UJI EFIKASI KLOROKUIN TERHADAP Nastgum Worm DAN FAKTOR-FAKTOR YANG MEMPENGARUHI KEJADIAN RESISTENSI DI KECAMATAN WANADADI DAN SEKITARNYA DI KABUPATEN BANJARNEGARA

Abstract

Background. Malaria, is one of the tropical diseases, which still becomes the main problem of the public health matter. Malaria eradication program is the effort to decrease morbidity and mortality in the community. One of the constraints that is often faced is treatment failure because of malaria parasite resistant to the medicine. Objective. This study were to get the description of the resistant P. falciparum against chloroquine, to get risk factors on resistant in Wanadadi Sub district and surrounding, and to recognize the content medicine, which were sold freely in shops in research area. Method. Descriptive study was to describe the chloroquine efficacy testing on P. falciparum, and also the chloroquine content in anti malaria medicine. Observational study was to identify the risk factors of P. falciparum resistant with cross sectional design. The observational population was the casualty of positive malaria falciparum, Which had been treated in Puskesmas I Wanadadi, from March — June 2002, also fit in the inclusive criteria. Result. Chloroquine efficacy testing on 79 observational subject until the 28th evaluation finds that there are 16,5% of late clinical failure (LCF), 6,3% of late parasitological failure (LPF), 77,2% adequate clinical and parasitological response (ACPR) and there is no casualty of Early Treatment failure (ETF). The result of chloroquine testing in medicine is 100% correct. Based on multivariate analysis, the risk factor that influence the resistant occurrence are the unfinished medicine, when the patient loses his or her symptoms (RP=15,3), side effects of nausea (RP=15,6), improper dosage (RP=4,9). Conclusion. Wanadadi Sub district, Punggelan and Banjarmangu are the areas of medication failure or resistant. The prevalence of droup out cases or resistant is 17,6% at Wanadadi, 22,9% at Punggelan, and 40% at Banjarmangu Sub District. The attitude of unfinished the medicine when the symptoms are vanished, side effects of nausea, and improper dosage are the risk factors of resistant. All chloroquine contents in medicine fulfill the requirement. Latar belakang. Penyakit malaria merupakan salah satu penyakit yang masih menjadi masalah kesehatan masyarakat. Upaya untuk menekan angka kesakitan dan kematian dilakukan melalui program pemberantasan malaria. Salah satu kendala yang sering dijumpai adalah kegagalan pengobatan karena parasit malaria yang telah resisten terhadap obat. Tujuan. Penelitian ini bertujuan memperoleh gambaran kejadian P. falczpa•um resisten terhadap klorokuin, faktor risiko kejadian resistensi di Kecamatan Wanadadi dan sekitarnya, dan untuk mengetahui kadar regimen obat yang dijual bebas di warung/toko di daerah penelitian. Metode. Penelitian deskriptif untuk uji efikasi klorokuin terhadap P. falciparum, serta uji kadar klorokuin dalam regimen obat antimalaria. Penelitian observasional untuk mengetahui faktor risiko terjadinya resistensi P. falciparum dengan rancangan cross sectional. Populasi studi adalah penderita positif malaria falciparum yang berobat di Puskesmas I Rawat hap Wanadadi, dari bulan Maret — Juni 2002 yang memenuhi kriteria inklusi. Hasil. Uji efikasi klorokuin pada 79 subyek penelitian sampai evaluasi hari ke-28 ditemukan 16,5% late clinical failure (LCF), 6,3% late parasitological failure (LPF), 77,2% adequate clinical and parasitological response (ACPR) dan tidak ada penderita Early treatment failure (ETF). Hasil uji kadar klorokuin dalam regimen obat 100% memenuhi syarat. Hasil analisis multivariat, faktor risiko yang mempengaruhi kejadian resistensi adalah obat disisakan bila gejala hilang (RP-15,3), adanya efek samping mual (RP-15,6) dan dosis tidak tepat (RP=4,9). Simpulan. Kec. Wanadadi, Punggelan dan Banjarmangu merupakan daerah ditemukan kasus gagal obat atau resisten. Prevalensi kasus gagal obat atau resisten di Kec. Wanadadi 17,6%, Punggelan 22,9% dan Banjarmangu 40%. Minum obat disisakan, efek samping mual dan dosis tidak tepat merupakan faktor risiko terjadinya resistensi. Kadar regimen obat yang diperiksakan 100% memenuhi syarat.