The Concept of Sustainable Eco-Urban Settlement in Yogyakarta Peri-urban Area Regarding to Public Health Prevalence Reduction Efforts

Settlement quality has always been a concern in development issues in Indonesia. Humans as residents who live in a settlement act as subjects and objects in development so the role of humans in the quality of settlements is also closely related. Settlement quality is one of the goals of the Sustainable Development Goals (SDGs), more precisely, the 11th goal which aims to make cities and settlements inclusive, safe, resilient, and sustainable. The general problem related to the quality of settlements is that most areas still have inadequate quality settlements and the density of existing settlements exceeds the carrying capacity and carrying capacity of the environment. This can affect the decline in environmental quality in these settlements. Diseases that occur due to environmental conditions can occur due to interactions between humans, human behavior, and the environment in which they live that have the potential to transmit disease. Poor residential environmental conditions will increase the risk of environmental-based disease transmission. One of the common environmental-based diseases that occurs in settlements is leptospirosis which is usually caused by poor environmental sanitation conditions and the presence of rats. Poor environmental conditions will indirectly affect the health conditions of residents, such as mothers and children in the house. Poor maternal and child health creates opportunities for stunting to occur. Stunting is a nutritional status outcome that occurs when a child has a height of less than −2.0 standard deviation (SD) compared to the population average.


Introduction
The existence of settlements is closely related to the population in an area.Settlement development continues to increase along with the increase in population.This is because humans who are residents in an area need a house as a place to live and carry out activities that support their livelihood and livelihood.Uncontrolled development of settlements can cause settlement problems, especially the quality of settlements.
The good or bad quality of a settlement can be measured using the concept of eco-settlement which has been regulated in Ministerial Regulation No.2/PRT/M/2016.According to Dewi, et al. [1], the concept of eco-settlement is a concept of living/living that is ecologically developed from the concept of sustainable development.According to him, this concept harmonizes three pillars, in the form of social, economic, and ecological supported by institutions.This concept is in line with the principle of regional development for each Regency/City in Indonesia which is stated in the Regional Spatial Plan (RTRW), in the form of sustainable development.Settlement quality has always been a concern in development issues in Indonesia.Humans as residents who live in a settlement act as subjects and objects in development so the role of humans in the quality of settlements is also closely related.Settlement quality is one of the goals of the Sustainable Development Goals (SDGs), more precisely, the 11th goal which aims to make cities and settlements inclusive, safe, resilient, and sustainable.The general problem related to the quality of settlements is that most areas still have inadequate quality settlements and the density of existing settlements exceeds the carrying capacity and carrying capacity of the environment.This can affect these settlements' environmental quality decline [2].Problems related to the quality of settlements are important to pay attention to because if left unchecked it can hinder development in an area.
Settlement quality can be related to the health of the population living in the settlement itself.One aspect of settlement quality that is closely related to health is the sanitation of the settlement environment [3].Diseases that occur due to environmental conditions can occur due to interactions between humans, human behavior, and the environment in which they live that have the potential to transmit disease.Poor residential environmental conditions will increase the risk of environmental-based disease transmission.One of the common environmental-based diseases that occurs in settlements is leptospirosis which is usually caused by poor environmental sanitation conditions and the presence of rats.
Poor-quality settlements identically with poor environmental quality and low hygiene and healthy living behavior will cause various health problems in the area [4].Poor environmental conditions will indirectly affect the health conditions of residents, such as mothers and children in the house.Poor maternal and child health creates opportunities for stunting to occur.Stunting is an outcome of nutritional status that occurs when a child has a height of less than -2.0 standard deviation (SD) compared to the population, et average [5].
According to the World Health Organization (WHO) [6], the nutritional status of stunting is calculated based on the suitability between height for age and the WHO z-score chart.The causes of stunting can be divided into two, namely direct causes and indirect causes.According to him, stunting is directly related to nutrition-specific interventions and indirectly related to nutrition-sensitive interventions.Nutrition-specific interventions are interventions or programs that address the determinants of nutrition and growth of the fetus and child, while nutrition-sensitive interventions are interventions that address the sources of the determinants of nutritional status and growth of the fetus and child [7].The incidence of stunting in children can have an impact on the development of human resources, the long-term impact of which can reduce cognitive and physical development, poor health, reduce work capacity, and increase the risk of degenerative diseases [5].
Stunting is a global health problem, approximately 155 million children under five in the world are stunted [6].Countries in the Southeast Asian region that are members of the Association of Southeast Asian Nations (ASEAN) also experience these health problems.According to WHO, Indonesia is one of the ASEAN countries that has a high prevalence rate of stunting besides Myanmar, Cambodia, and the Philippines.Based on the Indonesian Nutrition Status Study (SSGI), the prevalence of stunting in Indonesia in 2021 is 24.4% [8].This shows that almost a quarter of toddlers in Indonesia are stunted.The high prevalence of stunting has made the Government of Indonesia, including the Special Region of Yogyakarta (DIY) within it, accelerate the reduction of stunting through the government's priority programs listed in the 2020-2024 National Medium Term Development Plan (RPJMN).The government is targeting the stunting prevalence rate to drop to 14% by 2024.
The prevalence of stunting in DIY in 2021 is 17.3% [8].This figure has decreased from the previous year but still needs to be lowered again to reach the national target.The DIY government is making various efforts to reduce stunting in its area, one of which is in the form of collaboration between the Kulon Progo National Population and Family Planning Agency (BKKBN) and the Government of Seychelles which formed a Pilot Project for a Healthy Environment, Prosperous Family [8].This pilot aims to create a family that is healthy, clean, and aware of environmental cleanliness.This program was created as an effort to improve the quality of the environment so that families become prosperous which can reduce stunting rates.This program is considered to be able to control the indirect factors of stunting.This is because environmental factors can indirectly trigger digestive tract disorders which cause a diversion of energy that should be used for growth to be used for the body's resistance to infection [9].The program being implemented is in line with the research of Cumming and Cairncross [10], that environmental hygiene factors, access to clean water, and sanitation have sufficient potential to reduce the prevalence of stunting in developing countries.The influence of the environment on the incidence of stunting makes stunting an interesting issue when talking about the quality of settlements based on eco-settlement.Sleman Regency is one of the districts in DIY which has the largest population, around 1136 thousand people [11] with the highest economic level.This district is a highly developed economic center of DIY.This is evidenced by the Gross Regional Domestic Product (GRDP) of Sleman which has reached the highest figure compared to other districts/cities, namely reaching 49,500 billion rupiah in 2021 (Table 1.1).There are four main supporting sectors of the Sleman economy in 2021, including the manufacturing industry sector at 13.1%, the construction sector at 11.6%, the information and communication sector at 10.8%, and the education services sector at 10.7% [12].Apart from being an economic center, this district is one of the main food storage areas in the Province of DIY.Based on DIY Province BPS data (2022), in 2021 rice production in this district will increase by 10.7% from the previous year to 123.59 thousand tons of dry milled grain (GKG).Despite the relatively good condition and potential of the region and socio-economic community, it turns out that there are still many cases of stunting in Sleman.Several sub-districts that have several cases above the district average include Minggir, Pakem, Turi, Ngemplak, Sayegan, and Godean.
Yogyakarta's peri-urban area is an agricultural area that is used as a DIY's food barn.As time goes by, this area continues to experience the conversion of agricultural land to non-agricultural land due to the increasing need for settlements.The increase in the need for settlements is due to the increasing population in this sub-district.The increasing need for settlements in peri-urban areas has resulted in poor-quality settlements.
The impact of the existence of settlements with poor quality will indirectly cause problems in various aspects and will become one of the obstacles to development, both human development and environmental development it.The problem faced by these peri-urban areas is the problem of stunting rates.The increasing number of residents in this village has made the condition of the physical environment of the area worse.This is because residents prioritize their economy so that their basic needs are fulfilled rather than good physical environmental conditions.
Based on the description of the existing problems, it is necessary to evaluate the quality of settlements in peri-urban areas.This assessment is considered important to provide an overview of actual settlement conditions and to determine the effect of settlement quality on the high stunting rate in this village.The eco-settlement criterion is a concept used to assess settlement quality.The concept of eco-settlement is a concept developed from the concept of sustainable development by harmonizing three pillars, namely social, economic, and ecological supported by institutions.This concept is very appropriate to use because various aspects of it are related to settlements and indirect causes of stunting.In this regard, the questions that arise in this study are: 1.What is the quality of settlements in the urban peri-urban areas of Yogyakarta based on eco-settlement criteria?2. What are the implications of the quality of housing on stunting rates and the incidence of leptospirosis?In general, this research aims to: 1.To identify the quality of settlements in the urban peri-urban areas of Yogyakarta based on ecosettlement criteria; And 2. To assess the implications of settlement quality on stunting and leptospirosis rates.

Research Methods
Based on the research objectives to be achieved, this research includes exploratory-descriptive research.The research method used is quantitative.This research method is a research method that tests certain theories from previous research or theories that have developed by examining the relationships between variables [13].Theories in this quantitative research will later be tested deductively to prevent bias and to be able to generalize the findings.This quantitative research method uses descriptive statistical analytical tools.
Regarding the object of research, the data collection technique uses primary data (structured interviews) at selected locations.The analysis used mainly in spatial analysis.The sampling technique used purposive sampling.The location of this research is the Yogyakarta Peri-urban Area.This location was chosen because the Yogyakarta peri-urban area has conditions that have the potential for leptospirosis and stunting.As a phenomenon, this is quite by the research objectives that want to examine the process and implications of sustainable eco-settlement concept.
This research is geography research with the main focus on the spatial approach.The main study object studied was the phenomenon of settlement quality with an emphasis on assessing the relationship between settlement quality and public health conditions, especially the level of stunting and the incidence of leptospirosis.Identification of this process is intended to obtain an overview of the phenomenon that occurs.
The data used in this research are primary data and secondary data.Primary data is data obtained from direct observations and or measurements in the field or identified from research materials directly in the laboratory.Some of the primary data collected in this study were in the form of maps resulting from the interpretation of satellite imagery, observation data, and field observations, as well as data from interviews with selected respondents.Secondary data is data obtained from other sources outside of research, either in the form of published data that already exists and is trusted for the validity and accuracy of the data, or data obtained from previous research results.Some of the secondary data collected in this study included thematic maps, tables, and or graphs (especially population data) publications from various agencies.
According to the Research and Development Center of the Ministry of Public Work [14], the ecosettlement criteria are as shown in Table 2.

Results and Discussion
This study tries to confirm the concept of settlement quality based on eco-settlement criteria associated with the incidence of diseases in the community, namely leptospirosis and stunting.The results showed that the quality of housing was related to the incidence of leptospirosis and stunting.Leptospirosis is closely related to the location of the house, the environment suitable for rat habitat, and the untidiness in the house.Meanwhile, socio-economic conditions as reflected in physical quality, socio-economic quality, and occupant quality are closely related to the incidence of stunting.Forty Four heads of households as a sample, who are households living in peri-urban areas, namely in Prambanan District and Seyegan District, indicate that settlements with poor quality have the potential for leptospirosis and stunting.The frequency distribution of the quality of settlements in the Districts of Prambanan and Seyegan can be seen in Table 1.The quality of these settlements varies depending on the physical condition of the house building, the condition of the settlement environment, and the socioeconomic conditions of each household.The better the quality of each aspect that is influenced by the conditions of the occupants in it, the better the conditions and quality of the settlements owned.The quality of settlements in the study area is dominated by medium-quality settlements.To find out the locus of the research area more clearly, Figure 1 presents a map of the research locations based on the administrative map.

Quality of settlements in the urban peri-urban areas of Yogyakarta based on eco-settlement criteria
Settlement quality is a condition that indicates the quality of the availability of existing facilities and infrastructure in a settlement and the physical condition of the settlement which is influenced by the behavior of humans living in the settlement [16].The socioeconomic aspects that determine human behavior are closely related to the conditions of the settlements they live in, whether or not the quality of settlements in an area depends on the socioeconomic conditions of the population.According to Ridwan & Giyarsih [17], the higher the socio-economic quality of the residents of the settlements, the better the quality of the settlements they live in and vice versa.In addition to socio-economic conditions, the quality of settlements can also be influenced by the physical condition of the building itself and the environmental conditions around the settlement.Settlement quality can measure the degree of ability of a settlement environment to meet the needs of the people who live in it.The quality of settlements in the study area varies due to the social and economic conditions of the inhabitants as well as the physical conditions of the houses and settlement environment.
Eco-settlement is the concept of structuring sustainable settlements by harmonizing ecological, social, and economic aspects to achieve the sustainability of the settlement environment ecosystem followed by a capable institutional system.According to Dursun and Saglamer [18] several things are important to note in the quality of settlements, namely as follows.a. Contextual Aspect, namely the natural characteristics of the residential environment which are influenced by natural conditions.The contextual aspect is also related to the management of the residential environment to increase comfort, safety, and accessibility in the settlement.Settlement environmental conditions can be in the form of environmental sanitation which affects environmental health.b.Spatial Aspect, namely architectural characteristics or the beauty of a building and the size of the building in a settlement to create a beautiful and orderly settlement.The spatial aspect can be reflected in the physical condition of the house building which is closely related to the house building materials.c.Social Aspect, namely the social aspects of residents in a settlement in which there is social interaction that forms a social community in a residential community.Social aspects can influence human behavior in caring for and managing the settlements they live in.Humans are social creatures so that in social life in a settlement will form an interaction between one human being and another human being.d.Economic Aspect, namely the economic aspect that shows the economic condition of the population living in a settlement.This economic aspect can also be influenced by social aspects.The economic aspect affects the ability of the community to choose the neighborhood they want to live in and choose the preference for the housing they want to live in.The good economic condition of the population allows the population to have good residential preferences with high-quality settlements, on the other hand, the low economic condition of the population limits residents to choose the housing they want to live in.

Implications of settlement quality on stunting and leptospirosis rates.
Based on gender, leptospirosis sufferers are dominated by the male population with a total of 20 sufferers from 22 sufferers.This condition is confirmed by the research of Ariani and Wahyono [19] which suggests that men have a 2 times greater risk of contracting leptospirosis than women.Furthermore, when viewed from the age group, leptospirosis sufferers mostly infect the population in the age group of 45 years and over, namely the pre-retirement age group (45-54 years), the retirement age group (55-64 years), and the elderly (> 64 years).The percentage of 22 leptospirosis sufferers according to age group can be seen in Figure 2.This research is in line with the research of Prihantoro & Siwiendrayanti [20] and the research of Niza et al., [21] which stated that most leptospirosis sufferers occur in people aged over 40 years.The same condition occurs in stunting incidents.Male babies are more dominantly suffering from stunting than female babies, with a proportion of 65% to 35%.This shows that female babies are less likely to experience stunting than female babies.
The next characteristic of leptospirosis sufferers is seen from their livelihood.Livelihoods are positively correlated with the incidence of leptospirosis, especially the type of work carried out in muddy environments because the work environment is at high risk of being contaminated with Leptospira bacteria [22].The livelihoods of leptospirosis sufferers in the three sub-districts where the majority are farmers.Farmers are a type of work that has a high risk of leptospirosis transmission.According to Raharjo et al., [22] in their research, this type of risky work has a risk of exposure to leptospirosis 6.317 times higher than other jobs that are not at risk of leptospirosis transmission.This is also in line with the research by Mulyono et al., [23] and Cahyati and Kumalasari, [24] which stated that farmers working in rice fields are at high risk of leptospirosis because these farmers work in an environment that has stagnant water.Apart from farming, the livelihoods that many leptospirosis sufferers have are construction workers, namely as many as 3 people.Construction workers work is at risk of leptospirosis transmission because this job carries a risk of being injured while working.This research is in line with research by Rahayu et al., [25] which stated that construction workers are at risk of contracting leptospirosis because this work carries the risk of physical contact with dirty water while working so that the Leptospira bacteria infect the body through wounds on the individual's body.Quite the same condition occurs in stunting incidents.Babies whose his/her parent livelihood is farming have a higher risk of stunting than other jobs.This happens because the socio-economic conditions of farmers are relatively lower than those of households with non-farmer livelihoods.
The test of differences in the quality of settlements of leptospirosis sufferers and those who do not have leptospirosis in the Prambanan and Seyegan Sub-District showed an interesting result.The different test chosen is the non-parametric different test, the Mann-Whitney test which uses nonnormally distributed data with the independent variables in the form of ordinal data and the dependent variable in the form of nominal data.This differential test was carried out with the independent variables in the form of settlement quality classification (low, medium, and high) and the dependent variable the description of leptospirosis sufferers or non-leptospirosis sufferers.The results of the Mann-Whitney differential test can be seen in Table 4.The results of the Mann-Whitney differential test on settlement quality in total yielded a Sig (2tailed) value of 0.203.This value indicates that there is no significant difference between the quality of settlement of households with leptospirosis and households without leptospirosis.This is indicated by the quality of settlements with leptospirosis sufferers and non-leptospirosis sufferers, both of which are dominated by low to medium-quality settlements.Although there is no difference, it does not mean there is no difference at all.These differences still exist, in this study differences in the quality of settlements can be seen in the environmental aspects of settlements and socio-economic aspects.
Furthermore, the difference in settlement quality lies in the socio-economic aspect with the Sig (2tailed) value of the Mann-Whitney different test result of 0.038.Significant differences in the socioeconomic quality of households with leptospirosis and those without leptospirosis lie in the ownership of health insurance and the type of work held by the head of the family.The majority of households with leptospirosis and stunting come from poor families that are recognized by the government as indicated by the ownership of health insurance in the form of a Healthy Indonesia Card (KIS).In contrast to households that do not suffer from leptospirosis, which have independent health insurance by paying monthly, both class 2 and class 1 BPJS.This condition is in line with research by Vitale et al., [26] which suggests that poverty is closely related to leptospirosis due to poverty conditions.owned causes low awareness of maintaining cleanliness and health.Next, based on the type of work held by the head of the household, the majority of households with leptospirosis and stunting work as farmers in the rice fields.The heads of households whose main job is seasonal farming have low incomes because their income depends on the crops in the rice fields.According to research by Mangum & Mangum [27], the economic limitations of these farmers lead to the inability to purchase protective equipment that can be used in the fields, which increases the risk of infection with Leptospira bacteria from rat urine in the fields.In contrast to households that do not suffer from leptospirosis, which have an educated main type of occupation, such as self-employed and private employees.

Conclusion
Based on the research that has been done, several conclusions can be drawn.First, the quality of settlements in the research area with leptospirosis transmission and a stunting incidents in Prambanan and Seyegan are dominated by medium-quality settlements.The incidence of leptospirosis and stunting occurs in the majority male population, who work as a farmer, are over 45 years old, and have a low level of education.
Related to the analysis of differences, it can be seen that there is a significant difference between the quality of settlements with leptospirosis and the quality of settlements without leptospirosis sufferers.The same phenomenon in stunting incidents.

Table 1 .
Gross Regional Domestic Income of DIY Province by Regency/Municipality 2021

Table 4 .
Mann-Whitney Comparative test of Leptospirosis Suferrers and non-suferrers