PRESENTATION
Compliance Of Malaria Drug Intake And The Using Of Bed Nets Of Malaria Patients In Public Health Center Of Waipukang, Lembata District, East Nusa Tenggara In 2018
Ragu Harming Kristina, Jane A. Peni Health Polytechnic of MoH in Kupang Email: [email protected], [email protected]
Abstract
Background. Malaria is a disease that causes many deaths, immediate breakthrough efforts are needed and acceptable which can reduce the number of mosquito bites and decide on malaria parasites in the patient's body, namely through efforts to take malaria medicine and the use of insecticide treated bed nets. The purpose of this study was to determine the description of compliance of the using of bed nets and malaria drug intake of malaria patients working area of Waipukang Public Health Center, Lembata Regency, East Nusa Tenggara Province in 2018. Method. The type of research design in this study was a cross-sectional study design. The study was conducted in Lembata District, Waipukang Public Health Center area in Maret - Mei 2018. The population in this study was positive malaria patients with laboratory tests, as well as families of patients in the Waipukang Health Center area, Ille Ape District, Lembata District. The number of samples is 30 people, 15 cases of malaria patients and 15 families of patients. Results. The results showed that malaria patients who obediently took malaria drug as much as 60% (9 people), while those who did not obidient taking malaria drug were 40% (6 people). Malaria patients and families who used the mosquito nets at home as much as 53% (8 people) while 47% (7 people) do not comply with mosquito nets. Keywords: Compliance with Medication, Compliance with Use of Mosquito Nets, Malaria
* Correspondence: [email protected] Present Address: Piet A. Tallo St., Liliba- East Nusa Tenggara, Indonesia - 85111
©The Author(s) 2018. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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BACKGROUND screening in 2 Puskesmas work areas Malaria is a disease that causes namely Lewoleba Health Center was 29 many deaths in developing countries, cases (4.8%) and Waipukang Health children and pregnant women are the Center was 555 cases (97%). The results most vulnerable groups. Approximately a of the initial survey of limpha swelling in portion of the population in the world is elementary school children showed that at risk of malaria, and an estimated 225 only 5% experienced limpha swelling million cases of malaria with 781,000 (Kristina and Sadukh, 2016). This means deaths due to malaria in 2009 (World malaria drug resistance in small Health Organization, 2010). communities, but on the other hand the Regional health research number of malaria parasites is high in the (Riskesdas) results in 2010, there were blood, especially for plasmodium vivax. five provinces with the highest new cases The results of the initial survey of malaria were Papua (261.5 ‰), West show the local community habits related Papua (253.4 ‰), East Nusa Tenggara to community behavior: poor (117.5 ‰), North Maluku (103,2 ‰) and environmental hygiene behavior, poor Bangka Belitung Islands (91.9 ‰) handling and management of household (Indonesian Ministry of Health Research wastewater, high rates of breeding places and Development Agency, 2010). new(soil excavation holes as a source of Lembata Regency, in East Nusa community economic income) and local Tenggara Province, is a district with a community habits around the coastline, High Insidence Area with an API often looking for fish or shrimp and crabs percentage (Annual Parasite Incidence) in the swamp area that is the habitat of reaching 165.39% in 2012, 132.09% in mosquitoes, so the chances of contact 2013, and 102.74% in 2014. The highest with the mosquito anophelles are very number of malaria cases in Lembata high, besides that Most of the houses are District in 2014 amounted to 863 cases, near thebreeding places, so the chance of found in Lembata District Hospital with population contact withmosquitoes is 262 cases, Damian Hospital with 185 anopheles also very high (Kristina et al., cases, Waipukang Health Center with 151 2016). The factors mentioned above are cases, Hadakewa Health Center with 83 contributing factors to the high density cases (NTT Provincial Health Office, of mosquitoes, and the number of 2014). mosquito bites increases. Based on the results of the pre- To overcome the above eliminary survey conducted by Kristina problems, immediate breakthrough and Sadukh in October 2016 in Lembata efforts are needed and acceptable which District, the number of malaria case can reduce the number of mosquito bites
154 and decide on malaria parasites in the cross sectional study design. The research patient's body, namely through efforts to was conducted in Lembata District, take malaria medicine and the use of Waipukang Health Center area, which is insecticide-treated bed nets. The malaria a malaria endemic area. This location is treatment program as well as the use of taken because it is a region with high High mosquito nets are government programs, Incidence Rate. The study was conducted and district government institutions are in Maret - Mei 2018. The population in in the same area. This study aims to this study was positive malaria patients determine the level of adherence to with laboratory tests, as well as families taking medication in patients and of patients in the Waipukang Health adherence to using insecticide-treated Center area, Ille Ape District, Lembata bed nets in the community. District (30 people). Determination of sample size by purposive sampling METHOD method. The number of samples is 30 The type of research in this study people, 15 cases of malaria and 15 wasresearch analytic observational with a families of patients.
RESULT 1. Overview of Research Sites This study was carried out in malaria endemic areas of Waipukang Health Center, Lembata District, East Nusa Tenggara Province.
Figure 1. Map of Waipukang Health Center Area
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Based on the map of Waipukang Based on the retrieval of the coordinates Public Health Center area above, of the location of the houses of patients Waipukang Public Health Center was with malaria cases using GPS, the spread adjacent to: of positive malaria cases in Plasmodium a. The north was bordered to Petuntawa was found in all villages in the b. The east was bordered to East Ile Ape Waipukang Health Center Working Area. c. The south was bordered to The highest spread of malaria cases was Laranwutun in Laranwutu Village with 7 cases d. The west was bordered to Kolontobo (22.58%) and the lowest in Dulitukan, Muruona, Lamawara, Bunga Muda, 2. Malaria Cases in Waipukang Riangbao, Petuntawa and Beutaran Health Center Area Villages with 1 case of positive cases of The number of malaria cases in the Plasmodium (3, 23%). Distribution of Waipukang Health Center Work Area is malaria cases in the Work Area of positively Plasmodium from Waipukang Waipukang Health Center in 2011 was health center reports from November visualized in Figure 2. 2017 - February 2018 as many as 31 cases.
Figure 2. Map of spread malaria cases based onspecies Plasmodium in Waipukang Health Center Working Area November 2017 - February 2018
3. Characteristics of malaria patients are based on education level, age, and gender.
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Based on the results of the study, the characteristics of malaria patients in the Waipukang Health Center area are as follows.
Table 1. Description of Characteristics of Malaria Patients in Waipukang Health Center Area in 2018 Number Percentage Karakeristik (n) (%) 1. Education level a. Not yet in 2 13 b. kindergarten / early childhood 1 7 c. school Elementary 6 40 d. School 3 20 e. High School 0 0 f. Collage 3 20 2. Age a. 1 - 10 years 8 53 b. 11 - 20 yrs 4 27 c. 21 - 30 yrs 1 7 d. 31 - 40 yrs 0 0 e. > 40 yrs 2 13
3. Gender a. Female 6 40 b. Male 9 60 4. Work a. Student/Student 11 73 b. PNS / TNI / POLRI 1 7 c. Clergy 1 7 d. Other (not yet working) 2 13
From the table above it can be seen kindergarten/early childhood, that the highest education level of elementary and junior high school (73%). malaria patients is junior high school (40%), while the lowest education level is 4. Knowledge of Malaria Patients TK / PAUD (7%). The age of malaria Based on the results of the study, patients is at most 1-10 years old (53%) the level of knowledge of malaria while the lowest is aged 21-30 years (7%). patients in the Waipukang Health Center Most malaria patients are students both area is as follows.
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Table 2. Level of Knowledge of Malaria Patients in Waipukang Health Center Area in 2018 Knowledge Amount Percentage No Level (n) (%) 1 Good 4 27 2 Enough 6 40 3 Less 9 60 Total 15 100
Level of knowledge of malaria 5. Attitudes of Malaria Patients patients in the working area of Based on the results of the study, Waipukang Health Center which has the attitudes of malaria patients in the good knowledge of 27%, sufficient Waipukang Health Center area were as knowledge of 13% and lack of knowledge follows. as much as 60%.
Table 3. Attitudes of Malaria Patients in Waipukang Health Center Area in 2018 Number Percentage No Attitude (n) (%) 1 Supportive 3 20 2 Sufficiently supportive 5 33 3 Not supportive 7 47 Total 15 100
Attitudes of malaria patients in the 6. Practices of Malaria Patients working area of Waipukang Health Based on the results of the study Center who have an attitude support by found that the practices of malaria 20%, quite supportive of 33%, and less patients in the Waipukang Health Center supportive of 47%. area are as follows.
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Table 4. Practices of Malaria Patients in Waipukang Health Center Area in 2018 No Actions Number Percentage (n) (%) 1 Good 5 33 2 Enough 3 20 3 Less 7 47 Total 15 100
From the data in Table 4. above it 7. Compliance with Medicines for can be seen that malaria patients have Malaria Patients actions good at 33%, actions that are Based on the results of the study, good enough 20%, and behavior that is the behavior of malaria patients in the less as much as 47%. Waipukang Health Center area is as follows.
Table 5. Malaria Patients’ Compliance in Consuming Malaria Drug in the Region Health Center Waipukang 2018 Amount Percentage No. Measures (n) (%) 1 Obedience 9 60 2 Disobedience 6 40 Total 15 100
The data in Table 5 above it can be 8. Compliance Using Mosquito Nets seen that all patients with malaria with Malaria obediently using home mosquito nets at Based on the results of the study, 53%, while non-adherents at 47%. the behavior of malaria patients in the Waipukang Health Center area is as follows.
Table 6. Compliance Using Netting Malaria Patients in Region Health Center Waipukang 2018 Amount Percentage No. Measures (n) (%) 1 Obedience 8 53 2 Disobedience 7 47 Total 15 100 159
The data in Table 6 can be seen that 9. Characteristics of families of all malaria patients were adherent to use malaria patients based on mosquito nets at home each of them was education level, age, and gender 53% while the non-compliance was 47%. Based on the results of the study found the description of family characteristics of malaria patients in the Waipukang Health Center area are as follows.
Table 7. Overview Characteristics of the Patients with Malaria in the Region Health Center Waipukang 2018 Number Percent Characteristics (n) (%) 1. Level of education a. Elementary 5 33 b. Junior 5 33 c. High School 2 13 d. Collage 3 21 2. Age a. 21-30 yrs 2 13 b. 31-40 5 33 c. yrs>40 yrs 8 54 3. Sex a. Female 12 80 b. Male 3 20 4. Employment a. Not working 4 26 b. Farmer / trader / laborer 9 60 c. teacher / lecturer 1 7 d. Other 1 7
From the table above it can be seen Most of the families of malaria patients that the highest education level of are farmers (60%). families of malaria patients is elementary school and Middle School (33%), while 10. Knowledge of Families of the lowest education level is high school Malaria Patients (13%). The age of the families of malaria Based on the results of the study, it patients is at most> 40 years (54%) while was found that the level of knowledge of the lowest is aged 21-30 years (13%). families of malaria patients in the
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Waipukang Health Center area is as follows.
Table 8. Level of Knowledge of Families of Malaria Patients in Waipukang Health Center Area in 2018 Knowledge Number Percentage No Level (n) (%) 1 Good 4 27 2 Enough 3 20 3 Less 8 53 Total 15 100
Level of knowledge of families of 11. Family Attitudes of Malaria malaria patients in Waipukang Health Patients Center working area who have good Based on the results of the study it knowledge of 27%, sufficient knowledge was found that the attitude of the of 20% and insufficient knowledge of families of malaria patients in the 53%. Waipukang Health Center area was as follows.
Table 9. Family Attitudes of Malaria Patients in Waipukang Health Center Area in 2018 Number Percentage No Attitude (n) (%) 1 Supportive 3 20 2 Sufficiently supportive 4 27 3 Not supportive 8 53 Total 15 100
Attitudes of families of malaria 12. Families’s Practices of Malaria patients in Waipukang Health Center Patients who have supportive attitude of 20%, Based on the results of the study quite supportive of 27%, and less found the practices of families of malaria supportive of 53%. patients in the Waipukang Health Center area are as follows.
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Table 10. Families’s Practices of Malaria Patients in Waipukang Health Center Area in 2018 Amount Percentage No Action (n) (%) 1 Good 2 14 2 Enough 5 33 3 Less 8 53 Total 15 100
13. Compliance Using Family Nets of Based on the table above can be Malaria Patients seen that the family of malaria patients Based on the results of the study, it has good by 14%, good enough action was found that adherence to using 33% and less practices as much as 53%. mosquito nets by families of malaria patients in the Waipukang Health Center area was as follows.
Table 11. Patient Compliance Using Malaria Mosquito nets in Region Health Center of Waipukang in 2018 Number Percentage No. Compliance (n) (%) 1 Obedience 8 53 2 Disobedience 7 47 Total 15 100
Based on the data above it can be seen that the malaria-abiding families use mosquito nets at home each of them was 53% while the non-compliance was 47%.
DISCUSSION has a large influence and is closely 1. Knowledge of Malaria Patients related to the health status of individuals and Families and society. A person with a good level of Knowledge is the result of knowing knowledge of something will give greater everything that happens after a person concern to a related problem, in this case does sensing through the five senses. to malaria. Knowledge plays a big role in shaping a In this study, some of the person's behavior. A person's behavior respondents with malaria had 162 insufficient knowledge about malaria counseling methods, and respondents (60%). While the results of the study on and community responses to the malaria families of malaria patients were found program that had been greatly influenced that some respondents had insufficient by the characteristics of the people knowledge of malaria (53%). The concerned, for example: level of respondent's knowledge about malaria emotional, intelligence, and was assessed based on his knowledge of environment (socio-economic). the causes of malaria, the modes of To reduce the high number of transmission, symptoms, methods of malaria cases, it is expected that health distribution, and efforts to overcome workers in the Waipukang Health Center malaria. The low level of knowledge of work area can increase the frequency of respondents was due to the fact that most counseling about malaria by using malaria patients were in the age group of effective and interesting methods so that toddlers and school children with an they can increase public knowledge about elementary school education background malaria, its causes, and methods of that had not received much information treatment and prevention. The about malaria. Likewise, the level of implementation of this counseling was education of most families with malaria proven to increase people's knowledge is classified as low, namely at the about malaria and also be able to reduce elementary and junior high school levels. the incidence of malaria. According to Ginting (2003) said that education Notobroto (2009), it is very necessary to provides various information for people. educate people in neighboring areas, Knowledge of various problems including especially by puskesmas, regarding health problems can be influenced by the efforts to prevent malaria transmission level of education. The higher the level of and collaborate across administrative one's education, the more knowledge areas bordering the same ecological about health problems will be. The low characteristics in efforts to eradicate level of education can result in a lack of malaria. This is in line with the research public knowledge about the signs and of Friaraiyatini, et al (2006) that public dangers of malaria, resulting in a lack of knowledge about malaria needs to be public awareness to play an active role in improved by providing counseling by malaria prevention efforts. health workers, because in reality the In addition, the respondents' low public is more listening to information knowledge was also caused by several provided by people who are competent in things, including the lack of counseling health. The role of health workers is activities by malaria cadres as well as crucial in breaking the chain of life cycle local health center officials, improper of Anopheles sp. One form of
163 intervention by health workers is which will result in the formation of new providing health education about malaria vector spots. (Harijanto, 2010). eradicating malaria-causing mosquito In another study conducted by nests. Public health counseling aims to Kurniawan (2008) stated that attitude is make people aware of malaria prevention an evaluative response that can be both and eradication issues, thereby changing positive and negative. The attitude their behavior patterns to live healthy shown by these respondents mostly and clean lives. showed a negative attitude response (80%) towards treatment and prevention 2. Attitudes of Malaria and Family of malaria. This may be influenced by Patients internal factors (characteristics in the Attitude is a closed response to a respondent such as: awareness, stimulus or a particular object that has willingness, experience, etc.) and involved the opinion and emotion factor external factors (environment, socio- concerned (happy to be unhappy, not economic, cultural customs and so on). good, etc.), so that the attitude involves Therefore an approach is needed by thoughts, feelings, attention, and health workers and malaria cadres in the symptoms that others (Notoatmdjo, working area of the Waipukang Health 2010). Center to the community which also Based on the results of the research involves community leaders and on the attitudes of respondents, there religious leaders in the local area. were still a portion of malaria patients (47%) and families (53%) who did not 3. Practices of Malaria and support malaria treatment efforts and Patients’s Families various prevention efforts. This relates to An attitude has not been the level of knowledge of respondents automatically manifested in a practices who have characteristics of respondents (over behavior). To make it happen, the attitude of being a real act requires who have at least graduated from supporting factors or a possible elementary school (SD) and junior high condition, including facilities. In school (SMP). addition to facilities, there is also a need Community attitudes that do not for support from other parties, for support malaria prevention and control example from a husband or wife, parents efforts are the usual seeking self- or in-laws, etc. (Notoatmodjo, 2012). medication, the habit of being outdoors Based on the results of the research on the respondent's practices, it was or activities at night without protection found that most respondents with from mosquito bites, and the logging of malaria (47%) and families (53%) had mangrove forests by the community insufficient practices to prevent malaria
164 which included modification of the take every day and when the drug is physical environment and the stopped for drinking (Wuryanto, 2005). dissemination of information about In theory, the level of one's malaria through extension activities. knowledge is related to the level of This is due to the lack of knowledge and education. The level of education will awareness of the influence of the affect someone in understanding an cleanliness of the physical environment information or knowledge that he gets, on the spread of malaria. meaning that the higher the education According to the Ministry of Health someone will easily capture or of the Republic of Indonesia (2003) that understand the information he gets. actions related to the physical Based on the results of research by environment include cleaning, drainage Wuryanto (2005), it shows that the higher of standing water around the house, a the level of education, the better the level damp place is cleaned so that sunlight of knowledge. This fact is in accordance easily enters. with the results of research on the characteristics of malaria respondents, 4. Compliance with Medicines for most of which are education levels of Malaria Patients malaria patients, most of which are low, Compliance with treatment is a namely at the elementary and junior high condition that shows the behavior of school levels. patients who obey or do not comply with Another factor that affects the taking anti-malaria drugs. According to patient's adherence to taking medication Norton (1988) and Sarafino (1990), is the patient's level of trust in treatment. several factors that influence treatment Trust that will be formed is influenced by adherence include: (a) factors relating to one's knowledge. The better the health workers (education, knowledge, knowledge of malaria and its treatment, work, etc.), (b) factors related to the better the person's trust in malaria medicine (for example: side effects, taste will be. of the drug, form and amount, method of treatment), (c) factors related to the patient (for example: knowledge, 5. Compliance Using Mosquito education, trust, etc.). Patients with Malaria and Based on the results of the study, Family Patients the majority of respondents with malaria Based on the results of the study it patients did not adhere to taking malaria was found that there were still medicine (40%). This is because the level respondents with malaria patients who of knowledge of respondents who are did not comply with using mosquito nets lacking in malaria. Medicinal behavior (47%). This is due to the low awareness of that is not compliant due to ignorance of patients and families about the the rules for taking medicine, for importance of using mosquito nets as a example, how many medicinal items to way to prevent malaria. Some of the reasons stated by respondents include
165 heat and discomfort using mosquito nets. 47%. While good family practice is In addition, respondents' low knowledge 14%, enough 33%, less 53%. about how to prevent malaria affects the 4. Malaria patients who adhere to take level of compliance of respondents in medication by 60%, while those who using mosquito nets. This is in do not adhere to take medication by accordance with the theory from Lawrence Green that knowledge is one of 40%. the determining factors (predisposing 5. Malaria patients and families factors) for a person's behavior obediently use mosquito nets at (Notoadmojo, 2012). This is also home, that is equal to 53% and non- supported by Azwar (2013) who said that adherents by 47%. knowledge as one component of behavior is crucial in creating a lifestyle. Based on the research Ajami et al. (2016), there is a SUGGESTIONS correlation between the level of 1. There needs to be support and knowledge of respondents or the participation of community leaders community and the incidence of malaria. and religious leaders to eradicate Dalimunthe's research (2008) states that malaria. In addition, sub-district people's knowledge and attitudes about governments can form malaria care malaria affect people's participation in groups that work with health workers malaria prevention programs. in the local area to conduct counseling and mentoring for CONCLUSION malaria patients and families. 1. The level of knowledge of malaria 2. There is a need to assist malaria patients is based on good categories cadres for malaria patients and of 27%, enough 13%, and less 60%. families to improve medication While the level of good family compliance, use mosquito nets and knowledge is 27%, enough 20%, less modify the environment around the 53%. house. In addition, it was preceded by 2. The attitude of malaria patients in cadre training. In addition, regular the supporting category is 20%, and effective communicative enough to support 5%, and less counseling for the community, not support 47%. While the family only for visitors to the puskesmas, attitude that supports 20%, is enough but also at schools (SD, HR, SMA) and to support 27%, and is less supportive places of worship so as to increase of 53%. knowledge from the community 3. Malaria patients based on good about fiber malaria in how to prevent categories 33%, enough 20%, and less it.
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