence of ARI among Children
Under Five Years at Hamlet 1 of Ciampea Village, Ciampea Sub District, Bogor District on
2013

ARI
Total p-
Variables No Yes OR 95% CI
Value
N % N % N %
Age of Toddlers
- 25-59 Months 4 77, 1 22, 5 50,9 - - -
- < 25 Months 2 8 2 2 4 49,1 1,5 (0,65- 0,381
3 69, 1 30, 5 6 3,71)
6 2 6 8 2
History of
Immunization
- Complete 5 74, 2 25, 7 74,5 - - -
- Incomplete 9 7 0 3 9 25,5 1,2 (0,47- 0,801
1 70, 29, 2 4 3,27)
9 4 8 6 7
Sex of Toddler
- Male 4 81, 1 18, 6 56,6 - - -
- Female 9 7 1 3 0 43,4 2,6 (1,08- 0,045
2 63, 1 37, 4 1 6,34)
9 0 7 0 6

Table 3.
Final Model of Multivariate Analysis from Study of Exposure to EnvironmentalFactors with
ARI among Children under Five Years at Hamlet 1 of Ciampea Village, Ciampea Sub
District, Bogor District 2013
95%CI
Variabel B p-Value OR
Lower Upper
Ambient Air PM10 2,264 0,001 9,62 2,39 38,71
Residential Density of 1,432 0,004 4,19 1,57 11,19
House
Constant -1,961 0,000 0,14

Discussion
The average concentration of ambient air PM10 in study site is 391 g/m3. This shows
that the average concentration of PM10 in ambient air RW1 Ciampea Village , Ciampea Sub
District, Bogor District has exceeded the quality standard set by the Government and the US-
EPA in the amount of 150 g/m3 (Republik Indonesia 1999; and United States
Environmental Protection Agency 2012). Results of analysis conducted between ambient air
PM10 with ARI incidence in toddlers showed that the p-value = 0.002 and OR = 7.40 value (
95 % CI = 2.02 to 27.10 ), so there is a significant association between ambient air PM 10 with
ARI occurrence in toddlers . The results are consistent with other studies with r value of
0.656 indicating a strong relationship and a positive pattern means that the higher the
concentration of ambient air PM10, the higher ARI cases in toddlers (Dwiningsih, Martini
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2006). One of the source of ambient air PM10 is chimney. PM10 will stay in the air for a few
days or a few weeks. PM10 will fall and stick in the surrounding environment (Sastrawijaya
and Tresna 2000). Exposure to PM10 can cause health problems. The health effects of PM10
in the short term could affect the reaction pneumonia, respiratory infection or symptoms of
the respiratory tract, increasing the effects on the cardiovascular system, improving
emergency care, improve medication use, and increased mortality. As for the health effects of
PM10 in the long term by increasing the lower respiratory tract symptoms, exacerbation of
asthma, decreased lung function in children, an increase in chronic obstructive lung, adult
lung function decline, and the decline in the average age of life expectancy (World Health
Organization 2006).
The distance of toddlers house with the limestone processing industry associated with the
spread of pollutant particles from the source to the settlements. Box Gaussian model is a
deployment model approach by building a mathematical model according to the pollutant
concentration equation. The spread of the particles according to Box Gaussian model is
influenced by various factors such as the location of the emission source can be determined
from the coordinates of the emission sources, the rate and acceleration of air pollutant
emissions, physical stack height, exit gas temperature and diameter of the chimney, as well
as meteorological data include atmospheric stability, speed and wind direction, and
temperature udara (Mashuda 2012). Non significant relationship could be due to the
measurement of the distance from house to limestone processing plant in this study takes into
account only the coordinates of the emission sources and does not take into account factors
such as the physical height of the chimney or other meteorological data.
The standard of house air temperature is 180C-300C (Republik Indonesia 2011). The
change of temperature provide opportunities for a variety of pathogenic microorganisms
(viruses and bacteria) for growing wider. The threat of rising temperatures is a disease that
attacks the respiratory tract such as acute respiratory infection. It is due to the heat waves
cause the increasing of matter and amount of dust particulate in the air (Sinaga and Epi Ria
Kristina 2011). House air temperature showed no significant relationship with ARI in
toddlers because of from 63.2 % of toddlers who live in the house with not eligible air
temperature, only a small portion of toddlers who got ARI. Humidity is a good means for the
growth of pathogenic microorganisms so that the viability of the bacteria become longer
(Achmadi and Umar Fahmi 2008). Humidity and temperature are interrelated factors. The
results of the analysis showed no significant association because of most of the toddlers (96.2
%) who lived in the house with the not eligible air humidity, only a small portion of toddlers
who got ARI at the time of the study.
Toddlers who stay at home with vents that do not qualify will be more likely to be
exposed to health problems such as acute respiratory infection. This is due to air exchange
which does not qualify due to improper ventilation can make the fertile growth of
microorganisms that cause health problems to humans (Republik Indonesia 2011). The
relationship is not significant due to 99.1% of infants living in homes with ventilation which
does not qualify, only a small portion toddlers diagnosed with ARI at the time of the study.
Residential density of house is the ratio between house floor area (m2) by the number
of the inhabitants of the house. The recommended residential density of house is minimum of
8m2 per person (Kementerian Kesehatan Republik Indonesia 2007). Result of analysis
showed a p- value of 0.011 and the value of OR of 3.39 ( 95 % CI = 1,39-8.32 ), so there is a
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significant correlation between residential density of house with ARI occurrence in toddlers.
Toddlers who lived in the house with not eligible residential density 3.39 times greater risk of
developing acute respiratory infection compared to toddlers living in homes with eligible
residential densities ( Table 1 ). The results of this study support previous studies in which
toddlers living in homes with not eligible residential density 2.71 times higher risk of
developing acute respiratory infection compared to toddlers living in homes with eligible
residential density (Wahyuniand Ni Putu Sri 2013). Other studies have also shown that
toddlers who stay home with not eligible residential density 10.75 times greater risk of
respiratory infection compared with toddlers exposed to living in a house with eligible
residential density (Farieda and Asma 2009). Density of occupants in a dwelling house will
give effect to the occupants. Spacious home that is not comparable with the number of
occupant causes overcrowded. This is not healthy because it can cause the lack of oxygen
consumption and also facilitate transmission of infectious disease if one family member
affected by the infectious disease (Notoatmodjo and Soekidjo 2003).
The presence of family members affected by acute respiratory infection can affect
other family members. Transmission process in principle is a respiratory germ in the air
inhaled by the new host and get into the respiratory tract (World Health Organization 2009).
The absence of significant correlation may be due 39.6% of children under five who live at
home with family members during the last 2 weeks exposed to acute respiratory infection,
only a small portion of toddlers who got ARI. Environmental tobacco smoke contributes to
asthma exacerbations, accelerated the decline in lung function, and increased incidence of
infection in infants and children (Levy, et al. 2006). Relationship is not significant due to the
proportion of toddlers who got ARI but stay at home with family members who smoke more
slightly (27.7%). Mosquito repellent is considered not eligible in the form of coil, spray, or
electrically. This is because the type of that mosquito repellent when used containing
particulate or chemical compounds that released into the air. Particulate or chemical
compounds can be pollutants in the room (Republik Indonesia 2011). Non significant
relationship due to 45.3 % of toddlers living in homes with mosquito repellent, only a
fraction who got ARI. Type of cooking fuel which not qualified in this study in the form of
wood, charcoal, coal, and kerosene. The use of cooking fuels such as charcoal, wood, coal,
kerosene causing imperfect combustion which affects the human respiratory (Levy, et al.
2006). The absence of a significant relationship because of the 7.5 % of toddlers living in
homes with cooking fuel contain pollutants, only a small portion of toddlers who got ARI.
Location of kitchen that qualified in this study is separated with other rooms or there
is wall as separator and door that connects kitchen with another room (Ditjen PP dan 2010).
The kitchen which adjoined to the living room and bedroom potentially greater exposure to
particulate matter originating from the kitchen stove (Purwana, 1999). Absence of significant
correlation between the location of the kitchen with the incidence of respiratory infection in
toddlers can be caused because of the 53.8% of infants who lived at home with no separate
kitchen location, only a fraction who infected by ARI
In this study, the standard of age is according to the average value. Toddlers assumed
risk of respiratory infection when aged < 25 months. This is consistent with previous studies
in which the toddlers aged < 12 months who more suffering ARI (30 %) , compared to
children aged 12 months - 23 months (25.5 %) and children aged 24-59 months (17 , 4 % )
(Azad and Abdul Kalam 2009). The result of analysis showed that there was no significant
relationship between age of toddlers withARI in toddlers (Table 2). Influence of age on
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differences in the prevalence of respiratory tract infections caused by ARI associated with the
immune system, so that the immune system plays a factor in the relation between age and
ARI (Foster and Staley 1984). Age is associated with the occurrence acute of respiratory
infection in toddlers, especially infants have higher risk than children under five. This is
because the baby 's immature immune and respiratory tract of baby narrower than children
under five years (Mosley, Henry dan Lincoln and Chen, 1984). Toddlers aged less than 2
years old have a higher risk of developing ARI.38 Results of the analysis showed no
significant association because of 49.1 % aged under five susceptible ( < 25 months) , only a
fraction children under five with ARI.
Immunization history in this study is a history of hepatitis B immunization, BC , polio
, DTP and measles obtained toddlers that can be viewed on the Health Card or visit card to
other health facilities. Declared complete immunization history or incomplete based on age
of toddlers at the time of the interview. Immunization is an effort to improve the health of
one's immune to a disease that can prevent infection or reduce the effects of natural or wild
organisms. Immunization is an effective form of intervention efforts to reduce infant and
child mortality, immunization in this case is related to measles immunization (Lastyaningrum
and Ika 2011). Results showed no statistically significant relationship because of the 25.5 %
of infants who have incomplete immunization history , only a small portion of toddlers who
infected by ARI.
Morbidity in female sex are higher than male (Machmud and Rizanda 2006). Sex of
toddlers who is considered at risk of developing acute respiratory infection in this study is
female. The analysis showed that there was a significant relationship between sex toddler
with ARI incidence in toddlers. The results are consistent with research Azad (2009) (Foster
and Staley 1984) in Bangladesh and research Chalabi (2013)41 in Iraq. The linkage of sex
with ARI is inseparable from the relationship between sex and nutritional status. Poor
nutritional status is one of the important risk factors to the occurrence of ARI. Some studies
suggest a link between malnutrition with a lung infection. In addition, several other studies
have also shown a link between poor nutrition with a reduced immune system of children
against infections (Utomo, 1996). Gender is an internal factor that determines the nutritional
needs so that there is a correlation between the sex of the nutritional status (Lismartina 2000).
Based on research conducted in Baghdad and India found that the nutritional situation of
female is always lower than male toddlers. It shows that female toddlers are more at risk of
respiratory infection due to factors of nutritional status or nutritional status of female toddlers
lower than male toddler (Jusat 1992).
Conclusion
Environmental factors like ambient air PM10 emitted from limestone processing
industry activity in Hamlet 1 of Ciampea village associated with the occurrence of acute
respiratory infection in children under five years. Other environmental factors which also
associated with ARI in toddlers is the residential density of house. Cross-sectoral cooperation
is needed to reduce the occurrence of ARI, especially in the Ciampea Village. Coordination
with related sectors should be done so that the monitoring and handling of the impact of
formal and informal industry can be well integrated.

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