ABSTRAK
PREVALENSI DEMAM TIFOID PADA PASIEN ANAK-ANAK DI RSUP SANGLAH DENPASAR Demam tifoid adalah salah satu penyakit infeksius yang diakibatkan oleh bakteri Salmonella typhii yang memunculkan gejala sistemik pada penderitanya. Demam tifoid hingga saat ini masih sering dijumpai di wilayah-wilayah yang memiliki kualitas kebersihan dan sanitasi yang tidak memadai. Wilayah tersebut umumnya beriklim tropis dan sub-tropis. Setiap tahun, diperkirakan jumlah kasus tifoid di dunia mencapai 20 juta kasus, dimana 200.000 diantaranya berakhir kematian. Di Indonesia, prevalensi tifoid diperkirakan mencapai 800 per 100.000 penduduk pada tahun 2007, dengan hampir dua pertiga nya menjangkiti usia 4-19 tahun. Tingkat kematian pada pasien rawat inap mencapai hingga 10 persen. Penelitian ini dilaksanakan untuk mengetahui seberapa seringkah kemunculan pasien demam tifoid pada anak-anak usia 5-11 tahun (berdasarkan kriteria usia anak tahun 2009 menurut Departemen Kesehatan Republik Indonesia) yang terdiagnosis positif demam tifoid dan dirawat inap di RSUP Sanglah pada periode Maret hingga September 2016. Pengumpulan data memakai metode total sampel yang didapat dari hasil peninjauan rekam medis pasien. Hasilnya, dijumpai delapan pasien yang memenuhi kriteria umur yang ditetapkan. Dengan rata-rata usia pasien anak 7,6 tahun. Proposi laki-laki dan perempuan sama besar (50:50), sesuai dengan teori umum mengenai demam tifoid dimana tidak ada perbedaan signifikan pada kelompok jenis kelamin. Seluruh pasien terdiagnosis positif demam tifoid dengan pemeriksaan Tubex dengan nilai hasil berkisar dari +4 hingga +8. Kata kunci: demam tifoid, prevalensi, anak, RSUP Sanglah
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ABSTRACT PREVALENCE OF TYPHOID FEVER IN CHILDREN AT RSUP SANGLAH DENPASAR Typhoid fever is one of infectious disease that is caused by bacilli Salmonella typhii which showed systemic symptoms in patient. Typhoid fever still become one of frequent infectious diseases due to poor hygiene and sanitation, generally in tropic and sub-tropic climate area. Each year, about 20 millions of typhoid cases are reported in all around the world, while 200.000 of them ended with mortality. In Indonesia, prevalence of typhoid fever in year 2007 was up to 800 cases per 100.000 population, while two-third of them attacked age group of 4 to 19 years old. Mortality rate in hospitalized patients was up to ten percent. This research initiated to find out the frequency of occurrence of typhoid fever in children who is diagnosed and hospitalized at RSUP Sanglah. Age criteria of children is five to eleven year old, based on Indonesia Department of Health, in year 2009. Data collecting used total sampling method which is gathered from assessment of medical records. Within the period from March to September 2016, eight children patients were positive with typhoid fever. Mean age of patients is 7.6 year old. Gender proportion is balanced (50:50) between male and female, parallel to popular theories about typhoid fever which says there is no specific difference of typhoid fever occurrence between male and female. All patients diagnosed by Tubex examination, with various value from +4 up to +8. Keyword: typhoid fever, prevalence, children, RSUP Sanglah
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CONTENTS PREFACE .................................................................................................................iii ABSTRAK ................................................................................................................iv ABSTRACT ..............................................................................................................v CONTENTS ..............................................................................................................vi LIST OF TABLES ...................................................................................................viii
Chapter I INTRODUCTION ....................................................................................................1 1.1. Background …………………………………………………………...… 1 1.2. Problem Identification ……………………………………………….…. 3 1.3. Aim ……………………………………………………………………... 3 1.4. Benefit …………………………………………………………………... 3 Chapter II LITERATURE REVIEW........................................................................................4 2.1. Epidemiology.............................................................................................4 2.2. Etiology......................................................................................................4 2.3. Pathogenesis ..............................................................................................5 2.4. Clinical manifestations ..............................................................................6 2.5. Relapse.......................................................................................................7 2.6. Chronic carrier ...........................................................................................8 2.7. Diagnosis ...................................................................................................8
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Chapter III CONCEPTUAL FRAMEWORK ...........................................................................10 3.1. Mind concept .............................................................................................10 3.2. Research concept .......................................................................................11 Chapter IV RESEARCH METHODS ........................................................................................12 4.1. Research design .........................................................................................12 4.2. Place and time of research .........................................................................12 4.3. Population, sample population, and sample criteria ..................................12 4.4. Research variable .......................................................................................13 4.5. Research instrument...................................................................................13 Chapter V RESULTS & DISCUSSION ....................................................................................15 5.1. Result .........................................................................................................15 5.2. Discussion ..................................................................................................16 Chapter VI CONCLUSION AND SUGGESTION ...................................................................18 6.1. Result .........................................................................................................18 6.2. Discussion ..................................................................................................18
REFERENCES .........................................................................................................19
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LIST OF TABLES Table 1 Age of children patients with typhoid fever............................................. 15 Table 2 Age group of children patients ................................................................. 15 Table 3 Sex group of children patients…… ..........................................................16 Table 4 Positive Tubex value of patients .............................................................. 16
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CHAPTER I INTRODUCTION 1.1. Background Typhoid fever is one of the infectious disease caused by bacterium Salmonella typhi or Salmonella paratyphi. Today, typhoid fever is still being as serious health problems in developing country that caused huge amount of morbidity and mortality. Transmission usually by fecal-oral contamination to food and water supply that has poor hygiene maintenance as well as over population area with inadequate sanitation. Incidence number around the world reach over 20 million cases annually, which about 200,000 of them caused death (Kanj et al., 2015). Paratyphoid fever, which shows more benign, identical
symptoms with typhoid had about 5,400,000 cases in 2000 (Buckle, Walker and Black, 2012; Guerrant, Walker and Weller, 2011). High prevalence of typhoid fever
number is indicated in area with tropic or sub-tropic climate, such as central Asia (301 per 100,000 population), south Asia (409 per 100,000 population), southeast Asia (196 per 100,000 population), central Africa (557 per 100,000 population) and east Africa (537 per 100,000 population) (Mogasale et al., 2014). In Indonesia, typhoid prevalence in 2007 was about 358 – 810 cases per 100,000 populations, which 64% of the cases found in 3 – 19 years old. Mortality rate varies from 3.1 – 10.4% among hospitalized patients. Typhoid cases occurred throughout the year but peaking in dry season (Hatta, 2008). Indonesia Health Department reported in year 2010 that typhoid fever was the third most common health problems in hospitalized patients in Indonesia (41,081 cases)
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(Suhendro
et
al,
2014).
Typhoid
incidence
more
prevalent
in
countryside/suburban population than urban area, population with less economic income and inadequate education understanding. Typhoid fever symptoms have systemic effect, consist of fever, malaise, headache, hepatosplenomegaly, rash, anorexia, and gastrointestinal problems. Fatality rate as small as 1 - 4% if treated with proper antibiotics, but raise up to 30 - 40% in complicated patients with perforated intestine, which happened in 1 – 3% in hospitalized patients (Neil et al., 2012 and Buckle, Walker and Black, 2012). Gold standard diagnosis is blood culture, however, it takes up to seven days with well-equipped tools and skilled staff, such a common problem faced by developing country (Thriemer et al., 2012). Indonesia is one of the countries that were mentioned before, has high prevalence of typhoid fever due to its tropic climate. Denpasar city has dense population with various kind of living style. Unhygienic lifestyle is regularly found, such as in the traditional market, food sold with poor sanitation by street hawkers, or people’s habit to throw their litter not in the proper place, either because they are unconcerned about hygiene or because there are insufficient sanitation accommodations. Health problems due to infectious disease caused by dirty environment may appear and develop anytime, where children are more susceptible to the effect. Typhoid fever can spread through food and water contamination, whether by direct fecal oral route or by animal vectors. This research will determine how vast typhoid fever as one of the infectious disease, affect the children. 2
1.2. Problem Identification Based on previous background, this research is developed to measure the prevalence of typhoid fever at RSUP Sanglah, Denpasar, and correlate it to patient’s age.
1.3. Aim
Knowing the prevalence of typhoid fever at RSUP Sanglah, Denpasar. Knowing the correlation of age to typhoid incidence.
1.4. Benefit
For health practitioner and stakeholder: as a knowledge about typhoid fever prevalence at RSUP Sanglah, Denpasar, and source for assessment of health promotion in general population.
For writer: to accomplish the task given by medical department of Faculty of Medicine, Udayana University.
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