FAKTOR-FAKTOR RISIKO KEJADIAN MALARIA DI DESA SIGEBLOG WILAYAH PUSKESMAS BANJARMANGU I KABUPATEN BANJARNEGARA, JAWA TENGAH Risk Factors of Malaria in Sigeblog Village, Puskesmas Banjarmangu Banjarnegara District, Central of Java

Abstract

Malaria, one of reemerging diseases, is becoming one of the public health problems. Plasmodium, as as the agent of malaria, is transmitted by the vector, Anopheles mosquito. There are two kinds of hospes within Plasmodium's live cycle, the vertebrata and the insect. Within vertebrata as its hospes, the Plasmodium has an asexual cycle. The Plasmodium has a sexual cycle while its place in its second hospes, the insect (mosquito). When the Plasmodium was in its live cycle within human blood, physiological problems may appear as malaria clinical symptom. Although Java and Bali have been already declare as malaria free island but malaria case are still found in 90 kecamatan. In Banjarnegara District, 47,06 % of Puskesmas work area are in endemic status of malaria and there are 86 villages as HCI village. The aim of this retrospektif observasional research with Case Control Study was to measure independent variable risk (environment, behavior, social economic status and health service) effect to the dependenet variable, the incident of malaria . The Case group was the malaria patient and the control group was people with negative blood spesimen. The entire 29 patient with malaria was treated as sample in these research and 29 people was taken as the control group by matching. Univariat, bivariate, multivariate logistic regression and spatial were used to analyze the data. Seven species of Anopheles were found, but only 3 species declared as the vector of malaria, An. aconitus, An. maculates And An. balabcensis. An. aconitus was the dominant species as its lowest density is still higher than other vectors. The bivariate analysis shows there were 9 factors that have significant relation with incident of malaria in responden's family but multivariate shows only 5 factors with this significant relation. These 5 factors were usage of mosquito net (OR = 10,67, 95 % CI = 0,11-0,81), usage of "kelambu" ( OR = 8,09 , 95 % CI = 1,99¬32,79), existence of cattle ( OR = 13,89, 95 % CI = 3,7-51,8 ), pesticide/ insectiside usage (OR = 9,53 , 95 % CI = 1.89-47,93 ) and reppelant usage ( OR = 9,53 , 95 % CI = 4,33-62,23). The social economic and health service factors showed no significant relation. Spatial analysis indicated that regional characteristic and housing environment condition were very homogeneous. The existence of cattle, breeding places and river had positive contribution to transmission of the malaria because made the buffer only 100-300 metres is overall of house reside in the buffer, it showing mosquito can fly to reach house in its. Malaria termasuk jenis reemerging diseases yang menjadi salah sate permasalahan kesehatan masyarakat Plasmodium sebagai agent ditransmisi oleh vektor nyamuk Anopheles. Daur hidup Plasmodium mempunyai dua hospes yaitu vertebrata dan serangga yang di dalam tubuhnya dapat berlangsung siklus aseksual di dalam hospes vertebrata dan siklus seksual di dalam nyamuk. Pada saat teijadi siklus dalam darah manusia mengakibatkan gangguan fisiologis dengan memunculkan gejala malaria Minis. Pulau Jawa dan Bali secara makro sudah dinyatakan bebas malaria, tetapi di 90 kecamatan masih ditemukan kasus malaria. Di Kabupaten Banjarnegara 47,06 % wilayah Puskesmas dinyatakan endemis malaria dan 86 desa sebagai desa HCI. Penelitian retrospektif observasional dengan disain Case Control Study dilakukan untuk mengukur besar risiko variabel bebas meliputi lingkungan, perilaku, status sosial ekonomi dan pelayanan kesehatan berpengaruh terhadap variable terikat kejadian malaria. Kelompok kasus adalah penderita malaria sedangkan kelompok kontrol adalah pemilik spesimen darah negatif. Seluruh penderita berjumlah 29 orang dijadikan sebagai sampel dan kelompok kontrol juga 29 orang diambil dengan cara matching. Data dianalisis dengan univariat, bivariat, multivariate regresi logistik dan spasial. Ditemukan tujuh spesies Anopheles tetapi yang dinyatakan sebagai vektor malaria hanya tiga yaitu An. aconitus, An. maculates dan An. balabcensis. Spesies yang dominan adalah An. aconitus karena populasi kepadatan terendahnya masih lebih tinggi dari pada vektor yang lain. Hasil analisis bivariat menunjukkan ada sembilan faktor risiko yang hubungannya bermakna terhadap kejadian malaria pada keluarga responden tetapi dengan analisis multivariate hanya lima faktor risiko yang hubungannya bermakna. Kelima faktor tersebut adalah pemakaian kawat kasa nyamuk (OR = 10,67, 95 % CI = 0,11-0,81), pemakaian kelambu (OR = 8,09 , 95 % CI = 1,99-32,79), keberadaan kandang hewan (OR = 13,89, 95 % CI = 3,7-51,8 ), pemakai pestisida/insektisida (OR = 9,53 , 95 % CI = 1.89-47,93 ) dan pemakai reppelant (OR = 9,53 , 95 % CI = 4,33-62,23). Faktor risiko tingkat sosial ekonomi dan pelayanan kesehatan menunjukkan hubungan yang tidak bermakna. Analisis spasial menunjukkan bahwa karakteristik wilayah dan kondisi lingkungan perumahan sangat homogen. Keberadaan kandang hewan, breeding places dan sungai mempunyai kontribusi positif terhadap transmisi malaria karena dengan dibuat buffer hanya 100-300 meter keseluruhan rumah berada di dalamnya yang menunjukkan nyamuk mampu terbang menjangkau rumah di sekitarnya.