Galore International Journal of Health Sciences and Research Vol.4; Issue: 1; Jan.-March 2019 Website: www.gijhsr.com Original Research Article P-ISSN: 2456-9321

Effect of the Role of Caders on Decreasing the MoPI (Monthly Parasite Incidence) Numbers Malaria in Supiori District

Esau Leunufna1, A.L. Rantetampang2, Yacob Ruru3, Anwar Mallongi4

1Magister Program of Public Health, Faculty of Public Health, Cenderawasih University, Jayapura. 2,3Lecturer of Master Program in Public Health. Faculty of Public Health, Cenderawasih University, Jayapura 4Environmental Health Department, Faculty of Public Health, Hasanuddin University, Makassar

Corresponding Author: Anwar Mallongi

ABSTRACT INTRODUCTION The situation of the malaria case in Background: The large number of malaria Papua Province for the last five years has sufferers in Supiori District requires the role of decreased slightly when seen from changes malaria cadres in the village as a fast and in the 2013 to 2017 API (Annual Parasite appropriate step to reduce malaria MoPI Incidence) values respectively, 103 ‰, 50.7 (Monthly Parasite Incidence) by expanding the ‰, 55.2 ‰, 49.6 ‰ and 46.79 ‰. However, scope of patient discovery and treatment both ACD (Active Case detection) and PCD (Patient based on the stratification of the malaria Case Detection). region in Indonesia, Papua Province is Objective: To determine the role of malaria classified as the highest endemic area, so in cadres in decreasing malaria MoPI (Monthly the National program as stated in the Decree Parasite Incidence) in Supiori District of the Minister of Health Number 293 / Research method: Observational analytic with Menkes / SK / IV / 2009 concerning malaria cross sectional study approach. This study was elimination in Indonesia, Papua Province is conducted in October 2018 in 10 villages in targeted to be included in the elimination Supiori District with a population of village target malaria in 2030 (RI Ministry of malaria cadres with a sample of 30 people in Health, 2016). Referring to the Decree, the total population. Data were obtained by Papua Provincial Government issued questionnaire and analyzed using Chi-Square Test, and logistic binary regression test. Governor Regulation Number 44 of 2017 Research results: Obtained factors that concerning guidelines for eliminating influence the decrease in the number of malaria Malaria in Papua by prioritizing 3 Districts MoPI (Monthly Parasite Incidence) in Supiori to be included in the elimination stage in Regency are malaria education (p = 0,000), 2020 namely, Supiori District, Biak Numfor community empowerment (p = 0.001), malaria Regency, and Lani Jaya Regency (Health sufferer findings (p = 0.151), radical treatment Office Profile Papua, 2017). (p = 0,000), treatment follow-up (p = 0,007), The Supiori District Determination malaria patient referral (p = 0,118), posmaldes as one of the elimination priority priority village mapping (p = 0,007), malaria meeting (p districts in Papua Province is seen from its = 0,837), malaria reporting (p = 0,024). geographical location as Islands Regency Dominant factors that influence the decrease in MoPI (Monthly Parasite Incidence) malaria are which is favorable for control and patient discovery, radical treatment, treatment eradication and Annual Parasite Incidence follow-up, where radical treatment is the most analysis which has decreased significantly dominant factor in decreasing malaria numbers in the last 3 years where the API (Annual (Monthly Parasite Incidence) in Supiori District. Parasite Incidence) from 2015 amounting to 78.5 turun, down to 9.6 ‰ in 2017, but this Keywords: Malaria, cadre role, monthly parasite figure is still far from the national incidence (MoPI) elimination target where API <1 atau

Galore International Journal of Health Sciences and Research (www.gijhsr.com) 107 Vol.4; Issue: 1; January-March 2019 Esau Leunufna et.al. Effect of the Role of Caders on Decreasing the MoPI (Monthly Parasite Incidence) Numbers Malaria in Supiori District population or included in the Low Case optimal results in the discovery and Incidence (Papua Provincial Health Office, treatment of patients and prevention of 2017). The malaria discovery and treatment malaria transmission (Kurniasih, 2018; program carried out in Supiori District is Mallongi A. 2014, 2016) . still using the Pasive Case Detection method The establishment of village malaria in each health facility. According to the posts (posmaldes) in difficult areas in Indonesian Ministry of Health (2018) that Supiori District is very useful to expand the the discovery and treatment of malaria scope of malaria discovery and treatment, so sufferers is said to be successful if the SPR in 2017 Global Fund malaria (GF-Malaria) value (Slide Positive Rate) is <5%. This through YPMK PERDHAKI conducted a figure when compared with the Suprori malaria intervention by establishing 10 Regency SPR (Slide Positive Rate) in 2017 village malaria posts ( posmaldes) with 30 of 38% is still above the expected target, the malaria cadres as part of community effort to find and treat malaria sufferers by empowerment in the village, and assigned applying the Pasive Case Detection method according to the village malaria cadre is less effective because of the limited scope guidelines issued by the Indonesian of discovery and treatment of patients. This Ministry of Health (2012) namely; conduct condition is certainly one of the triggers for malaria counseling activities, empower the the high rate of malaria transmission in community, find malaria sufferers on ACD Supiori District. According to Tuti S., ed., (active case detection) and PCD (passive Al (2009) that the limited discovery of case detection), carry out radical treatment, malaria cases is a trigger factor for high follow up treatment, refer malaria sufferers, malaria cases in one area. conduct village mapping posmaldes, Malaria transmission and morbidity participate in and initiate malaria meetings, rates were still quite high in 38 villages in and report all malaria activities in the Supiori District. Difficulty in managing village to the Puskesmas in their working malaria due to people's behavior, area. According to Ompusunggu., Et., Al geographical conditions, limited eradication (2005) that community participation in budgets from local governments, so that one malaria prevention through the appointment effective and efficient strategy is to of malaria field workers (TLM) who applied empower communities to expand the scope their role to the maximum would increase of malaria discovery and treatment. the percentage of population seeking According to Erni., Ed., Al (2007) that one treatment from 29.7% to 86.8%. This, if form of community empowerment is implemented well in difficult areas in effective and efficient through the Supiori District, certainly greatly influences establishment of village malaria posts the extent of malaria discovery and (posmaldes). The village malaria post treatment in the field so that transmission (Posmaldes) is a forum for community can be suppressed. empowerment in the prevention and control Seeing the importance of the role of of malaria that is formed from, by and for a village malaria cadre in the village malaria the community independently and post (posmaldes), the authors are interested sustainably (Ministry of Health, 2009), with in seeing how far the role of 30 malaria the aim of reducing malaria morbidity and cadres temporarily served in 10 remote mortality, especially in areas far out of reach villages in Supiori District to reduce malaria health services (difficult areas), and MoPI (Monthly Parasite Incidence) so that accommodating all activities carried out by later make reference to the establishment of the community in malaria prevention so that Posmaldes in other difficult villages in they can be implemented in a planned, Supiori District. directed, integrated, comprehensive and sustainable manner so that they can provide

Galore International Journal of Health Sciences and Research (www.gijhsr.com) 108 Vol.4; Issue: 1; January-March 2019 Esau Leunufna et.al. Effect of the Role of Caders on Decreasing the MoPI (Monthly Parasite Incidence) Numbers Malaria in Supiori District

Table 1 shows that of the 20 cadres 2. MATERIALS AND METHODS who carried out malaria education activities in their working areas there were 19 cadres 2.1. Research design (95%) whose malaria MoPI (Monthly This study included an observational Parasite Incidence) rate decreased and 1 analytic study using the cross sectional cadre (5%) did not decrease, while 10 approach, namely the type of research that cadres who did not carry out extension emphasizes the time of measurement or activities malaria in its working area has 2 observation of data in one time that is done cadres (20%) whose malaria MoPI on the dependent variable and the (Monthly Parasite Incidence) number independent variable. This approach is used decreases and 8 cadres (80%) malaria MoPI to see the influence of the independent (Monthly Parasite Incidence) number. The variables on the dependent variable. results of the chi square statistical test on the significance value of 95% (α = 0.05) 2.2. Research Population and Samples obtained p-value 0,000 <α (0.05). This i. Research Population means that there is a significant effect of The population in this study were all malaria education on decreasing the number malaria cadres in Supiori District, which of malaria MoPI (Monthly Parasite numbered 30 people. Incidence) in their working area. Results of ii. Research Samples the value of RP = 4,750; CI95% (1,370 - The sample of this study was 30 malaria 16,474) explains that cadres who carry out cadres with the reason that the population malaria counseling can reduce malaria was below 100. According to the opinion of MoPI (Monthly Parasite Incidence) number Arikunto (2013). 4.8 times than cadres who do not carry out iii. Sampling technique malaria counseling in their working area. Sampling uses saturated sampling method where the determination of the sample by 3.2 Effect of Community Empowerment on taking all members of the population as malaria MoPI (Monthly Parasite Incidence) respondents amounted to 30 people. figures

3. RESULTS Table 2 Effect of community empowerment on MoPI (Monthly Parasite Incidence) in Supiori District in 2018 Bivariate analysis was conducted to Number of (Monthly Community Parasite Incidence) determine the effect of independent No empowerment malaria n % variables with the dependent variable and in Decrease Stable n % n % this study used the Kai Square or Chi 1 Conducted 20 87 3 13 23 100 Square Test. Not 2 Conducted 1 14,3 6 85,7 7 100 Total 21 70 9 30 30 100 3.1 Effect of malaria counseling on malaria p-value = 0,001, RP = 6,087, CI95% (0,985 - 37,623) MoPI (Monthly Parasite Incidence) numbers Table 2 shows that of the 23 cadres Table 1 Effect of malaria cure on the MoPI (Monthly Parasite Incidence) number of malaria in Supiori District in 2018 who carry out community empowerment Number of MoPI activities in their working areas there are 20 Malaria (Monthly Parasite No education Incidence) malaria n % cadres 87%) whose MoPI (Monthly Parasite Decrease Stable Incidence) number decreases and 3 cadres n % n % 1 Conducted 19 95 1 5 20 100 (13%) with malaria MoPI (Monthly Parasite Not Incidence) numbers, while 7 cadres who did 2 Conducted 2 20 8 80 10 100 Total 21 70 9 30 30 100 not carry out community empowerment p-value = 0,000, RP = 4,750, CI95% (1,370 - activities in their working areas there were 1 16,474) cadre (14.3%) with decreased MoPI (Monthly Parasite Incidence) number and 6

Galore International Journal of Health Sciences and Research (www.gijhsr.com) 109 Vol.4; Issue: 1; January-March 2019 Esau Leunufna et.al. Effect of the Role of Caders on Decreasing the MoPI (Monthly Parasite Incidence) Numbers Malaria in Supiori District cadres (85.7%) remained. The results of the Table 4 Effect of radical treatment on MoPI (Monthly Parasite Incidence) figures in Supiori District in 2018 chi square statistical test on the significance Number of Monthly Radical Parasite Incidence value of 95% (α = 0.05) obtained p-value No treatment malaria n % 0.001 <α (0.05). This means that there is a Decrease Stable n % n % significant effect of community 1 Conducted 21 91,3 2 8,7 23 100 empowerment on decreasing malaria MoPI Not (Monthly Parasite Incidence) in their 2 Conducted 0 0,0 7 23,3 7 100 Total 21 70 9 30 30 100 working area. The results of the value of RP p-value = 0,000, PR = 0,087, CI95% (0,023 - 0,327) = 6.087, CI95% (0.985 - 37,623) explain that cadres who do community Table 4 shows that of the 23 cadres empowerment can reduce the MoPI who carried out radical treatment activities (Monthly Parasite Incidence) number 6.0 in their working area there were 21 cadres times than cadres who do not empower the (91.3%) with decreased malaria MoPI community in their working area. (Monthly Parasite Incidence) attack rate while 2 cadres (8.7%) did not carry out 3.3 Effects of clinical malaria sufferer radical treatment activities Fixed MoPI findings on malaria MoPI (Monthly Parasite (Monthly Parasite Incidence) number. The Incidence) figures results of the chi square statistical test on the significance value of 95% (α = 0.05) Table 3 Effect of clinical malaria sufferer findings on MoPI (Monthly Parasite Incidence) in Supiori District in 2018 obtained p-value 0,000 <α (0.05). This Number of Monthly malaria means that there is a significant effect of Parasite Incidence No sufferer malaria n % malaria radical treatment on decreasing findings Decrease Stable malaria MoPI (Monthly Parasite Incidence) n % n %

1 Conducted 21 75 7 25 28 100 in the area of work. The results of the PR Not value = 0.087, CI95% (0.023-0.327) 2 Conducted 0 0,0 2 100 2 100 Total 21 70 9 30 30 100 explained that cadres who carry out malaria p-value = 0,151, PR = 0,250, CI95% (0,132 - 0,475) radical treatment can reduce the MoPI (Monthly Parasite Incidence) number 0.087 Table 3 shows that of the 28 cadres times than cadres who do not carry out who carried out malaria discovery activities malaria radical treatment in their working in their working area there were 21 cadres area. (70.0%) with decreased malaria MoPI (Monthly Parasite Incidence) and 7 cadres 3.5 Effect of treatment follow-up on malaria (23.3%) remaining or not declining. The MoPI (Monthly Parasite Incidence) numbers results of the chi square statistical test on the significance value of 95% (α = 0.05) Table 5 Effects of treatment follow-up on decreasing malaria MoPI (Monthly Parasite Incidence) in Supiori District in 2018 obtained p-value 0.151> α (0.05). This Number of Monthly treatment Parasite Incidence means that there is no significant effect of No follow-up malaria n % the discovery of clinical malaria sufferers on Decrease Stable decreasing malaria MoPI (Monthly Parasite n % n % 1 Conducted 20 83,3 4 16,7 24 100 Incidence) in their working area. The results Not of PR values = 1,500, CI95% (0.674 - 2 Conducted 1 16,7 5 83,3 6 100 Total 21 70 9 30 30 100 3,339) with a lower value <1 so that the p-value = 0,007, PR = 5,000, CI95% (0,828 - 30,191) findings of malaria sufferers are not a significant factor in decreasing the number Table 5 shows that of the 24 cadres of malaria MoPI (Monthly Parasite who carried out medication follow-up Incidence) in their working area. activities in their working areas there were 3.4 Effects of radical treatment on malaria 20 cadres (83.3%) with decreased MoPI MoPI (Monthly Parasite Incidence) numbers (Monthly Parasite Incidence) numbers and 4

Galore International Journal of Health Sciences and Research (www.gijhsr.com) 110 Vol.4; Issue: 1; January-March 2019 Esau Leunufna et.al. Effect of the Role of Caders on Decreasing the MoPI (Monthly Parasite Incidence) Numbers Malaria in Supiori District cadres (16.7%) remained. The results of the Supiori District to provide understanding to chi square statistical test on the significance the community about the importance of value of 95% (α = 0.05) obtained p-value malaria transmission prevention, practical 0.007 <α (0.05). This means that there is a efforts to avoid mosquito bite contact with significant effect of malaria treatment the community, behaviors that are at risk of follow-up on decreasing malaria MoPI malaria, early discovery and treatment of (Monthly Parasite Incidence) in the area of malaria. The observation that of the 30 work. The results of the PR value = 5,000, malaria cadres who served in Supiori CI95% (0.828 - 30,191) explain that cadres District, as many as 20 cadres carried out who follow malaria treatment can reduce malaria extension activities and 19 cadres malaria MoPI (Monthly Parasite Incidence) (95%) experienced a decrease in malaria numbers 5 times than cadres who do not MoPI (Monthly Parasite Incidence) in their follow malaria treatment in their work area. working area. This shows that there is a change in community behavior after malaria 3.6 Influence Referral of malaria sufferers extension activities are carried out by to malaria MoPI (Monthly Parasite cadres. Behavior changes occur due to the Incidence) numbers emergence of public knowledge about malaria prevention and eradication efforts. Table 6. Effect of malaria patient referral on MoPI (Monthly The results of statistical tests illustrate that Parasite Incidence) in Supiori District in 2018 Number of Monthly there is a significant effect of malaria Malaria Parasite Incidence No patient extension activities carried out by cadres on malaria n % referral Decrease Stable decreasing malaria MoPI (Monthly Parasite n % n % Incidence) in the area of their work (p-value 1 Conducted 17 81 4 19 21 100 Not = 0,000), where PR = 4,750, CI95% (1,370 - 2 Conducted 4 44,4 5 55,6 9 100 16,474), explains that cadres who carry out Total 21 70 9 30 30 100 p-value = 0,118, PR = 1,821 CI95% (0,852 - 3,892) malaria extension activities in their working area can reduce malaria MoPI (Monthly Table 6 shows that of the 21 cadres Parasite Incidence) rate 4.8 times compared who carried out patient referral activities in to cadres who do not carry out malaria their working area there were 17 cadres extension activities in their working area. (81%) with decreased MoPI (Monthly The results of this study are in line Parasite Incidence) numbers and 4 cadres with the research conducted by Suwarni (19%) remained. The results of the chi (2014), that there was a significant square statistical test on the significance difference in the level of final knowledge value of 95% (α = 0.05) obtained p-value between the control group and the 0.118> α (0.05). This means that there is no experiment (p = 0,000). There were significant effect of malaria patient referrals significant differences between the level of on decreasing malaria MoPI (Monthly final knowledge and the initial level of Parasite Incidence) in their working area. knowledge in the experimental group. The results of the PR value = 1.821 CI95% According to Maulana in Suwarni (2014) (0.852 - 3.892) with a lower value <1 so that that knowledge is a guideline in shaping referencing patients with malaria is not a one's actions. Formed behavior especially in significant factor in decreasing the case of adults begins with knowledge, then the monthly Parasite Incidence in its working attitude arises towards the object he knows. area. After the object is known and fully realized then a response arises in the form of action. 4. DISCUSSION A similar theory was put forward by 4.1 Malaria extension Notoatmodjo where the first stage of the Malaria extension activities are one behavior change process starts from of the main tasks of malaria cadres in knowledge, then followed by changes in

Galore International Journal of Health Sciences and Research (www.gijhsr.com) 111 Vol.4; Issue: 1; January-March 2019 Esau Leunufna et.al. Effect of the Role of Caders on Decreasing the MoPI (Monthly Parasite Incidence) Numbers Malaria in Supiori District attitude and practice. Thus, in order for the the form of mobilizing the community to community to be able to behave in a healthy carry out environmental cleaning services manner, it is necessary to increase and PSN (Eradication of Mosquito Nests) knowledge through one of them is health every week. According to Zega in Faizah education (2016) that efforts to empower the community through malaria cadres turned 4.2 Community empowerment out to be able to increase changes in Community empowerment is an community behavior where communities effort to restore or enhance the ability of a directly participate in malaria control community to be able to do according to efforts. These changes are in the form of their dignity and dignity in carrying out mutual assistance activities to clean their rights and responsibilities as members trenches, bushes and advice if there are of the community (Mubarak in Prasetyo, members of the community who are sick 2015). The community empowerment with malaria to go to the Puskesmas or the analysis conducted by 30 cadres in Supiori Sub-Puskesmas. District can be said to be successful, In this view the involvement of the because 23 cadres who carry out community community in development is more directed empowerment activities, as many as 20 at the form of participation, not for cadres (87%) with decreasing MoPI mobilization. Community participation in (Monthly Parasite Incidence) numbers. program formulation makes the community Statistically it shows that there is a not only as program consumers, but also as significant influence of community producers because they have participated in empowerment activities carried out by the process of making and formulating it, so cadres on decreasing MoPI (Monthly that people feel that they have the program Parasite Incidence) malaria numbers (p- and have responsibility for its success and value = 0.001), where PR = 6.087, CI95% have more motivation for participation in (0.985 - 37,623) explains that cadres do the next stages. empowerment activities the community in Active community participation is very its working area can reduce malaria MoPI important in the success of the malaria (Monthly Parasite Incidence) number 6.1 control program. William Rojar in Faizah times compared to cadres who do not carry (2016), states that community participation out community empowerment activities in in malaria control is effective in preventing their working area. Community malaria. Efforts to break the chain of empowerment in Supiori includes the use of transmission between hosts, agents, and mosquito coils, the use of mosquito nets, the environment must be carried out by the use of wire mesh to avoid mosquito bites, community itself in efforts to control mutual cooperation activities to clean malaria. For this reason, the community gutters, bushes, drain stagnant water to must have confidence, skills in suppress and eliminate malaria transmitting implementing malaria control. In increasing populations and breeding so that the attack malaria control beliefs and skills, rate malaria as measured by API (Annual contributions from village malaria cadres Parasite Incidence) in 2016, decreased are needed in carrying out their duties. significantly from 62.3 ‰ to 9.6 ‰ in 2017. According to Kusumawati and Darnoto in This research is in line with the research Faizah (2016), the public awareness model conducted by Faizah et al (2016), that can be more effective if carried out by community empowerment by malaria cadres health cadres or community leaders because is effective in increasing community these role models are directly involved in participation in efforts to control malaria in community activities and closer to the RW I of Hargorojo Village, Purworejo community. District (p = 0,000). This participation is in

Galore International Journal of Health Sciences and Research (www.gijhsr.com) 112 Vol.4; Issue: 1; January-March 2019 Esau Leunufna et.al. Effect of the Role of Caders on Decreasing the MoPI (Monthly Parasite Incidence) Numbers Malaria in Supiori District

4.3 Discovery of malaria sufferers The discovery of malaria cases by Statistically, there was no significant cadres in Supiori District was carried out in influence from malaria cadre discovery 2 forms of activities, namely the form of activities by malaria cadres on decreasing ACD (Active Case Detection) where active malaria MoPI (Monthly Parasite Incidence) cadres visited 20 homes a day to find and in their work area (p = 0.151) where; PR = find malaria sufferers while the PCD 0.250, CI95% (0.132 - 0.475), explains that (Pasive Case Detection) activity in which cadres who carry out malaria discovery cadres waited for malaria sufferers came to activities in their working area 5 times check up at the village malaria post. Since smaller reduce the MoPI (Monthly Parasite this activity has been carried out the number Incidence) rate of malaria compared to of malaria discoveries in the village has cadres who do not carry out community increased by 100% compared to before the empowerment activities in their working presence of cadres. The community really area. heard what was conveyed by the cadres The results of this study are when they were encouraged to check consistent with Zubaidah's (2015) study, themselves out, they assumed that cadres that there is no relationship between the were the length of time the health workers implementation of home visits in and cadres were a community leader who accordance with the cycle by the Village was appointed by the community Malaria Interviewer (JMD) with positive themselves so that they were valued and malaria cases at the village level in respected. According to Research Faizah Banjarnegara Regency (p = 0.437), but and Febriana (2016) that the presence of different from the results of research studies cadres is only 49%-64.8% of the community Sekartuti, et al. (2016) showed that the hears, and is willing to take blood from presence of malaria cadres in their work cadres. Some residents who are unwilling to area had a significant decrease in SPR be taken give reasons to be afraid, because (Slide Positive Rate) from 18.9% to 3.1%, they consider cadres not yet skilled. But in this study was in line with the research of general the community is happy with the Arga Gumilang (2010), which stated that presence of cadres and states that cadre ACD (Active Case Detection) case finding activities need to be continued. by malaria cadres was more than PCD Most of the Supiori District areas are remote (Pasive Case Detection) case finding. The rural areas where most people live far from theory says that malaria cadres are one form health facilities; this is one of the obstacles of community empowerment and the in the malaria eradication program. This malaria prevention strategy developed today situation is one of the risk factors for is on the basis of integrated partnerships malaria, so that the identification of malaria based on the district with community sufferers by empowering cadres is one way empowerment. According to William Rojar, to expand coverage or range of services. et al (2011) the participation of the The results of this study indicate that community in malaria control is effective in the closeness of the variable influence is preventing malaria. This theory was later low (0.132) this occurs because there are corroborated by Sahat (2005), where the concomitant factors that are not controlled. participation of the community can help the Observations on the reports from the Health performance of puskesmas in increasing the Office and Puskesmas in Supiori District coverage of active malaria case discoveries revealed that there were MBS (Mass Blood increasing by 4 times compared to before. Survey) or MFS (Mass Fever Survey) Coverage of case finding will affect activities, spraying and kelambunisasi in treatment so that case transmission can be cadre work areas in 2015 and 2017 before reduced or even stopped. this research was conducted, so that these factors is a supporting factor that allows a

Galore International Journal of Health Sciences and Research (www.gijhsr.com) 113 Vol.4; Issue: 1; January-March 2019 Esau Leunufna et.al. Effect of the Role of Caders on Decreasing the MoPI (Monthly Parasite Incidence) Numbers Malaria in Supiori District decrease in the number of MoPI (Monthly malarial drugs not only shortens the Parasite Incidence) of malaria in the work duration of malaria but also reduces the area of cadres. incidence of complications and death. In 2004, ACT (Artemisinin Combination 4.4 Radical malaria treatment Therapy) treatment was used as a radical Radical treatment is a combination malaria treatment because chloroquine treatment of two or more simultaneous treatment was proven to be resistant to blood schizontocidal antimalarial drugs in plasmodium vivax in 1973. WHO (World which each drug has an independent work Health Organization) calls on several method and has different biochemical countries to only use ACT (Artemisinin targets on the parasite. The combination of Combination Therapy) for malaria radical malaria treatment is intended to improve the treatment to prevent the possibility of efficacy of the efficacy of each of the anti- malaria immunity because ACT malarial drugs, increase the cure rate, and (Artemisinin Combination Therapy) speed up treatment response (Tjitra treatment is a combination treatment to Emeliana 2004). According to Kinansi et al increase anti-malaria efficacy and (2013), a combination treatment of anti- antimalarial synergic activity and slowing malaria drugs currently used in Indonesia the progression of parasite resistance to new refers to WHO guidelines using ACT anti-malarial drugs (Simamora & Fitri, (Artemisinin Combination Therapy). 2007). Artemisinin derivatives were chosen as the basis for important antimalarial combination 4.5 Follow-up on malaria treatment therapy because they were able to reduce The results of multivariate analysis parasitemia faster ten times than other anti- in this study showed that there was a malarial drugs. significant influence from cadres who The results of multivariate analysis undertook treatment follow-up on a in this study show that cadres who carry out decrease in malaria MoPI (Monthly Parasite malaria radical treatment with ACT Incidence) in their work area (p-value = (Artemisinin Combination Therapy) have a 0.007), where PR = 5,000, CI95% (0.828 - significant effect on decreasing malaria 30,191) explains that cadres who follow up MoPI (Monthly Parasite Incidence) in their treatment in malaria patients can reduce work area (p-value = 0,000), where PR = malaria MoPI rates 5 times greater than 0.087, CI95% (0.023 - 0.327) thus cadres cadres who do not carry out malaria follow- who carry out malaria radical treatment up activities in their working area. activities in their working areas in Supiori The results of this study are in line with the Regency can reduce malaria MoPI (Monthly research conducted by Siswantoro et al. Parasite Incidence) numbers 0.087, or 11.5 (2011), that good and correct treatment times smaller than cadres who do not carry follow-up can minimize treatment failure out radical treatment activities. and improve clinical symptoms and asexual The results of this study are similar to those parasitemia on H3 <50%, H7> 50% and of Leunufna Esau (2009), that malaria H21 ≥ 75%. sufferers who received malaria radical Completing the treatment to treatment with ACT (Artemisinin completion becomes an obstacle to Combination Therapy) recovered 2.3 times treatment management, usually the compared to malaria sufferers who were not community after taking the drug two days a treated with ACT (Artemisinin Combination day the body feels better and does not Therapy). continue treatment to completion. Treatment Appropriate treatment is a major with cadre supervision needs to be done and component of the global strategy to raising awareness of malaria sufferers to eradicate malaria. Proper use of anti- take medicine to completion (Kesuma AP &

Galore International Journal of Health Sciences and Research (www.gijhsr.com) 114 Vol.4; Issue: 1; January-March 2019 Esau Leunufna et.al. Effect of the Role of Caders on Decreasing the MoPI (Monthly Parasite Incidence) Numbers Malaria in Supiori District

Pramestuti N, 2014) One form of with plasmodium vivax, with higher TNF-α monitoring in medicine is to follow up with levels compared with plasmodium patients who have received radical treatment falciparum infection with the same level of in the form of taking a blood re-preparation parasitemia, besides that plasmodium vivax based on the type of parasite. Only a small is also younger found in peripheral smear on proportion of cases given treatment were all stadiums. The difference with followed up by officers including taking plasmodium falciparum, which is at an blood preparations until the 28th day after advanced stage, is difficult to find in the first day of treatment. Referring to the peripheral blood. This shows the occurrence Indonesian Ministry of Health's rules, the of cytoadherence in post-capillary venules. malaria treatment follow-up was carried out This process is a fundamental factor in the by malaria cadres in Supiori District at p. occurrence of severe malaria compared to vivax was carried out on days 3, 7, 14, 28 plasmodium vivax in the adult stage, which and 3 months after radical treatment while tends not to form and usually does not occur at p. falciparum is carried out 4 times in cytoadherence or microvascular sequences. patients, namely the 3rd, 7th, 14th and 21st day. The follow-up results are used to 5. CONCLUSIONS analyze the occurrence of drug use Based on the research that has been done, it according to dosage, relapse or new can be concluded that: sufferers (Profile of Supiori Health Office, 1. There is a significant effect of malaria 2017) counseling carried out by cadres on the decrease of malaria MoPI (Monthly Parasite 4.6 Referring to malaria sufferers Incidence) in Supiori District p-value = Referral of malaria sufferers is 0,000, OR = 4,750, CI95% (1,370 - 16,474) carried out by cadres when there are people There was a significant effect of community with severe malaria, complications or empowerment by cadres on the decrease in pregnant women who are far from the reach malaria MoPI in Supiori District p-value = of health services and are one of the tasks 0.001, OR = 6.087, CI95% (0.985 - carried out by malaria cadres. Statistically, 37.6623) 44.4% of malaria cases declined in the work There is no significant effect of the area where cadres did not conduct malaria malaria patient examination conducted by referral. This condition occurs because of cadres on the decrease in the MoPI the early discovery of malaria sufferers, (Monthly Parasite Incidence) number of radical treatment and follow-up of treatment malaria in Supiori District p-value = 0.151, carried out by health workers, malaria OR = 0.250, CI95% (0.132 - 0.475) cadres in the form of ACD (Active Case There is a significant effect of radical Detection) and PCD (Active Case treatment carried out by cadres on Detection). The low reference is influenced decreasing the number of malaria MoPI by the species found in the service area. (Monthly Parasite Incidence) in Supiori According to WHO in Suwandi et al (2017) District p-value = 0,000, OR = 0.087, that patients with severe malaria occur due CI95% (0.023 - 0.375) to plasmodium falciparum infection with There is a significant effect of complications consisting of cerebral malaria treatment follow-up by cadres on decreasing (coma), acidemia / acidosis, severe anemia, malaria MoPI (Monthly Parasite Incidence) acute renal failure and hypoglycemia. in Supiori District p-value = 0.007, OR = Suwandi et al. (2017) further said that the 5,000, CI95% (0.828 - 30,191) value of parasitemia in plasmodium vivax There is no significant effect of malaria was lower than plasmodium falciparum. patient referrals carried out by cadres on the This is related to the inflammatory response decrease of malaria MoPI (Monthly Parasite of the larger activated host when infected Incidence) in Supiori District p-value =

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