Penapisan dengan gejala klinis malaria oleh kader malaria dalam upaya penemuan penderita malaria di Kota Ternate Provinsi Maluku Utara tahun 2005

PORA, Mohammad Irfan, dr. Haripurnomo, K, MPH, DrPH

2009 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Pembangunan kesehatan pada hakekatnya bertujuan agar semua lapisan masyarakat dapat memperoleh pelayanan kesehatan secara mudah, merata dan terjangkau. Oleh karena itu salah satu upaya menurunkan untuk angka kesakitan akibat penyakit malaria adalah dengan melibatkan peran serta masyarakat dalam menemukan penderita malaria melalui kegiatan pemetaan, pemeriksaan breeding place, penyuluhan dan rujukan berdasarkan gejala klinis yang rasakan tersangka malaria. Tujuan:. Untuk mengetahui upaya penemuan penderita malaria oleh kader malaria melalui penapisan gejala klinis malaria dalam upaya penanggulangan malaria di Kota Ternate Provinsi Maluku Utara. Metode: Penelitian ini merupakan penelitian observasional deskriptif dengan unit analisis puskesmas. Besar sampel 63 orang kader malaria yang tersebar di Kota Ternate. Hasil: Sebagian besar tersangka malaria yang dtemukan kader malaria menunjukkan gejala klinis sakit kepala 80,7%, demam 87,1%, menggigil 74,1%, berkeringat setelah menggigil 60,6%, ikterus 24,2%, pegal linu 38,0%, selerah makan menurun 61,2% dan batuk pilek 32,0%. Hasil penapisan gejala klinis diketahui demam memiliki sensitivitas 86,3% diikuti sakit kepala 84,0%, menggigil 77,9%, sakit kepala+demam 75,6% dan demam+menggigil 71,0%. Spesitifisitas diketahui ikterus 78,0% diikuti batuk pilek 67,7% dan pegal linu 61,2%. Positive predictive value adalah ikterus 42,0 dan terendah nafsu makan 34,7. Negative predictive value adalah menggigil 69,1% dan terendah nafsu makan menurun 61,7%. Hasil kegiatan penyuluhan 31,4%, pemetaan 76,9%, pemeriksaan bleeding place 15,7% dan rujukan 28,4% dari semua tersangka malaria yang ditemukan kader malaria. Kesimpulan: Hasil penapisan gejala klinis diketahui demam memiliki sensitivitas tinggi diikuti sakit kepala, menggigil, sakit kepala+demam, dan demam+menggigil. Spesitifisitas tertinggi adalah ikterus diikuti batuk pilek dan pegal linu. Positive predictive value adalah ikterus dan terendah nafsu makan. Negative predictive value adalah menggigil dan terendah nafsu makan menurun. Sebagian besar kader malaria melakukan pemetaan tersangka malaria dan sebagian kecil saja kader melakukan penyuluhan, pemeriksaan bleeding place dan rujukan terhadap tersangka malaria yang ditemukan kader.

Background: Health development is primarily intended to provide all people with easy, equal, and affordable access to health services. Among the efforts to reduce the rate of illness causing by malaria is by encouraging participation of the community members in finding out malaria sufferers through mapping, examination of breeding place, outreach, and referral, based on clinical symptoms swhon by malaria suspects. Purpose: To find out efforts by malaria cadres in finding malaria sufferers through screening of clinical malaria symptoms in order to prevent malaria in Ternate Town of Maluku Utara Province. Method: It was descriptive observational study with the community health centers as the its units of analysis. The sample consisted of 63 malaria cadres in Ternate town. Results: Most of the malaria suspects found by the cadres exhibited clinical symptoms of headache, 80.7%, fever, 87.1%, shivering, 74.1%, sweating after shivering, 60.6%, icterus, 24.2%, stiffness, 38.0%, reduced appetite, 61.2%, and cough-cold, 32.0%. The results of screening of clinical symptoms found that fever had the sensitivity of 86.3%, followed by headache, 84.0%, shivering, 77.9%, headache+fever, 75,6%, and fever+shivering, 71.0%. Specificity of the clinical symptoms was icterus, 78.0%, which was followed by cough-cold, 67.7%, and stiffness, 61.2%. The highest positive predictive value was icterus, 42.0, and the lowest one was appetite, 34.7. The highest negative predictive value was shivering, 69.1%, and the lowest one was appetite, 61.7%. From all malaria suspects, 31.4% was found from outreach activity, 76.9% from mapping, 15.7% from examination of bleeding place, and 28.4% from referrals. Conclusion: The results of clinical symptom screening found that fever had highest sensitivity, followed by headache, shivering, headache+fever, and fever+shivering. The highest specificity was icterus, followed by cough-cold and stiffness. The highest positive predictive value was icterus and the lowest one was appetite. The highest negative predictive value was shivering and the lowest one was appetite. Most of malaria cadres carried out mapping for malaria suspects and only a few of them performed outreach, examined the bleeding place and made referrals for malaria suspects.

Kata Kunci : Penapisan,Penyakit malaria,Kader malaria, Screening, malaria disease, malaria cadre