Sekar Tuti

Endemic coastal malaria in the Thousand Islands District, near Jakarta, Indonesia

Objectives  To conduct malaria surveillance near Jakarta where only imported malaria has been described over the past two decades and to characterize endemicity and risk to heavily populated peri‐urban locations.

Malaria prevalence in Nias District, North Sumatra Province, Indonesia

BackgroundThe Nias district of the North Sumatra Province of Indonesia has long been known to be endemic for malaria. Following the economic crisis at the end of 1998 and the subsequent tsunami and earthquake, in December 2004 and March 2005, respectively, the malaria control programme in the area deteriorated. The present study aims to provide baseline data for the establishment of a suitable malaria control programme in the area and to analyse the frequency distribution of drug resistance alleles associated with resistance to chloroquine and sulphadoxine-pyrimethamine.MethodsMalariometric and entomology surveys were performed in three subdistricts. Thin and thick blood smears were stained with Giemsa and examined under binocular light microscopy. Blood blots on filter paper were also prepared for isolation of parasite and host DNA to be used for molecular analysis of band 3 (SAO), pfcrt, pfmdr1, dhfr, and dhps. In addition, haemoglobin measurement was performed in the second and third surveys for the subjects less than 10 years old.ResultsResults of the three surveys revealed an average slide positivity rate of 8.13%, with a relatively higher rate in certain foci. Host genetic analysis, to identify the Band 3 deletion associated with Southeast Asian Ovalocytosis (SAO), revealed an overall frequency of 1.0% among the 1,484 samples examined. One hundred six Plasmodium falciparum isolates from three sub-districts were successfully analysed. Alleles of the dhfr and dhps genes associated with resistance to sulphadoxine-pyrimethamine, dhfr C59R and S108N, and dhps A437G and K540E, were present at frequencies of 52.2%, 82.5%, 1.18% and 1.18%, respectively. The pfmdr1 alleles N86Y and N1042D, putatively associated with mefloquine resistance, were present at 31.4% and 2%, respectively. All but one sample carried the pfcrt 76T allele associated with chloroquine resistance. Entomologic surveys identified three potential anopheline vectors in the area, Anopheles barbirostris, Anopheles kochi and Anopheles sundaicus.ConclusionThe cross sectional surveys in three different sub-districts of Nias District clearly demonstrated the presence of relatively stable endemic foci of malaria in Nias District, North Sumatra Province, Indonesia. Molecular analysis of the malaria parasite isolates collected from this area strongly indicates resistance to chloroquine and a growing threat of resistance to sulphadoxine-pyrimethamine. This situation highlights the need to develop sustainable malaria control measures through regular surveillance and proper antimalarial drug deployment.

Distribution of Plasmodium vivax pvdhfr and pvdhps alleles and their association with sulfadoxine-pyrimethamine treatment outcomes in Indonesia.

AbstractBackgroundSympatric existence of Plasmodium falciparum and Plasmodium vivax, and the practice of malaria treatment without microscopic confirmation suggest that the accidental treatment of vivax malaria with sulfadoxine–pyrimethamine (SP) is common.MethodsIn this study, the frequency distribution of alleles associated with SP resistance were analysed among the P. vivax infections from malariometric surveys and its association with SP treatment failure in clinical studies in Indonesia. The dhfr and dhps alleles were detected using PCR–RFLP method.ResultsAnalysis of 159 P. vivax isolates from malariometric surveys and 69 samples from in vivo SP efficacy study revealed various the existence of various alleles of the pvdhfr and pfdhps genes including 57L/I, 58R, 61M, and 117N/T. Allele 13L of the dhfr gene and 553G of the dhps gene were not detected in any isolates examined in both studies. In the dhfr gene, tandem repeat type-A was the major tandem repeat observed in any isolates analysed. In the dhps gene, only the 383G allele was observed. Isolates carrying double, triple and quadruple mutants of dhfr gene were found in Lampung, Purworejo, Sumba, and Papua. Although this study revealed a wide distribution of dhfr and dhps alleles among the P. vivax isolates across a broad geographic regions in Indonesia, impact on SP efficacy was not observed in Sumba.ConclusionWith proper malaria diagnosis, SP may still be used as a rational anti-malarial drug either as a single prescription or in combination with artemisinin.

Brugia Rapid™ antibody responses in communities of Indonesia in relation to the results of ‘transmission assessment surveys’ (TAS) for the lymphatic filariasis elimination program

BackgroundThe Global Programme to Eliminate Lymphatic Filariasis recommends the transmission assessment survey (TAS) as the preferred methodology for determining whether mass drug administration can be stopped in an endemic area. Because of the limited experience available globally with the use of Brugia Rapid™ tests in conducting TAS in Brugia spp. areas, we explored the relationship between the antibody test results and Brugia spp. infection as detected by microfilaremia in different epidemiological settings.MethodsThe study analyzes the Brugia Rapid™ antibody responses and microfilaremia in all ages at three study sites in: i) a district which was classified as non-endemic, ii) a district which passed TAS, and iii) a district which failed TAS. Convenience sampling was done in each site, in one to three purposefully selected villages with a goal of 500 samples in each district.ResultsA total of 1543 samples were collected from residents in all three study sites. In the site which was classified as non-endemic and where MDA had not been conducted, 5 % of study participants were antibody positive, none was positive for microfilaremia, and age-specific antibody prevalence peaked at almost 8 % in the 25–34 year-old age range, with no antibody-positive results found in children under eight years of age. In the site that had passed TAS, 1 % of participants were antibody positive and none was positive for microfilaremia. In the site which failed TAS, 15 % of participants were antibody positive, 0.2 % were microfilaremic, and age-specific antibody prevalence was highest in 6–7 year olds (30 %), but above 8 % in all age levels above 8 years old.ConclusionsThese results from districts which followed the current WHO guidance for mapping, MDA, and implementing TAS, while providing antibody profiles of treated and untreated populations under programmatic settings, support the choice of antibody prevalence in the 6- and 7-year-old age group in TAS for making stopping MDA decisions. Since only one study participant was microfilaremic, no conclusions could be drawn about the relationship between antibodies and microfilaremia and further longitudinal studies are required to understand this relationship.

TRANSMISI LOKAL MALARIA DI KODYA MANADO

In Indonesia, the National Household Health Survey (SKRT) is still the main source of information on causes of death, which is now integrated with the National Socio Economic Survey (Susenas). The SKRT uses technique of verbal autopsy with open questions then classifies the diseases using ICD 10. There were 1719 cases obtained with 97,8% response rate of deaths reported by Susenas to the SKRT. Eventhough there are some limitations, the 1995 SKRT using proportion analysis is able to show the pattern of cause of death. The pattern in Java-Bali shows the current trend of epidemiologic transition - the changing pattern of infectious diseases towards degenerative diseases. For the first time the 1995 SKRT reveals the replacement of dominant infectious diseases by circulatory (cardio as well as cerebrovascular) diseases. The SKRT observation in the period of 1980 -1995 shows that the transition has happened with rapid trend compared to the England and Wales experience. Yet infectious diseases are still the important cause of death particularly among young age groups and population in the rural areas. Circulatory diseases do not affect only the old age groups but the productive age groups as well. The circulatory diseases can not be disregarded in the rural areas. This condition affects both sexes male and female. Maternal together with perinatal diseases are still quite substantial causes of death.A survey of heavy metals (Hg, Cd, Pb) in drinking water at small and very small houses was conducted in Jakarta, Bogor, Tangerang and Bekasi (Jabotabek), in 1992. The purpose of this study was to get information about water quality and environmental condition of water sources at low cost housing and very low cost housing in Jabotabek. Forty to sixty water samples were taken from each location and analyzed by Atomic Absorption Spectrophotometer. The mercury concentration was analyzed using Cold Vapor Technique , whereas Cd and Pb were analized using The Air-acetylene method . Water samples were collected in dry season and rainy season. Interview of the owners of the house and of environmental observation of the water sources were done to get information about the condition of drinking water sources. The highest concentration of mercury detected in Jakarta was in the rainy season (2.50 mg/l). Cadmium and Lead were detected in Bogor, (Cd: 0.26 mg/l) in the rainy season and Pb : 0.16 mg/l in dry season). However 41.5% water samples from Jakarta were exceeding the mercury concentration standard, 25.4% water samples from Bogor were exceeding cadmium concentration standard, and 41.1% water samples from Bogor were exceeding lead concentration standard Heavy metals concentration in drinking water at Bekasi and Tangerang were relatively lower than Bogor and Jakarta. The environmental condition of shallow wells in Bekasi and Tangerang were also better than Bogor and Jakarta.

PENGGUNAAN RAPID DIAGNOSTIC TEST (RDT) OLEH KADER SEBAGAI ALAT BANTU DALAM PENEMUAN KASUS MALARIA DI DESA GUNTUR, KECAMATAN BENER, KABUPATEN PURWOREJO

Sequence of Diseases of Mercury Poison. This review conducted in order to know sequence of diseases of mercury poison. Using four nodes paradigm is very helpfull to identify agent sources up to occuring diseases. Many activities and mercury compound as an emission, path way of mercury compound from environment to human, inditators of human exposures and symptom of poison or diseases can identify from this paradigm. Many studies have been conducted to identify what happen in every nodes. Environmental pollution by Mercury and mercury compound caused by human activities or naturally. Mercury metal or vapor can enter to human mostly by inhalation, mercury in urine and blood can use as indicator of exposure. Health impact is on central nerveous system. In organic mercury entered to human by inhalation, ingestion or contact to skin. Mercury in urine and blood can use as an indicator of exposure. Health impact is on central nerveous system. Organic mercury especially methyl mercury entered to human mostly by ingestion. Mercury in blood and hair can use as indicator of exposure. Health impact is on central nerveous system and probably cancer. This review can help the researcher further more to study the diseases or symptoms and bioindicator of mercury poison. Keywords: Sequence of disease, poison, mercuryThis review has been conducted in order to inform that amalgam filling can be a source ofmercury vapor pollution. Population at risk are dentist, assistant and patient. The dentist and assistant exposed by inhalation and contact to skin. The patient exposed by mercury from amalgam filling in corosive process. Many studies informed that 13% dentists and assistants take risk from indoor airpollution. For patient Jess than 2% get alergy reaction. Using amalgam in capsule can decrease mercury indoor air pollution. Beside that can use high copper alloy with low mercury as a filling material. Periodically indoor air pollution monitoring and biomonitoring (mercury in blood and urine) dentists and assistant must be done. Physically amalgam filling is a good material filling, so still can use as a filling with a proper handling. Keywords: dental, amalgam, mercury

SITUASI PATEN OBAT ANTI DIABETES, ANTI HIPERTENSI, ANTI MALARIA DAN ANTI TUBERKULOSIS DI INDONESIA

Abstrak Indonesia merupakan negara berpenduduk keempat terbanyak setelah Cina, India dan Amerika. Indonesia sedang mengalami transisi epidemiologi, dimana terjadi peningkatan penyakit tidak menular (PTM), sementara penyakit menular (PM) seperti malaria, tuberkulosis dan demam dengue prevalensinya masih tinggi. Tingginya morbiditas merupakan lahan yang bagus untuk melaksanakan obat anti PM dan anti PTM yang mendapat paten karena pangsa pasarnya yang sangat luas. Sayangnya potensi pasar yang masih luas ini hanya ditangkap oleh luar negeri. Data dari Direktorat Jendral Hak Kekayaan Intelektual (Ditjen HKI) pada tahun 2010 menunjukkan pemohon paten dalam negeri yang mendapatkan persetujuan perlindungan paten (granted) hanya 4,6% sedangkan dari luar negeri sebanyak 92,03%. Hal yang sangat ironis bagi Indonesia yang merupakan negara dengan potensi bahan dasar obat alam dan keanekaragaman hayati terbanyak ketiga setelah Brazil dan Cina. Tujuan penelitian ini untuk mengevaluasi situasi paten obat yang terdaftar di Direktorat Paten, Ditjen HKI, Kementerian Hukum dan Hak Asasi Manusia RI dalam 7 tahun terakhir (tahun 2005 sampai 2011) untuk PM (malaria dan tuberkulosis) dan PTM (hipertensi dan diabetes). Metode observasional dengan penelusuran dokumen paten dari alamat web instansi terkait. Hasilnya Indonesia hanya mendaftarkan 4,9% dari seluruh paten yang didaftarkan di Dirjen HKI dari tahun 2005 sampai dengan 2011, sebagai berikut untuk obat anti-hipertensi 3,4% dari 89 paten, anti-diabetes hanya 4,8% dari 250 paten, anti malaria 21,1% dari 18 paten anti-tuberkulosis 7,1% dari 14 paten. Sebagian besar paten yang didaftarkan oleh pendaftar Indonesia merupakan paten obat ekstrak herbal atau komposisinya. Kesimpulan dari penelitian ini adalah paten obat untuk PTM dan PM di Indonesia masih didominasi paten luar negeri. Kata Kunci : Situasi paten, obat, Ditjen HKI, Indonesia Abstract Indonesia is the fourth most populous country after China, India and America. There has been an epidemiological transition. While the prevalence of infectious diseases such as malaria, tuberculosis and dengue fever is still high, the incidence of non-communicable diseases is increasing. High rates of morbidity becomes good opportunity to develop medicine for infectious diseases as well as non-communicable diseases to get patent because of a very large market share. Unfortunately, the vast market potential is only captured by foreign countries. Data from the Directorate General of Intellectual Property Rights (IPR DG) in 2010 showed that domestic patent applicants who get approval (granted) were only 4.6% while overseas were 92.03%. This situation is very ironic, since Indonesia is a country with potential basic ingredient of natural medicines and the third highest biodiversity after Brazil and China. The aim of this study was to evaluate patent situation of medicine registered in IPR DG, Law & Human Rights Ministry in the last 7 years (2005 to 2011) for infectious diseases (malaria and tuberculosis) and non communicable (hypertension and diabetes). This study used observational method by tracing patent documents from web addresses of the relevant agencies. It showed that Indonesia only registered 4.9% patent from all patents registered in IPR DG from 2005 to 2011. Indonesia only registered 3.4% from 89 patents for anti-hypertension, 4.8% from 250patents for anti-diabetic, and 21.1% from 18 patents for anti-malaria, and 7.1% from 14 patents for antituberculosis. Most of the patents filled or registered by Indonesian registrant is a patent medicine of herbs’ extract or its composition, it was concluded that medicine patents for non-communicable diseases and infectious diseases in Indonesia are dominated by foreign country. Keywords : Patent situation, medicine, IPR-DG, Indonesia

SITUASI FILARIASIS DI PULAU ALOR PADA TAHUN 2006

Background: The Ministry of Health has a special guidance for increasing the utilization of generic drugs in governmental health facilities. Beside, The Ministry of Health also has regulation for writing a generic drugs prescription at governmental hospital (permenkes RI No. 085/Menkes/Per/I/1989). This regulation push the doctors in governmental hospital to write prescription on generic and essential drugs, for the patient treatment. The objective of this research was getting information about the availability of generic and essential drugs in governmental health facilities as well as private health facilities upon same district and cities in Indonesia. Methods: This research has been conducted in July to December 2006, using the cross sectional research design. Location selected consist of three areas, there were archipelagoes, wide continent and development area. A purposive sample has been selected, there were 10 distributor unit, 10 govermental hospitals, 20 primary health centers (puskesmas), and 20 dispensaries, as well as 10 drugstores. The method of data collection were interviewed using structure question instrument, prescription observation in hospital, primary health centers, and dispensaries, private dispensaries in hospital, drugstore as well. Results: A descriptive analyzed has been done to get some tables presenting as result. The results show that the range of availability of generic drugs in primary health centers 84.89–100% (x¯ = 95.4%), in governmental hospital 11.29–95.65%) (x¯ = 51.44%) and in dispensaries 1.97–66.6% (x¯ = 18.73%). Generic medicine prescription in primary health centers 91.60–100% (x¯ = 98.82%) while the essential medicine prescription in primary health centers 92.83–100% (x¯ = 97.22%). The range of generic medicine prescription in governmental hospital is 14.58–100% (x¯ = 55.38%), and essential medicine prescription in governmental hospital 52.30–91.75% (x¯ = 69.93%). In dispensaries generic medicine prescription have range 2.63% - 80.20% (x¯ = 26.24%), while the essential medicine prescription in dispensary 46.85–78.88% (x¯ = 52.74%). Due to those results, the suggestion are to develop Rational Drug Use Training in hospital and private clinic continuely. Besides advocation to distric health office (Dinkes Kab/kota) to implement utilization generic and essential medicine and also activation of Pharmacy and Therapy Commission to monitoring and evaluating rational drug use. Key words: generic medicine, essential medicine, primary health care, governmental hospital, dispensary, drugstore

PENURUNAN EFIKASI KLOROKUIN DAN SULFADOKSIN/PIRIMETAMIN UNTUK PENGOBATAN MALARIA FALSIPARUM RINGAN DI PULAU BINTAN, PROVINSI KEPUALAUAN RIAU, TAHUN 2003

To support Malaria Control Program, on July 2002 to December 2003 monitoring the efficacy of chloroquine (CQ) and sulphadoxine/pyrimethamine (S/P) as a first and second line drugs for uncomplicated falciparum malaria treatment had been conducted using WHOs method version 2001 guideline. The study was conducted in Bintan Island -Kepulauan Riau Province, which is bordering with Singapore and Malaysia. The activities conducted in two Health Centers (Tanjung Uban and Kijang). It was found that CQ in treated patients as many as 26.67% cases showed ACPR (Adequate Clinical and Parasitological Responses), 33.33% with ETF (Early Treatment Failure) and 40% considered as LTF (Late Treatment Failure). The overall treatment failure was 73.33%. For S/P treated patients, as many as 87.5% cases showed ACPR and 12.5% cases considered as LTF. The fever clearance time (FCT) in ACPR patients mostly 88.89% occurred on day-1. As many as 7 patients had no temperature increasing since day-0 (below 37.5°C). While the parasite clearance time (PCT) on day-2 was 43.75% and on day-3 was 50%. It was concluded that there was a significant decreased of chloroquine efficacy for uncomplicated falciparum malaria in Bintan Island area, Kepulauan Riau Province compared to the efficacy status in the year of 2000. As a preliminary result, the efficacy of S/P in this area is 87.5% Considering the result of the study, the people movement and local malaria situation, this area is not suitable to be one of national sentinel sites for and malaria drug monitoring in Indonesia. Keywords: Falciparum, malaria treatment, drug efficacy.One of the efforts to decrease tuberculosis prevalence in Indonesia is to increase cure rate minimally by 85 percent. The impact of not cured or drop out of tuberculosis medication is that respondents will transmit the disease and became resistance toward the medicine. This analysis used the 2004 National Tuberculosis Prevalence Survey and the 2004 Susenas (National Socio-Economic Survey) data. This survey was household survey, cross sectional and designed for national representative. Totally, there were 20,000 households with 34,606 respondents and the respondent with the age > 15 year old were interviewed for their tuberculosis history and their medication. Limitation of this study is that the information was obtained only from their statement stated in the questionnaire. Drop out of tuberculosis medication was defined as respondents who ever diagnosed tuberculosis and stopped medication before declared cured by health provider. Percentage of respondents who ever diagnosed TB by health provider was 1.65 percent (571 from 34,606 respondents) and the percentage of drop out from tuberculosis medication of these respondents was 48 percent (274 out of the 571 respondents). The main reason of drop out was feeling better and had no money. Bivariate analysis found that five out of nine independent variables had significant value P <0.05, which were: place of living, region, household expenditure, access to health facility and health seeking behavior. Multivariate analysis (final model) showed that four variables with p value <0.05, which were: region, household expenditure, education and health seeking to health facility. Respondents in Eastern Indonesia had twice dropped out of tuberculosis treatment than those in Java and Bali. Respondents with low household expenditure had twice dropped out of tuberculosis treatment than respondents with high household expenditure. The lower their education the higher they stop medicine. Respondents who went to private practice tend to drop out comparing to respondents who went to health center and hospital. The highest drop out occurred in the private health facility. Compliance or adherence of tuberculosis treatment is the very important issue especially for low educated, poor people and living inthe Eastern Indonesia. Drug taking watcher (PMO= Pengawas Minum Obat) methods need to be improved to reach the target. Keywords: Tuberculosis, drop out of tb treatment, drug taking watcherBenzoyl phenil urea which is registered as Akuiron 100 EC is known as IGR synthetic and being introduced to control mosquito in the pre mature stadium. The research was conducted in order to determine the effectiveness of an insect growth regulator (IGR) benzoyl phenil urea against Culex quinquefasciatus larvae in Kokap District, Kulon Progo Regency, Daerah Istimewa Yogyakarta. The research used 8 concentrations of IGR, that were 0.005 ppm, 0.01 ppm, 0.1 ppm, 0.25 ppm, 0.5 ppm, 1ppm, 2.5 ppm, and 5 ppm in treated control and untreated control. Every concentration was used 3 replications. The result showed that the effectiveness of IGR to kill were: 80.84 %, 94.90%, 95.65 %, 96.85%, 100%, 92.87%, 86.13% and 76. 27% larvae Cx.quinquefasciatus with the concentration of: 0.005 ppm, 0.01 ppm, 0,1 ppm, 0,25 ppm, 0,5 ppm, 1 ppm, 2,5 ppm and 5 ppm respectively. Probit analysis test showed that the concentration level to control 50% (LC50) and 90% (LC90) larvae Cx.quinquefasciatus were 0,00064 ppm and 0,3 ppm respectively. In anova analysis had a different reduction percentage of larvae at different concentration (p < 0.05). The time needed to reach 70% reduction larvae was one day. Keywords: Culex quinquefasciatus, larvaciae, Effectivenes.One of the WHOs step of TB strategy reflects the importance of the need to improve care for children with TB. However, children with TB often are neglected to cure, even in the countries with high TB incidence. Around 20 percent children estimated with TB, caused by the spreading of adult TB, and many of them without specific symptom as adult. The aim of this study is to get information about the relation between demography, socio-economic, environmental factors, vaccination status, and contact with adult TB patient, and TB treatment practice of children aged <15 years. The sample was a cross-sectional data of TB Prevalence Survey 2004 and Susenas 2004, which had been merged. The method of analysis was multivariate. The result showed that the significant variable were Sumatera region, household expenditure, BCG scars, and contact with TB patients with log-likelihood < 0.05 (p=0.000). Final model for determinant factors of TB treatment practice for children aged < 15 years were children contact with adult TB patient in the household that had risk of 1.9 times (CI 95%: 1.26-2.89) and place of living classification (Sumatera region) that had risk of 2.6 times (CI 95%: 1.65-4.01). To handle child TB cases and their treatment, there are some actions could be applied, namely: to cure every adult TB until recovery, to conduct active case finding, to educate TB patients and their family to be discipline in taking the drug, to support financial transportation to go to health facility for TB patient in poor family, and to prevent from drop out by supervising them closely. Keywords: Determinants, tuberculosis treatment, children

MASALAH FILARIASIS DI KABUPATEN SIKKA, PROVINSI NUSA TENGGARA TIMUR (NTT)

In February April 2007 a survey had been performed assessing chemical and physical quality of rural drinking water supply in the Sub-district of Ciruas, Serang. Data collection was done by performing interview, observation, and laboratory analyses. There were 63 household respondents, 16 water samples were chemically analyzed, and 35water samples were physically assessed. As many as 53.97 % respondents using treated river water to fuljll their drinking water demand ( where 17.65 % out of them using Poly ammonium chloride for the water treatment), 39.68 % respondents using dugwell, and 17.46 % respondents using rain water. Among 16 water samples chemically analyzed, as many as 13 samples (81.25 %) complied with the existing standards, the rest, 3 samples (18.75 %) did not comply with the standard. The percentage of water samples which did not comply with the chemical quality standards in Kadikaran Village was 10.00 %, much lower than water samples in Pulo Village, namely 33.33 %. Based on the water samples kinds, from 8 drinking water samples laboratory analyzed, 2 samples (25.00 %) did not comply with chemical quality standards. Then, from 7 clean water laboratory analyzed, all samples (100 %) complied with chemical quality standards, and I river water sample did not comply with chemical quality standards. Furthermore, out of 35 water samples physically assessed, as many as 34 samples (97.14 % ) complied with turbidity standard, 2lwater samples (60.00 %) complied with taste standard, and all of the water samples complied with color and odor standards.DISKRIMINASI GENDER DALAM KESEHATAN REPRODUKSI SUKU AMUNGME DAN SUKU KAMORODI KABUPATEN MIMIKA PAPUADISTRIBUSI PARASIT PENCERNAAN DI SEKOLAH DASAR NEGERI MIAWA ECAMATAN PIANI KABUPATEN TAPIN PROVINSI KALIMANTAN SELATAN TAHUN 2008