Faktor Bebas Gametosit Pada Malaria Falciparum Tanpa Komplikasi Dengan Pengobatan Dihidroartemisinin- Piperakuin Di Indonesia

sarwo handayani, Armedy Ronny Hasugian, Riyanti Ekowatiningsih, Emiliana Tjitra

Abstract


Gametocytes are a source of malaria transmission, so gametocytes clearance is an important factor especially for falciparum malaria treatment. Since 2010, a combination of dihidroartemisinin-piperaquine(DHP) was applied for malaria treatment in Indonesia. To determine the effect of DHP, we analyzed the factors affecting to gametocytes clearance on uncomplicated falciparum malaria subject treated withDHP in Indonesia. The source of data is a joint research of the efficacy and safety of DHP on uncomplicated falciparum malaria in Kalimantan and Sulawesi in 2007, 2010 and 2012. The subjects werepatients with gametocytes prior to 3 days DHP treatment without primaquine, with 42 days observation.Descriptive analysis was performed to determine the proportion and correlation factors influencing gametocytes clearance, such as the subject characteristics, axillary temperatur, asexual and sexual parasite densities and hemoglobin levels. From the 236 uncomplicated falciparum malaria subjects, wefound 65 subjets with gametocytes before treatment (D0). The analysis showed the average gametocytes clearance was 8.6 days. The proportion of gametocytes decreased from 40% to 5% on D7 andD28, and fully disappeared on D35. Characteristics of respondents affected to gametocytes clearance before and after completed treatment of DHP were age (p = 0.227), original from Papua province (p =0.037), anemia (Hb <11 g / dl, p = 0.008) and gametocytes density on D0 (p = 0.000). Remaining gametocyteson D28 is a potential factor for malaria transmission therefore gametocytes observation is required, especially in areas with malaria vector.

Keywords: gametocyte clearance, DHP, falciparum malaria

 

Abstrak

Gametosit merupakan sumber transmisi malaria, sehingga bebas gametosit merupakan faktor penting dalam pengobatan malaria terutama malaria falciparum. Sejak tahun 2010 pengobatan malaria di Indonesia menggunakan kombinasi dihidroartemisinin-piperakuin (DHP). Untuk mengetahui efek gametosidal DHP, dilakukan analisis faktor-faktor yang mempengaruhi bebas gametosit pada subyek malaria falciparum tanpa komplikasi, dengan pengobatan lengkap DHP di Indonesia. Sumber data adalah gabungan penelitian efikasi dan keamanan DHP pada malaria falciparum tanpa komplikasi diKalimantan dan Sulawesi tahun 2007, 2010 dan 2012. Subyek adalah penderita malaria falciparum dengan gametosit sebelum pengobatan DHP 3 hari tanpa primaquine dengan waktu pengamatan selama 42 hari. Analisis secara deskriptif berupa proporsi dan korelasi faktor-faktor yang mempengaruhi bebas gametosit seperti karakteristik subyek, suhu aksila, densitas parasit aseksual dan seksual sertakadar hemoglobin. Dari 236 kasus malaria falciparum tanpa komplikasi, 65 kasus diantaranya dengan gametosit sebelum mendapat pengobatan (H0). Hasil analisis menunjukkan waktu bebas gametosit rata-rata adalah 8,6 hari. Proporsi gametosit menurun dari 40% pada H7 menjadi 5% pada H28, dan menghilang sempurna pada H35. Karakteristik responden yang mempengaruhi waktu bebas gametositsebelum dan sesudah pengobatan lengkap DHP 3 hari tanpa primakuin adalah umur subyek (p = 0,227),asal Provinsi Papua (p = 0,037), anemia (Hb < 11 g/dl, p = 0,008) dan densitas gametosit awal (p =0,000). Masih ditemukannya gametosit pada H28 menjadi potensi penularan, oleh karena pengamatan gametosit sangat diperlukan untuk monitoring pengobatan, terutama di daerah yang mempunyai vektor malaria.

Kata Kunci: bebas gametosit, DHP, malaria falciparum


Keywords


bebas gametosit; DHP; malaria falciparum; gametocyte clearance; DHP; falciparum malaria

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