Analysis of Wound Etiology on Floods and Landslides Disasters in Manado City

Disasters such as floods, landslides, earthquakes, and so on can cause health problems including injuries and skin disorders such as open or closed wounds to skin infections. The Manado City Government had made efforts to deal with floods and landslides through BNPB, one of which was by evacuating residents from areas prone to flooding and landslides. This study aimed to determine the factors that cause injuries in the floods and landslides that occurred in January-February 2021 in Manado City. This study was a quantitative descriptive study with non-probability sampling technique, with a total of 44 respondents. The inclusion criteria were Manado City residents and had injuries or wound due to floods or landslides. Exclusion criteria was residents who already had injuries before the disaster. The result of this study were: most respondents were in the early and late elderlies age group, were male, were inside of their houses when the disaster occurred. Most type of injuries occurred due to irritation of floodwater. It can be concluded that there was no significant relationship between age and location when the disaster occurred and the wound etiology and there was a significant relationship between gender, which was male, and wound etiology. It is recommended that residents in disaster-prone areas be given education about disaster preparedness to prevent injuries when a disaster occurred.

There are two categories of wounds, namely acute wounds and chronic wounds. Acute wounds are usually caused by mechanical damage such as blunt or sharp objects. Meanwhile, chronic wounds are caused by complications of certain diseases, such as diabetes, which takes a longer time to heal than acute wounds (Wang, Lu, Yu, Huang, & Du, 2019). The category of injuries in floods and landslides is acute injuries. This is because the wound has just occurred and is not a complication of any illnesses.
The causes of injuries are very diverse, some of which are sharp of blunt trauma, chemical exposure, and animal bites (Sjamsuhidajat & De Jong, 2017). In acute wounds, the causes can be in the form of abrasion or friction with a rough surface, lacerations or wounds caused by blunt objects, stab wounds caused by sharp objects, or wounds caused by sharp objects (Drugs.com, 2021;Gitaraja, W.S., 2017). In addition to these causes, Virgayanti (2020), as a dermatologist at St. Carolus Hospital Jakarta also mentioned skin diseases that can occur due to flooding, namely contact dermatitis due to exposure to irritants on the skin, skin infections such as those caused by fungi that are exacerbated by skin being submerged in floods, and insect bites such as mosquitoes, ants or centipedes.
Natural disasters, according to the Law of Republic Indonesia Number 24 of 2007, Article 1 Paragraph 2 is "Disasters caused by events or series of events caused by nature, including earthquakes, tsunamis, volcanic eruptions, floods, droughts, hurricanes and landslides". Where landslides and floods are included in the type of geological natural disaster. This disaster occurs on the earth's surface, which often occurs in areas with high rainfall, especially during the rainy season. Some areas in North Sulawesi, especially the City of Manado have steep slopes with minimal vegetation. This also makes the area prone to landslides. Meanwhile, the flood disaster that occurred in Manado City was caused by geographical conditions, where Mando City itself was surrounded by several large rivers. So that if there is heavy rain, it can cause overflow of water from rivers and ditches which causes flooding (Polawan & Alam, 2019;Topo, Tondobala, & Makarau, 2020).
Although the Government through the National Disaster Management Agency (BNPB) has made efforts in disaster management, the occurrence of injuries during the disaster is inevitable (Awusi, Nayoan, Tompudung, 2018). This encourages researchers to conduct this research to determine the factors that caused injuries in floods and landslides in Manado City. It is hoped that through this research, floodaffected communities can find out the cause of their injuries so that they can then take appropriate prevention and treatment measures, such as proper wound care according to the type of injury.

METHODS
The research design used in this study was descriptive quantitative design with an analytical approach. Respondents in this study were all residents in different urban villages in Manado City who had experienced injuries and wounds during floods and landslides in 2021. The independent variables in this study were age, gender, and the location of the respondents during floods and landslides. While the dependent variable was the cause of injuries or wounds in floods and landslides in Manado City.
The sampling technique was purposive sampling with inclusion criteria such as people who had injuries or wounds that were caused by floods or landslides. People who had wounds such as diabetic wounds, injuries due to accidents or skin irritation due to allergies prior to the disasters that were exacerbated by the floods were excluded in this study. The number of the respondents were 44 people. Data gathering was done from November 2021 to January 2022. The data were analyzed using Chi-square test to determine the etiology or cause of wounds during natural disaster such as flooding and landslides.

RESULTS
Based on the research result analysis, it was obtained the age of the majority of the respondents were at 46-55 years old, males, and were inside the house when disasters happened.  (2022) Based on Table 1 above, the majority of respondents were in the early elderlies, as many as 31.8%, followed by the late elderlies, as many as 25%, late adulthood as many as 15.9%, and late teens, early adults, and seniors with the total of 9.1% each. The majority of respondents were 56.8% male and 43.2% female, and according to the location when the disaster happened, 68.2% or the respondents were inside the house and 31.8% of the respondents were outside of the house.  (2022) Based on Table 2, all the respondents were injured in floods and landslides, with the highest percentage of the types of wound etiology was due to the exposure of skin irritants as many as 50% of the total respondents. It was followed by sharp object trauma in the form of cuts or stabbed nails as many as 29.5%, and blunt object trauma in the form of impact as many as 20.5% of the total number of the respondents.  (2022) From the results in Table 3, it can be seen that the most wounds experienced by the respondents were wounds due to irritant exposure and in the early elderly age group, as many as 18.2% followed by late elderly as many as 11.4%, and late adulthood as many as 9.1%; with floodwater as the source of the irritants. Early and late elderly also experienced wound due to trauma from sharp objects, such as slashed by sharp objects or stabbed by nails, with the total of 9.1% of the population. A total of 4.54% of early adulthood and seniors experienced wounds due to the exposure to irritants, 4.54% of late adulthood, early elderly, and late elderly people experienced wounds due to blunt object trauma.
While only 2.27% of late adulthood experienced wounds due to the exposure to irritants and blunt object trauma, 2.27% of early adulthood and late adulthood experienced injuries due to sharp object, and 2.27% of the seniors were wounded due to blunt and sharp object trauma. The p-value obtained is 0.987 which is more than the 0.05 significant value, which means that the age of the respondents was not related to the etiology of the wounds in floods and landslides disasters in Manado City. In Table 4, it can be seen that male respondents have the highest percentage of wounds, as follows: 22.7% due to sharp object trauma, 18.2% due to blunt object trauma, and 15.9% due to the exposure of the irritants in the form of floodwater. Meanwhile, most the female respondents experienced wounds due to the exposure of irritants, as many as 34.1%, 6.81% due to sharp object trauma, and 2.3% due to blunt object trauma. The p-value obtained is 0.003 or less than 0.05 significant value, which means that gender had a relationship with wound etiology in floods and landslides disasters in Manado City.
Based on Table 5, when the disaster occurred, most of the respondents were inside the house but they were still wounded. As many as 40.91% of the respondents were wounded due to exposure to irritants, 20.45% of the respondents had sharp object trauma wounds, and 6.28% of the respondents had blunt object trauma wounds. Meanwhile, the respondents who were outside of the house at the time of the disasters had blunt object trauma wound as many as 16.63% of the total respondents, and 0.09% of the respondents respectively had sharp object trauma wounds and wounds due to exposure to irritants. The p-value obtained is 0.31, which is more than 0.05 significant value. It means that the location of the respondents during floods and landslides did not have a relationship with wound etiology.

Characteristics of Wounded Respondents at Manado City
The characteristics of the wounded respondents were dominated by early and late elderlies, were mostly male, and were inside their house when the disaster happened. Revis (2015) in Puspitasari (2018) mentioned that one of the intrinsic factors of pressure wound etiology is age. The older a person gets, skin elasticity and vascularity decreased thus increasing the risk of injury. As for the majority of the respondents were males, because they were the first responders in their respective family. They were wounded during the process of evacuating their other family members, thus they stepped on sharp object, were hit by sharp object, or stayed for prolonged time in the floodwater thus causing skin irritation and wound.

Types of Wound Etiology
The types of wound etiology were caused by Irritant, Sharp Object, and Blunt Object or Blunt Force Trauma respectively from the highest cases to the lowest, as found in this research. As stated by Sjamsuhidajat & De Jong in 2017, sharp & blunt trauma can cause injuries as well as chemical exposure. In this case, the respondents were hit by sharp materials such as roof, punctured by nails, hit by bamboo or other floating objects, and even exposed to floodwater that acted as irritants to the skin, thus causing wounds. A dermatologist named Virgayanti in 2020 mentioned that during flooding, skin diseases can occur due to submersion of parts of the human body in the floodwater.

Relationship of Age with Wound Etiology
Age was not significantly related to the cause of the wound based on the result obtained in this study. The study of Yao, Niu, & Cheng, (2020), found that those with older age were more prone to developing chronic wounds, but in this research, age had nothing to do with the occurrence of the wounds based on the etiology. Although those in early elderly stage were the highest in number of respondents wounded by irritants, but the numbers decreased in late elderly stage and even lower in the senior stage.

Relationship of Gender with Wound Etiology
Based on the result of this study, gender had a significant relationship with wound etiology. Where male respondents who were wounded were more than female respondents in this study. The study of "Gender Differences in the Epidemiological Characteristics and Long-Term Trends of Injuries in Taiwan from 1998 to 2015: A Cross-Sectional Study" by Chou, et al., (2022) also had the similar result which stated that male patients had higher risks of injury rate compared to female patients. This was because of the protected nature of males so they were the ones who warned and helped others evacuating, even stayed behind to clean up.

Relationship of Location and Wound Etiology
The location of the respondents, whether they were being indoor or outdoor during the disaster had no relationships with the etiology of the wounds itself. The highest cause of the wound was irritant. The irritant itself was the dirty floodwater, so whether the respondents were inside or outside of the house when the disaster happened, they were still exposed or submerged in knee depth floodwater that caused the wound. According to Centers for Disease Control and Prevention (CDC, 2019), floodwater is dangerous. It contains chemicals, various diseases, sharp and blunt object, even insects and other dangerous animals like reptiles. Therefore, floodwater can cause skin rash and wound infection.
The findings of this study lead to the awareness of the cause of injury or wound. Thus, it can help the people in the disaster-prone area who are unable to migrate to safer places or house due to their economic situation or even emotional attachment with their neighborhoods, by educating them for flood preparation such as evacuation plans, supplies, and protective clothing to wear to prevent new injuries or wound in times of disaster (Ready, 2021).

CONCLUSION
It can be concluded based on the finding of this research that by age, most respondents were in their early and late elderlies, most respondents were male, and were wounded even when they were indoors. The type of wound etiology was mostly caused by irritant which was the floodwater.
There was no significant relationship between age and location of the respondents with wound etiology. However, there was a significant relationship between gender and wound etiology. It is suggested that health education must be given to those living in disaster prone area to prepare better for disaster and to prevent injuries or wound if another disaster was to happen. The researchers needed to include respondents who were not wounded during the January-February 2021 disaster.