HUBUNGAN DEFISIENSI GLUCOSE-6- PHOSPHATE DEHYDROGENASE (G-6-PD) DENGAN KEPADATAN PARASIT MALARIA PADA ANAK USIA SEKOLAH DI DAERAH ENDEMIS MALARIA

Abstract

Background : Glucose — 6 - Phosphate Dehydrogenase Defficiency ( G6PD ) is a certain inherited disorders and the mode of inheritance is X—linked ressesive Enzyme G6PD is needed to avoid the hemolytic anemia following oxygen stress. G6PD defficiency individuals usually have an hemolytic episode after oxygen stress exposure. The severity of • G6PD defficiency is differ in various ethnic group, and there would be more than 4,000 G6PD varian. The reported incidence approximately 1% to 14% in Indonesia. Luzzato studies (1969) showed the prevalens of G6PD defficieny in malaria endemic area compared with non endemic area. Erythrocyte cell in G6PD defficiency persons suspected have the capability to protect them from P. falciparum infection. In vitro, they described that invasion of P. falciparum into erythrocyte suffer from G6PD defficiency is normal, but the intracellular growth schizogoni form is abnormal. East Sumba district — East Nusa Tenggara province considered as malaria endemic area, shown by stratification of 2001 with 106 villages out from 139 were area with "High Incidence Area". Objective : to determine the proportion of G6PD defficiency among school children and the correlation between G6PD defficiency in childhood to parasit malaria density in study area. Methods A cross sectional studies. Subject is school age children in East Sumba district. Data collected from quesioner and blood samples, using thick and thin blood smear with giemsa staining to detect the parasit and malaria density, also blood dropped at disc paper to screens G6PD defficiency using formazan ring method. Analysis data was performed using regression logistic to determine relation between variabels (significant p<0.05) Results There were 210 samples included in the study ( 117 girls and 93 boys ), which 135 children originate from Sumba and 75 children non Sumba. G6PD defficiency were found in 19 children ( 9,3%) ; 8 of them were boys. Twenty two children ( 10,5%) had positive malaria, which 7 ( 3,3% ) children of them were G6PD defficiency. High malaria density was found at 12 children ( 5,7% ), 4 ( 1,9% ) of them were G6PD defficiency. Children with G6PD defficiency showed lower malaria density compare borderline G6PD or normal, which showed significant correlation (p = 0.008, PR : 6.057, CI 95 : 1.590 — 23.079). Conclusion : The proportion of G6PD defficiency at school age children in East Sumba district is 9,3%, consistent with the incidence in Indonesia which is 1 — 14 %. The proportion of positive malaria test of blood sampling in school age children from East Sumba district is 10,5%. The density of malaria with G6PD defficiency which showed significant correlation. Key word : G6PD defficiency, malaria, malaria density malaria Latar Belakang : Defisiensi Glukosa-6-Phosphate Dehidrogenase (G6PD) merupakan kelainan diturunlcan secara x-linked recessive. Enzim G6PD diperlukan untuk mencegah hemolisis eritrosit akibat stres oksidan. Individu defisiensi G6PD akan mengalami episode hemolisis bila terpapar stres oksidan. Beratnya defisiensi G6PD bervariasi diantara kelompok etnis / ras dan telah diketahui lebih dari 400 varian G6PD. Di Indonesia insidennya diperlcirakan antara 1-14 %. Studi Lunato 1969 menunjuldcan prevalensi defisiensi G6PD di daerah endemis malaria lebih tinggi dibanding di daerah non endemis malaria. Diduga sel eritrosit individu defisiensi G6PD mempunyai kemampuan selektif melindungi terhadap infeksi P. falsifarum Studi in vitro menunjuldcan invasi P. falsifarum pada sel eritrosit dengan defisiensi G6PD adalah normal, tetapi pertumbuhan intraseluler (terutama schizogoni) terganggu. Kabupaten Sumba Timur propinsi Nusa Tenggara Timur merupakan daerah endemis malaria dimana menurut stratifikasi tahun 2001 dari 139 desa, 106 desa merupakan daerah High Incidence Area (HIA). Tujuan : mengetahui proporsi defisiensi G6PD pada anak usia sekolah dan mengetahui hubungan antara defisiensi G6PD dengan kepadatan parasit malaria pada anak usia sekolah di daerah studi. Metodelogi Penelitian : studi belah lintang. Subyek penelitian adalah anak usia sekolah di Kabupaten Sumba Timur. Penggumpulan data dilalculcan dengan kuesioner dan pengambilan sampel darah, yang dilalcukan sediaan darah hapus tebal dan tipis dengan pengecatan giemsa untuk memeriksa parasit dan kepadatan malaria serta tetesan darah pada kertas disk untuk pemeriksaan slcrining defisiensi G6PD dengan metode formazan ring. Analisa data inenggunalcan regresi logistik untuk menentukan ada tidalawa hubungan antara variabel -(bermakna p<0.05) Hasil Penelitian : telah diperiksa 210 sampel yang terdiri 117 anak perempuan dan 93 anak lalci-lalci, dimana 135 anak berasal dari suku sumba dan 75 anak berasal dari suku non sumba. Ditemulcan 19 anak (9,3%) yang mengalami defisiensi G6PD, yang termasuk didalamnya 8 anak lald-laki. Terdapat 22 anak (10,5%) positif malaria, dimana 7 anak (3,3%) defisiensi G6PD sediaan darahnya positif malaria. Kepadatan malaria tinggi ditemukan pada 12 anak (5,7%), dimana termasulc didalamnya 4 anak (1,9%) defisiensi G6PD. Individu defisiensi G6PD menunjuklcan kepadatan malaria lebih rendah dibanding individu G6PD borderline atau G6PD normal, hubungan tersebut signifikan bermakna p=0.008, Prevalence Ratio (PR) : 6.057, confidence interval (CI) 95 % : 1.590 — 23.079. Kesimpulan : proporsi defisiensi G6PD pada anak usia sekolah di Kabupaten Sumba Timur adalah 9,3%, sesuai dengan perkiraan bahwa insidennya di Indonesia adalah 1 — 14 %. Proporsi malaria positif pada sediaan darah anak usia sekolah di Kabupaten Sumba Timur adalah 10,5%. Ditemulcan bahwa individu dengan defisiensi G6PD berhubungan bermakna dengan kepadatan malaria.