Identifikasi dan penerapan diagnosis klinis malaria di darah AMI tinggi dan AMI sedang Kabupaten Belitung

SUHARSONO, dr. Suharyanto Supardi, MPH.,MSPH

2004 | Tesis | S2 Ilmu Kesehatan Masyarakat

Annual malaria incidence (AMI) kabupaten Belitung tahun 2001 51‰. AMI puskesmas tertinggi 107‰, terendah 19‰. Slide positive rate (SPR) kabupaten tahun 2001 rendah 21%. Rendahnya SPR ini disebabkan belum adanya pedoman diagnosis klinis malaria yang baku (kriteria diagnosis klinis), dan uji sensitivitas, spesifisitas, dan positive predictive value (PPV) atau SPR selama ini belum pernah dilakukan. Tujuan penelitian ini untuk identifikasi gejala klinis malaria, membuat kriteria diagnosis klinis baru. Kriteria diagnosis klinis baru dan yang sudah ada dari daerah lain diterapkan di daerah AMI tinggi dan AMI sedang kabupaten Belitung. Mengetahui nilai sensitivitas, spesifisitas dan PPV atau SPR dari penerapan kriteria diagnosis klinis. Manfaat penelitian ini untuk memperbaiki ketepatan diagnosis klinis malaria di puskesmas atau di unit pelayanan kesehatan (UPK), sehingga pemeriksaan sediaan darah (SD) yang tidak perlu berkurang, dan nilai SPR meningkat. Rancangan penelitian yang digunakan cross sectional study, dilaksanakan di 9 puskesmas, 3 puskesmas AMI tinggi dan 6 puskesmas AMI sedang di kabupaten Belitung. Subyek penelitian penderita klinis malaria umur diatas 15 tahun ditemukan secara passive case detection (PCD). Waktu penelitian selama 3 bulan pada bulan April sampai dengan Juni 2002. Penerapan kriteria diagnosis klinis A, B, Pangade, Ambarita dan bagian Pangade Ambarita yang paling cocok diterapkan di daerah AMI tinggi kabupaten Belitung adalah kriteria diagnosis klinis B, yang mempunyai nilai sensitivitas 93%, spesifisitas 59,8%, dan PPV 39,9%. Penerapan kriteria diagnosis klinis C, D, E, Pangade, Ambarita dan bagian Pangade Ambarita yang paling cocok diterapkan di daerah AMI sedang kabupaten Belitung adalah kriteria diagnosis klinis D, yang mempunyai nilai sensitivitas 93,2%, spesifisitas 58,8%, dan PPV 32,1%. Penerapan kriteria diagnosis klinis B di daerah AMI tinggi kabupaten Belitung dapat menurunkan jumlah sediaan darah yang diperiksa secara laboratorium sebanyak 215 kasus (48%) dari 448 kasus menjadi 233 kasus, SPR atau PPV meningkat 1,8 kali dari 22,3% menjadi 39,9%. Penerapan kriteria diagnosis klinis D di daerah AMI sedang di kabupaten Belitung dapat menurunkan jumlah sediaan darah yang diperiksa secara laboratorium sebanyak 297 kasus (49,8%) dari 596 kasus menjadi 299 kasus, SPR atau PPV meningkat 1,8 kali dari 17,3% menjadi 32,1%.

Background: Annual malaria incidence (AMI) of Belitung regency in 2001 was 51‰. The highest AMI puskesmas was 107‰, the lowest 19‰. Slide positive rate (SPR) of the regency was low in 2001, 21%. The low SPR resulted from the unavailability of a standard malaria clinical diagnosis guidance (clinical diagnosis criteria), and sensitivity test, specificity, and positive predictive value (PPV) or SPR has not been conducted. Objectives: The objectives of the study were to identify the clinical symptoms of malaria, to establish the criteria of new clinical diagnosis. The existing new clinical diagnosis criteria of other region were applied to the high-AMI region and middle- AMI region in Belitung regency. Given the sensitivity value, the specificity and the PPV and the SPR of the application of the malaria clinical diagnosis, the usefulness of the study was to improve the accuracy of the malaria clinical diagnosis in the puskesmas or in unit pelayanan kesehatan (UPK), that the examination of blood supply (SD) showed that it was not reduced and the SPR value increased. Materials and Method: The study design was of cross sectional study, conducted in 9 puskesmas, 3 puskesmas of high AMI and 6 puskesmas of middle AMI in Belitung regency. The subjects of the study were those with malaria of above 15 years of age and determined using passive case detection (PCD). The period of the study was 3 months from April to June 2002. Results: The clinical diagnosis criteria A, B, Pangade, Ambarita and the part of Pangade Ambarita were applied and that most appropriate to apply o the high-AMI region of Belitung regency was the clinical diagnosis criteria B with the sensitivity value of 93%, specificity 59%, and PPV 39.9%. The clinical diagnosis criteria C, D, E, Pangade, Ambarita and the part of Pangade Ambarita that were most appropriate with the middle-AMI, while the clinical diagnosis criteria D was applied in Belitung regency with the sensitivity value of 93.2%, specificity of 58.8%, and the PPV of 32.1%. Conclusion: The clinical diagnosis criteria B was applied in the high-AMI region in Belitung regency and the criteria could decrease the blood supply examined in laboratory was from 215 subjects (48%) of 448 subjects become 233 subjects. The SPR increased 1.8 times from 22.3% to 39.9%. The application of the clinical diagnosis criteria D in the middle AMI of Belitung regency could decrease the blood supply of those examined in the laboratory, 297 subjects (49.8%) of 596 subjects of 299 subjects, SPR increased 1.8 times from 17.3% to 32.1%.

Kata Kunci : Epidemiologi Lapangan, Malaria, Diagnosis Klinis, AMI Sedang dan Tinggi,