Hubungan pengetahuan terhadap peresapan antibiotik dan antidiare pada tatalaksana diare akut pada balita di Puskesmas Kota Yogyakarta

MUHAMMADY, Mahbub, dr. Nenny Sri Mulyani, Sp.A(K)

2009 | Tesis | S2 MS-PPDS-Ilmu Kesehatan Anak

Latar belakang: Diare merupakan penyakit kedua terbanyak pada balita setelah ISPA, penyebab utama malnutrisi, dan merupakan kasus rawat inap tertinggi pada balita. Lebih dari 50% penyebab diare adalah virus. Berbagai informasi serta pelatihan tatalaksana diare cair akut pada anak telah diberikan pada dokter sejak tahun 1970-an sampai sekarang dengan tujuan meningkatkan pengetahuan dokter tentang diare, namun kenyataannya penggunaan obat-obatan terutama antibiotik dan antidiare pada tatalaksana diare cair akut di puskesmas sangat tinggi. Tujuan: Melihat hubungan antara pengetahuan dokter mengenai diare cair akut terhadap peresepan antibiotik dan antidiare pada terapi diare cair akut pada balita. Metode: Rancang bangun penelitian adalah potong lintang, subyek penelitian adalah dokter puskesmas yang terpilih berdasarkan simple random sampling. Pengukuran pengetahuan dokter tentang diare dan penatalaksanaanya dilakukan dengan memberikan kuesioner tentang pengetahuan diare cair akut dan penatalaksanaanya. Peresepan antibiotik dan antidiare pada balita penderita diare cair akut diketahui dengan melihat 30 rekam medis pasien balita penderita diare cair akut tiap dokter. Dengan total rekam medis yang dianalisis sebanyak 1050. Data dianalisis menggunakan uji-t, korelasi pearson, dan regresi linier. Hasil: Tiga puluh lima dokter puskesmas terpilih dengan metode simple random sampling dari 18 puskesmas di wilayah kota Yogyakarta. Berdasarkan hasil pengukuran tingkat pengetahuan dokter diketahui bahwa setiap peningkatan skor 1 poin berhubungan dengan penurunan prosentase peresepan antibiotik sebesar 1,11% dan antidiare 1,03% (p<0,05). Kelompok dokter yang bekerja di puskesmas yang bersertivikasi ISO 9001:2000 mersepkan antibiotik dan antidiare < 8% dibandingkan kelompok dokter yang bertugas di puskesmas yang belum bersertivikasi ISO yang meresepkan >56% (p< 0,01) Simpulan: Terdapat hubungan antara pengetahuan dokter tentang diare terhadap peresepan antibiotik dan antidiare pada balita penderita diare cair akut. Kelompok dokter yang bertugas di puskesmas yang berstandar ISO 9001:2000 meresepkan antibiotik dan antidiare sangat minimal.

Background: Diarrhea is the second most common dissease in children under five years old, the main cause of malnutrition, and also the most frequent cases for hospitalization in children under 5 years old. More than 50% etiology of acute diarrhea caused by virus. Many information and workshops have been given to physicians about these standarized managements of acute waterry diarhea in children. But in fact, the irrational use of antibiotics and antidiarrheas for acute watery diarrhea in children in Primary Health Care is still very high. Objective: To find the correlation between the physician’s knowledge of antibiotics and antidiarrheas prescription in management of acute watery diarrhea for children under five years old in Yogyakarta Pimary Health Cares. Methode: A crossectional study was done to Primary Public Health Care’s physicians as the subject of this study who enrolled by simple random sampling method. Their knowledge of acute watery diarrhea management measured by giving them a quiz which contain about management guideline of acute watery diarrhea . We also extracted data from medical records to know the patern of how each physician prescribed antibiotics and antidiarrheas in every 30 patients they examined for acute watery diarrhea cases. Totally, we collected 1050 prescription letters in this study. The data analized by t-test, pearson correlation, and linier regretion. Result: Thirty five primary health care physicians enrolled in this study by random sampling method from 18 primary health cares in Yogyakarta city. Based on the quiz score result, there is 1 additional point of knowledge score equal with 1,11% decreasing of antibiotic prescription and 1, 03% for antidiarrhea (p<0,05). From this study we also found that physician who work for primary health care with ISO:9001 certificate status prescribed less antibotics and antidiarrhea about less than 8 % compared to over 56 % prescribed by physician who work in non ISO certificate primary health care. Conclution: There is correlation between physician’s knowledge of antibiotics and antidiarrhea in acute watery management diarrhea for children under 5 years old in Yogyakarta primary health care. Minimal antibiotics and antidiarrhea prescription wrote by physicians who work in ISO certificate status primary health cares.

Kata Kunci : Pengetahuan,Diare cair akut,Antibiotik,Antidiare,Dokter puskesmas, Knowledge, acute watery diarrhea, antibiotic, antidiarrhea, physician